Invasive aspergilllosis and candidiasis:
Loading dose 70 mg IV on day 1 followed by 50 mg daily thereafter.
In patients weighing more than 80 kg, 70 mg daily is recommended for the loading and continuous therapy
Anaemia, headache, tachycardia, phlebitis, dyspnoea, abdominal pain, nausea, diarrhoea, vomiting rash, pruritus, sweating, fever elevated liver values (AST, ALT, alkaline phosphatase, bilirubin), increased serum creatinine, decreased haemoglobin
Caspofungin decreases tacrolimus trough concentrations by 26%. AUC of caspofungin is increased 35% by ciclosporin A. Trough concentrations of caspofungin are reduced by 30% with rifampicin at steady state (although caspofungin exposure may initially increase in the first few days with rifampicin).
Caution – check SmPC for drug interactions with antiretrovirals
The NNRTIs, efavirenz and nevirapine reduce caspofungin levels by 20-40% and increasing the dose of the later (from 50-70 mg/day) is recommended.
Dose as in normal renal function
For mild hepatic insufficiency (Child–Pugh score 5–6), no dosage adjustment is needed. For patients with moderate hepatic insufficiency (Child–Pugh score 7–9), caspofungin 35 mg daily is recommended. An initial 70- mg loading dose should be administered on Day 1. There is no clinical experience with severe hepatic insufficiency (Child–Pugh score greater than 9)
No Human Data – Animal Data Suggest Risk
Caspofungin plasma concentrations were on average 17–38 % higher in women than in men, though dose adjustment not thought necessary