Paediatric: Caspofungin
General Information
Restricted formulary antimicrobial:
- Treatment and prophylaxis of invasive fungal infections as recommended by Infection team
- For use in haematology and oncology according to local guidelines (by consultant initiation only)
Standard dose
|
Age |
Dose (IV infusion) |
|
Less than 3 months |
25mg/m2 OD |
|
3 -11 months |
50mg/m2 OD |
|
1-17 years |
Loading dose: 70mg/m2 OD (max per dose 70mg) for 1 day Maintenance dose: 50mg/m2 OD (max per dose 70mg). Can be increased to 70mg/m2 OD (max per dose 70mg) if tolerated but inadequate clinical response |
|
1-17 years and concurrent use of enzyme inducer* |
Loading dose: 70mg/m2 OD (max per dose 70mg) for 1 day Maintenance dose: 70mg/m2 OD (max per dose 70mg) |
|
Moderate hepatic impairment for all ages |
Loading dose: Usual initial dose for age Maintenance dose: Use 70% of normal maintenance dose OD (consider age and if on enzyme inducers) |
*Phenytoin, Carbamazepine, Dexamethasone, or Rifampicin. This list is not exhaustive see BNFC and SPC for drug interactions.
Renal and hepatic impairment
Renal impairment
No dose adjustment necessary
Hepatic impairment
Moderate hepatic impairment - See dosing table above.
Severe hepatic impairment: Avoid. No information available for use in severe impairment in children.
Monitor liver function tests during caspofungin therapy and if evidence of worsening hepatic function, re-evaluate the risk/benefit of continuing caspofungin therapy.
Based on clinical experience in adults, increased exposure to caspofungin is expected in children with hepatic impairment.
Pregnancy and breastfeeding
Pregnancy
Discuss with pharmacy
Breastfeeding
Discuss with pharmacy
Additional information
Clinically significant interactions:
Ciclosporin:
Use if benefit outweighs the risk of hepatic impairment. Monitor liver enzymes closely when caspofungin and ciclosporin are used concomitantly.
Tacrolimus:
Tacrolimus trough concentrations are reduced by 26%. Monitor tacrolimus levels and adjust tacrolimus dose when used with caspofungin.
References
-
Wockhardt UK Ltd. Summary of product characteristics Caspofungin 50mg Powder for concentrate for solution for infusion. Last updated 03/08/2017. Accessed via https://www.medicines.org.uk/emc/product/2334/smpc on 20/06/2022.
-
The Renal Drug Database. Caspofungin. Last updated 20/02/2018. Accessed via renaldrugdatabase.com on 20/06/2022.
-
British National Formulary. Caspofungin. Available via bnf.nice.org.uk/drug/caspofungin.html. Accessed 20/06/2022.