Cancidas

For adult & childn ≥12 mth: Empirical therapy for presumed fungal infections (eg, Candida or Aspergillus) in febrile, neutropenic patients whose fever has failed to respond to broad-spectrum antibiotics. Candidemia & other Candida infections (intra-abdominal abscesses, peritonitis & pleural space infections); esophageal candidiasis; invasive aspergillosis in patients who are refractory to or intolerant of other therapies.

IV Slow IV infusion over approx 1 hr. Adult ≥18 yr Empirical therapy Single 70 mg loading dose on day 1 followed by 50 mg daily thereafter, continue until up to 72 hr after resolution of neutropenia. Treat patients w/ fungal infection for a min of 14 days; continue treatment for at least 7 days after both neutropenia & clinical symptoms are resolved. Max daily dose: 70 mg. Candidemia & other Candida infections Single 70 mg loading dose on day 1 followed by 50 mg daily thereafter. Continue for at least 14 days after the last +ve culture. Esophageal candidiasis 50 mg daily. Invasive aspergillosis Single 70 mg loading dose on day 1 followed by 50 mg daily thereafter. Co-administration w/ efavirenz, nevirapine, rifampicin, dexamethasone, phenytoin or carbamazepine Consider 70 mg as daily dose. Adult w/ moderate hepatic insufficiency 35 mg daily. If recommended, administer a 70 mg loading dose on day 1. Ped 12 mth-17 yr Individualized dosing based on BSA. All indications (except esophageal candidiasis) Single 70 mg/m² loading dose (max actual dose: 70 mg) on day 1 followed by 50 mg/m² daily thereafter (max actual daily dose: 70 mg). Esophageal candidiasis 50 mg/m² daily (max actual daily dose: 70 mg). Co-administration w/ rifampin, efavirenz, nevirapine, phenytoin, dexamethasone or carbamazepine Consider 70 mg/m² as daily dose (max actual daily dose: 70 mg).

Hypersensitivity.

Discontinue use &/or administer appropriate treatment if anaphylaxis & possible histamine-mediated AR occur. Patients w/ history of allergic skin reactions; potential SJS & TEN. Patients w/ serious underlying conditions receiving multiple concomitant medications; monitor for evidence of worsening hepatic function & evaluate for risk/benefit of continuing therapy in patients who develop abnormal LFTs. Concomitant use w/ cyclosporine; consider close monitoring of liver enzymes. Treatment duration >4 wk. Pregnancy. Woman receiving treatment should not breastfeed. Childn 3-11 mth; neonates & infants <3 mth; ped patients w/ endocarditis, osteomyelitis & meningitis due to Candida; initial therapy for invasive aspergillosis.

Adult: Decreased Hb, haematocrit & WBC count; hypokalemia; headache; phlebitis; dyspnoea; nausea, diarrhoea, vomiting; elevated liver values (ALT, AST, blood alkaline phosphatase, conjugated & blood bilirubin); rash, pruritus, erythema, hyperhidrosis; arthralgia; pyrexia, chills, infusion-site pruritus; decreased blood K & albumin. Childn: Fever. Increased eosinophil count; headache; tachycardia; flushing, hypotension; elevated liver enzyme levels (AST, ALT); rash, pruritus; chills, catheter site pain; decreased K, hypomagnesemia, increased glucose, increased or decreased P.

Increased AUC by cyclosporine. Reduced blood conc of tacrolimus. Induced & inhibited disposition w/ net induction at steady state by rifampicin. Conc may be reduced by efavirenz, nevirapine, phenytoin, dexamethasone, carbamazepine.

Antifungals

J02AX04 - caspofungin ; Belongs to the class of other systemic antimycotics.

POM