Echinocandin
Candida sp. including azole-resistant strains. Activity against molds difficult to quantify but includes Aspergillus sp Table 1, Table 2
Non-competitive inhibition of the enzyme b-(1,3)-glucan synthase.
Echinocandins have more fungicidal effects against Candida species compared to filamentous organisms. In-vitro studies have demonstrated concentration-dependent fungicidal activity against Candida sp.
Half-life: 11.6-15.2 hours; Volume of distribution: 14L; Clearance (total): 13ml/min; Protein binding: 99%; Table 3
Hepatic: mild elevation in liver transaminases – dose related and reversible upon discontinuation of drug, and bilirubinemia
Dermatologic: rash, pruritis,
Intravenous only – available as 50mg single use vials
Esophageal Candidiasis: 150mg I.V. q24h
Candida prophylaxis in hematopoetic stem cell recipients: 50mg I.V. q24h
Disease state based dosing:
Hepatic failure: In mild to moderate hepatic impairment, dosage adjustment is not necessary. Pharmacokinetic data are lacking in patients with severe hepatic failure.
Renal failure: No dosing adjustment necessary
Geriatric: No dosing adjustment necessary
Sirolimus: Concomitant administration with caspofungin leads to a 21% AUC increase in sirolimus. Sirolimus levels should be monitored and adjusted.
Nifedipine: Concomitant administration with caspofungin leads to an 18% AUC increase in nifedipine. Monitoring for toxicity is recommended
Category C: Risk unknown. Human studies inadequate.
Routine monitoring of hepatic enzymes is recommended
Brand names/Manufacturer: Mycamine/Astellas pharmaceuticals
Marketed as Mycamine in the United States
Marketed as Funguard in Japan