What are the contraindications of caspofungin?

Contraindications of Caspofungin

Caspofungin is contraindicated only in patients with known hypersensitivity (including anaphylaxis) to any component of the product. 1

Absolute Contraindication

• Hypersensitivity reactions: The sole absolute contraindication is documented hypersensitivity to caspofungin or any component of the formulation 1
  • This includes anaphylaxis, which has been reported during caspofungin administration 1
  • Other hypersensitivity manifestations include rash, facial swelling, angioedema, pruritus, sensation of warmth, and bronchospasm 1
  • Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), some with fatal outcomes, have been reported 1

Important Clinical Warnings (Not Absolute Contraindications)

While not contraindications, the following situations require careful consideration and monitoring:

Concomitant Use with Cyclosporine

• Use caspofungin with cyclosporine only when potential benefit outweighs risk 1
• Cyclosporine increases caspofungin area under the curve by approximately 35% 2
• Elevated liver enzymes have occurred with this combination 1
• Transient elevations of hepatic aminotransferase enzymes were observed in single-dose interaction studies 2
• Monitor liver function tests closely if this combination is necessary 1

Hepatic Impairment

• Dose reduction required for moderate hepatic insufficiency (Child-Pugh score 7-9): reduce daily maintenance dose to 35 mg 3, 1, 4
• Caspofungin undergoes hepatic metabolism with some spontaneous chemical degradation 2, 3
• Monitor patients with abnormal liver function tests for evidence of worsening hepatic function 1
• Isolated cases of clinically significant hepatic dysfunction, hepatitis, and hepatic failure have been reported, though causal relationship not established 1

Drug Interactions Requiring Dose Adjustment

• Inducers of drug clearance may reduce caspofungin concentrations, requiring dose increase to 70 mg daily 2
  • These include: efavirenz, nelfinavir, nevirapine, phenytoin, rifampin, dexamethasone, and carbamazepine 2

Tacrolimus Interaction

• Caspofungin reduces tacrolimus area under the curve by approximately 20% 2
• Monitor tacrolimus levels and adjust dose accordingly 2

Administration Precautions

• Do not mix or co-infuse with other medications - no compatibility data available 1
• Do not use diluents containing dextrose - caspofungin is not stable in dextrose-containing solutions 1
• Discontinue immediately at first sign of hypersensitivity reaction and administer appropriate treatment 1

Common Pitfalls to Avoid

• Do not assume renal dose adjustment is needed: No dosage adjustment required for renal insufficiency or dialysis 3
• Do not overlook hepatic dosing: Unlike other echinocandins (anidulafungin, micafungin), caspofungin is the only one requiring dose reduction in moderate hepatic dysfunction 3
• Monitor for histamine-mediated reactions: Though rare, these may be related to rapid infusion rates 2, 1, 5