Indications for: CANCIDAS
Presumed fungal infections in febrile neutropenia, as empiric therapy. Candida infections of the esophagus, blood, peritoneum, intraabdominal abscess, pleural space. Invasive aspergillosis in patients refractory to or intolerant of other therapies (not for initial therapy).
Give by slow IV infusion over 1hr. ≥18yrs: Esophageal candidiasis: 50mg once daily. Other Candida infections, aspergillosis, or empiric: 70mg once on Day 1 then 50mg daily. Empiric: treat for at least 14 days; continue for at least 7 more days after resolution of neutropenia and clinical symptoms; may increase to 70mg/day. All others: continue at least 14 days after last positive culture. Moderate hepatic impairment: 35mg daily (may give 70mg on Day 1 when indicated). Concomitant rifampin: 70mg once daily. Concomitant other CYP inducers (eg, nevirapine, efavirenz, carbamazepine, dexamethasone, phenytoin): consider 70mg once daily.
<3months: not established. Give by slow IV infusion over 1hr. 3mos–17yrs: 70mg/m2 once on Day 1, then 50mg/m2 daily. May increase to 70mg/m2 daily; max 70mg. Empiric: treat for at least 14 days; continue for at least 7 more days after resolution of neutropenia and clinical symptoms. All others: continue at least 14 days after last positive culture. Concomitant rifampin: 70mg/m2 once daily. Concomitant other CYP inducers (eg, nevirapine, efavirenz, carbamazepine, dexamethasone, phenytoin): consider 70mg/m2 once daily.
Severe hepatic impairment. Obtain liver function tests. Discontinue at 1st sign of a hypersensitivity reaction and treat appropriately. Pregnancy. Nursing mothers.
Glucan synthesis inhibitor (echinocandin).
Elevated liver enzymes with concomitant cyclosporine. Antagonizes tacrolimus; monitor levels. Antagonized by potent CYP3A4 and other CYP inducers (see Adults and Children).
Diarrhea, pyrexia, chills, rash, increased alkaline phosphatase and ALT/AST, hypokalemia, anaphylaxis, histamine-mediated symptoms. Children: also hypotension.