Pharmacokinetics in children

In the studies by Neely et al., Walsh et al. and Sáez-Llorens et al., the following kinetic parameters were found:

t½ (hours)
12-17 yrs: 11.2±1.7
2-11 yrs: 8.2±2.4
3-23 months: 8.8±2.1

Cl (ml/min)
12-17 yrs 12.6±5.5
2-11 yrs 6.4±2.6
3-23 months 3.2±0.4

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Renal impaiment in children > 3 months

GFR ≥10 ml/min/1.73m2: Dose adjustment not required.

GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Diarrhoea, dyspnoea, respiratory distress. As in adults, similar histamine-mediated symptoms have been reported.

Children: Very common (> 10%): fever. Common (1–10%): pain at the infusion site, shivers. Headaches. Transient redness of the face and neck, hypotension. Tachycardia. Skin rash, itchiness. Increases in liver enzyme values (ASAT, ALAT). Elevated eosinophil count. Lowered potassium value, hypomagnesemia, lowered and elevated phosphorus value, elevated glucose value/blood sugar level. Also noted: swelling at the infusion site, peripheral oedema, hypocalcaemia, impaired liver function. Nephrotoxicity.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Only prescribe after consulting an infectiologist/microbiologist. The dosage must be adjusted in adults with moderately impaired liver function. No studies have been carried out in children with impaired hepatic function; caution is therefore needed in severe liver function disorders.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

• ANTIINFECTIVES FOR SYSTEMIC USE
• ANTIMYCOTICS FOR SYSTEMIC USE

ANTIMYCOTICS FOR SYSTEMIC USE

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

References

1. Walsh TJ, et al, Pharmacokinetics, safety, and tolerability of caspofungin in children and adolescents., Antimicrob Agents Chemother., 2005, 49(11), 4536-45
2. Fisher BT, et al, Caspofungin for the treatment of pediatric fungal infections., Pediatr Infect Dis J., 2008, 27, 1099-102
3. Lehrnbecher T, et al, Experiences with the use of caspofungin in paediatric patients., Mycoses., 2008, 51, 58-64
4. Koo A, et al, Efficacy and safety of caspofungin for the empiric management of fever in neutropenic children., Pediatr Infect Dis J., 2007, 26, 854-6
5. Merlin E, et al, Efficacy and safety of caspofungin therapy in children with invasive fungal infections, Pediatr Infect Dis J., 2006, 25, 1186-8
6. Neely M, et al, Pharmacokinetics and safety of caspofungin in older infants and toddlers., Antimicrob Agents Chemother., 2009, 53, 1450-6
7. Sáez-Llorens X, et al, Pharmacokinetics and safety of caspofungin in neonates and infants less than 3 months of age., Antimicrob Agents Chemother., 2009, 53, 869-75
8. Zaoutis TE, et al, A prospective, multicenter study of caspofungin for the treatment of documented Candida or Aspergillus infections in pediatric patients., Pediatrics, 2009, 123, 877-84
9. Zaoutis T, et al, Safety Experience With Caspofungin in Pediatric Patients., Pediatr Infect Dis J., 2009, [Epub ahead of print]
10. Jeon GW et al. , Successful caspofungin treatment of persistent candidemia in extreme prematurity at 23 and 24 weeks’ gestation, J Formos Med Assoc, 2014 , Mar;113(3), 191-4
11. Maertens JA et al. , A randomized, double-blind, multicenter study of caspofungin versus liposomal amphotericin B for empiric antifungal therapy in pediatric patients with persistent fever and neutropenia, Pediatr Infect Dis J, 2010, May;29(5), 415-20
12. Mohamed WA et al, A randomized, double-blind, prospective study of caspofungin vs. amphotericin B for the treatment of invasive candidiasis in newborn infants., J Trop Pediatr. , 2012, Feb;58(1), 25-30
13. Natarajan G et al., Experience with caspofungin in the treatment of persistent fungemia in neonates. , J Perinatol, 2005, Dec;25(12), 770-7
14. Odio CM et al, Caspofungin therapy of neonates with invasive candidiasis, Pediatr Infect Dis J, 2004, Dec;23(12), 1093-7

Changes

Therapeutic Drug Monitoring

Overdose