Plasma concentrations of caspofungin at two different dosage regimens in a patient with hepatic dysfunction.
The currently recommended dosage regimen of caspofungin (50 mg/day) was developed for patients with invasive candidiasis. With invasive aspergillosis, successful outcomes occur in less than half the patients. We evaluate the pharmacokinetics in a patient with elevated liver enzyme levels after liver transplantation, who received caspofungin for the treatment of aspergillosis. Plasma concentrations of caspofungin were monitored at 2 different dosage regimens. The area under the concentration-time curve (AUC) at a dosage of 70 mg was 191 mg h/L and was associated with an increase in liver enzymes. After dose reduction to 50 mg with an AUC of 100 mg h/L, liver enzymes normalized. In conclusion, caspofungin plasma concentrations may be helpful to evaluate exposure and reduce the need for off-label dosing.
Department of Hospital and Clinical Pharmacy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. k.c.m.van.der.elst@umcg.nl
K C M
KC
van der Elst
R J M
RJ
Brüggemann
M G G
MG
Rodgers
J W C
JW
Alffenaar
D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics*; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology; D000077336:Caspofungin; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D054714:Echinocandins / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D055666:Lipopeptides; D008107:Liver Diseases / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin