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- Title
Caspofungin dosage adjustments are not required for patients with Child-Pugh B or C cirrhosis.
- Authors
Gustot, Thierry; Heine, Rob ter; Brauns, Elisa; Cotton, Frédéric; Jacobs, Frédérique; Brüggemann, Roger J; Ter Heine, Rob
- Abstract
<bold>Background: </bold>Controversies remain over caspofungin dosage adjustments in cirrhosis, particularly Child-Pugh (CP) B or C. The product information for of caspofungin recommends a maintenance dose reduction from 50 to 35 mg for patients with CP-B cirrhosis.<bold>Objectives: </bold>To quantify the impact of cirrhosis and the severity of hepatic impairment on the pharmacokinetics (PK) of caspofungin.<bold>Patients and methods: </bold>We performed PK studies of a single 70 mg dose of caspofungin in patients with decompensated CP-B (n = 10) or CP-C (n = 10) cirrhosis and of multiple doses in 21 non-cirrhotic ICU patients with hypoalbuminaemia. A Monte Carlo simulation was performed to investigate the impact of a maintenance dose reduction from 50 to 35 mg on the steady-state area under the 24 h concentration-time curve.<bold>Results: </bold>We observed a marginal reduction of caspofungin clearance in a PK study in patients with decompensated CP-B or CP-C cirrhosis. Dose reduction to 35 mg in cirrhotic patients resulted in lower drug exposure than with the approved dose in non-cirrhotic patients.<bold>Conclusions: </bold>In contrast to the product information, we recommend giving the full dose of caspofungin regardless of the presence and severity of cirrhosis to avoid a subtherapeutic exposure.
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2018, Vol 73, Issue 6, pN.PAG
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dky189