Rx Update: April 2001
Mary Ross, R.Ph., M.B.A.
Peer Review Status: Internally Reviewed
The most common adverse reactions associated with iron sucrose include hypotension, cramps/leg cramps, nausea, headache, vomiting, and diarrhea. Severe, life-threatening anaphylaxis (hypotension, arrhythmias, cardiovascular shock, bronchospasm, apnea, and angioedema) is very rare, occurring in less than 0.01% of patients. This compares favorably to iron dextran, another parenteral iron product, which has an incidence of severe anaphylactic reactions of about 1%.
The dosage of iron sucrose is expressed in terms of mg of elemental iron. The recommended dosage is 100 mg delivered intravenously during the dialysis session. Most patients require a minimum cumulative dose of 1000 mg of elemental iron, administered over 10 sequential dialysis sessions. Iron sucrose should be administered intravenously, directly into the dialysis line, either by slow injection or by infusion. It may be administered as a bolus injection, undiluted at a rate of 20 mg per minute, or it may be diluted in a maximum of 100 ml of 0.9% sodium chloride infused over a period of at least 15 minutes. Iron sucrose injection is available as 100 mg of elemental iron per 5 ml vial.
Caspofungin
Caspofungin (Cancidas®) is an antifungal medication that is
in a new class of agents known as echinocandins. It is indicated for
patients who are unresponsive to or intolerant of standard therapies
for invasive aspergillosis.
During limited clinical trials, adverse reactions to caspofungin were relatively uncommon. Adverse reactions observed include infusion reactions (pruritus, erythema, induration, or pain), headache, symptoms associated with histamine release (flushing, wheals, rash, facial edema, wheezing, and bronchoconstriction), nausea, abdominal pain, and diarrhea. The most common laboratory test changes noted were elevated liver function tests and, less often, elevated serum creatinine levels. Coadministration of cyclosporine and caspofungin is not recommended due to elevated liver function test values that were observed in some patients treated with both agents. In addition, caspofungin may reduce tacrolimus levels, so standard monitoring of tacrolimus levels and dosage adjustments are recommended. An increase in the daily dose of caspofungin may be necessary when it is coadministered with efavirenz, nelfinavir, nevirapine, phenytoin, rifampin, dexamethasone, or carbamazepine. Ritonavir, indinavir, lopinavir/ritonavir, amprenavir, saquinavir, or delavirdine may also necessitate adjustments in caspofungin dosing.
The recommended adult dose of this agent is a single 70 mg loading dose followed by daily doses of 50 mg. Duration of therapy is based upon the patient's underlying disease and clinical response. Dosing increases up to 70 mg per day are based upon lack of clinical response. Patients with hepatic disfunction require downward dosing adjustments. Caspofungin is administered by intravenous infusion in 250 ml of 0.9% sodium chloride over a period of 1 hour.
Caspofungin is a Protocol Drug at UIHC and may only be used in patients who are refractory to or intolerant of amphotericin B or amphotericin B lipid complex, or by recommendation of Infectious Diseases Division consult.