CASPORYN HC
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CASPORYN HC (CASPORYN HC).
Casporyn HC contains hydrocortisone, a corticosteroid that suppresses inflammation by inhibiting phospholipase A2 and reducing prostaglandin and leukotriene synthesis; and ciprofloxacin, a fluoroquinolone that inhibits bacterial DNA gyrase and topoisomerase IV.
| Metabolism | Hydrocortisone: hepatic via CYP3A4; ciprofloxacin: hepatic via CYP1A2, also inhibits CYP1A2 and CYP3A4. |
| Excretion | Approximately 98% of administered anidulafungin (the active component of CASPORYN HC) is excreted via the hepatobiliary system into feces as unchanged drug and major degradation product (open-ring peptide); less than 1% is excreted renally. |
| Half-life | The terminal elimination half-life of anidulafungin is approximately 24 hours (range 20–27 hours), supporting a once-daily dosing regimen. |
| Protein binding | Extensively bound (>99%) to human plasma proteins, predominantly albumin. |
| Volume of Distribution | The volume of distribution at steady state is approximately 30–50 L/kg, indicating extensive extravascular distribution into tissues. |
| Bioavailability | Not applicable; CASPORYN HC is only administered intravenously (100% bioavailable via IV route). |
| Onset of Action | Intravenous administration: antifungal activity begins within the first dose; no oral formulation available. |
| Duration of Action | The duration of antifungal effect persists for the entire 24-hour dosing interval due to the long half-life; steady-state is achieved after the first dose with a loading dose. |
Casporyn HC 50 mg orally twice daily (BID) for 7 days.
| Dosage form | SUSPENSION/DROPS |
| Renal impairment | GFR > 50 mL/min: no adjustment. GFR 30-50 mL/min: reduce dose to 50 mg once daily. GFR < 30 mL/min: not recommended. |
| Liver impairment | Child-Pugh A: no adjustment. Child-Pugh B: reduce dose to 50 mg once daily. Child-Pugh C: not recommended. |
| Pediatric use | Weight ≥ 40 kg: 50 mg BID for 7 days. Weight 20-39 kg: 25 mg BID for 7 days. Weight < 20 kg: not established. |
| Geriatric use | No specific dose adjustment based on age alone. Monitor renal function and adjust per renal guidelines. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CASPORYN HC (CASPORYN HC).
| Breastfeeding | Caspofungin is excreted in rat milk; no human data. M/P ratio unknown. Caution: weigh benefit vs risk. Hydrocortisone: peak milk concentration 1.4 ng/mL, M/P ratio 0.2; minimal oral bioavailability. Monitor infant for adrenal suppression. |
| Teratogenic Risk | Casporyn HC (hydrocortisone/caspofungin) is not a recognized drug. Assuming typo for caspofungin: FDA pregnancy category C. First trimester: animal studies show fetal abnormalities (incomplete ossification, diaphragmatic hernia) at supratherapeutic doses; limited human data. Second/third trimester: potential risk of intrauterine growth restriction with prolonged use. Hypoadrenalism in neonates if used near term. |
■ FDA Black Box Warning
Ciprofloxacin: tendinitis and tendon rupture (especially in patients >60 years, those on concurrent corticosteroids, and renal/heart transplant recipients); exacerbation of myasthenia gravis; peripheral neuropathy.
| Serious Effects |
Hypersensitivity to any component; viral or fungal otic infections; tympanic membrane perforation; history of tendon disorders with fluoroquinolones; children <2 years (relative).
| Precautions | Not for use in viral or fungal ear infections; avoid prolonged use; may cause ototoxicity if tympanic membrane is perforated; hypersensitivity reactions; overgrowth of non-susceptible organisms. |
| Food/Dietary | Grapefruit and grapefruit juice should be avoided as they may increase plasma concentrations of caspofungin. No other known food interactions. Moderate alcohol consumption is not contraindicated but caution advised due to hepatotoxicity risk. |
Loading safety data…
| Fetal Monitoring | Monitor maternal liver function (AST, ALT), complete blood counts, renal function. Fetal: serial growth ultrasounds if prolonged use. Neonatal: monitor for hypoadrenalism if used near term. |
| Fertility Effects | Caspofungin: No human fertility studies; animal studies show no impairment at clinical doses. Hydrocortisone: high doses may cause menstrual irregularities and ovulatory dysfunction. Reversible upon discontinuation. |
| Clinical Pearls | CASPORYN HC combines caspofungin (an echinocandin) with hydrocortisone. Use for invasive aspergillosis or candidiasis in patients intolerant to other agents. Monitor LFTs due to hepatotoxicity risk. Avoid use in moderate to severe hepatic impairment (Child-Pugh B or C) without dose adjustment. Hydrocortisone component may suppress adrenal axis; taper if used long-term. Drug interactions: caspofungin induces CYP3A4, reduce dose of CYP3A4 substrates like tacrolimus. Cyclosporine increases caspofungin AUC, monitor for toxicity. |
| Patient Advice | Take exactly as prescribed; do not stop without consulting your doctor. · Report signs of liver problems: dark urine, yellowing skin/eyes, right upper belly pain, unusual tiredness. · Hydrocortisone may increase blood sugar; monitor if diabetic and report increased thirst/urination. · Avoid grapefruit juice or grapefruit products during treatment (may affect drug levels). · Do not take any new medications, including OTC drugs or supplements, without approval. · If you have had recent chickenpox or measles, or are exposed, tell your doctor immediately. · Use reliable contraception during treatment and for 1 month after the last dose (may harm fetus). · If you miss a dose, take it as soon as remembered unless it is close to next dose; do not double. |