Details of Drug

Drug General Information (ID: D0268)
Drug Name	Caspofungin
Drug Type	Small molecule
Drug Synonymous	CASPO; Cancidas; Capsofungin; Caspofungin [INN]; M991; Cancidas (TM); Cancidas (TN); Caspofungin (INN); MK-0991; L-743,872; [1(R)-hydroxyethyl]-1,4,7,13,16,22-hexaazatricyclo[22.3.0.0(9,13)]heptacosane-2,5,8,14,17,23-hexaone diacetate; Pneumocandin B0, 1-[(4R,5S)-5-[(2-aminoethyl)amino]-N2-(10,12-dimethyl-1-oxotetradecyl)-4-hydroxy-L-ornithine]-5-[(3R)-3-hydroxy-L-ornithine]-(9CI); (4R,5S)-5-((2-Aminoethyl)amino)-N(sup 2)-(10,12-dimethyltetradecanoyl)-4-hydroxy-L-ornithyl-L-threonyl-trans-4-hydroxy-L-prolyl-(S)-4-hydroxy-4-(p-hydroxyphenyl)-L-threonyl-threo-3-hydroxy-L-ornithyl-trans-3-hydroxy-L-proline cyclic (6-1)-peptide; (4R,5S)-5-((2-aminoethyl)amino)-N(2)-(10,12-dimethyltetradecanoyl)-4-hydroxy-L-ornithyl-L-threonyl-trans-4-hydroxy-L-prolyl-(S)-4-hydroxy-4-(p-hydroxyphenyl)-L-threonyl-threo-3-hydroxy-L-ornithyl-trans-3-hydroxy-L-proline cyclic (6-1)-peptide; 1-[(4R,5S)-5-[(2-aminoethyl)amino]-N(2)-(10,12-dimethyl-1-oxotetradecyl)-4-hydroxy-L-ornithine]-5-[(3R)-3-hydroxy-L-ornithine]-pneumocandin B0 Click to Show/Hide
Disease Class	1F29-1F2F: Fungal infection
Therapeutic Class	Antifungal Agents
Structure
Structure	3D Structure		2D Structure
Formula	C52H88N10O15
InChI	1S/C52H88N10O15/c1-5-28(2)24-29(3)12-10-8-6-7-9-11-13-39(69)56-34-26-38(68)46(55-22-21-54)60-50(75)43-37(67)19-23-61(43)52(77)41(36(66)18-20-53)58-49(74)42(45(71)44(70)31-14-16-32(64)17-15-31)59-48(73)35-25-33(65)27-62(35)51(76)40(30(4)63)57-47(34)72/h14-17,28-30,33-38,40-46,55,63-68,70-71H,5-13,18-27,53-54H2,1-4H3,(H,56,69)(H,57,72)(H,58,74)(H,59,73)(H,60,75)/t28?,29?,30-,33-,34+,35+,36-,37+,38-,40+,41+,42+,43+,44+,45+,46+/m1/s1
InChIKey	JYIKNQVWKBUSNH-OGZDCFRISA-N
Canonical SMILES	CCC(C)CC(C)CCCCCCCCC(=O)NC1CC(C(NC(=O)C2C(CCN2C(=O)C(NC(=O)C(NC(=O)C3CC(CN3C(=O)C(NC1=O)C(C)O)O)C(C(C4=CC=C(C=C4)O)O)O)C(CCN)O)O)NCCN)O
External Link
	Pubchem ID	2826718
	CAS Number	162808-62-0
	CHEBI ID	474180
	TTD ID	D00ZCN
	VARIDT ID	DR00493

Drug-Drug Interaction Network
Sunburst Graph		Legend Information AM004 Affected intra/extra-hepatic metabolism AM006 Pharmacodynamic additive effects BM022 CYP450 enzyme induction BM055 Increased risk of hepatotoxicity
Relation Graph

Full list of drugs interacting with Caspofungin
Affected intra/extra-hepatic metabolism
	CYP450 enzyme induction					Drug Num: 41
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0255		Carbamazepine	C15H12N2O	2554	Major		Inter Info	[1]
D0453		Dexamethasone	C22H29FO5	5743	Major		Inter Info	[1]
D0554		Efavirenz	C14H9ClF3NO2	64139	Major		Inter Info	[1]
D0697		Fosphenytoin	C16H15N2O6P	56339	Major		Inter Info	[1]
D1400		Rifampicin	C43H58N4O12	135398735	Major		Inter Info	[8]
D1119		Nelfinavir	C32H45N3O4S	64143	Major		Inter Info	[1]
D1128		Nevirapine	C15H14N4O	4463	Major		Inter Info	[1]
D1283		Phenytoin	C15H12N2O2	1775	Major		Inter Info	[1]
D0178		Bexarotene	C24H28O2	82146	Moderate		Inter Info	[1]
D0224		Butabarbital	C10H16N2O3	2479	Moderate		Inter Info	[1]
D0225		Butalbital	C11H16N2O3	2481	Moderate		Inter Info	[1]
D0071		Amobarbital	C11H18N2O3	2164	Moderate		Inter Info	[1]
D0095		Apalutamide	C21H15F4N5O2S	24872560	Moderate		Inter Info	[1]
D0194		Bosentan	C27H29N5O6S	104865	Moderate		Inter Info	[1]
D0300		Cenobamate	C10H10ClN5O2	11962412	Moderate		Inter Info	[1]
D0406		Dabrafenib	C23H20F3N5O2S2	44462760	Moderate		Inter Info	[1]
D0555		Elagolix	C32H30F5N3O5	11250647	Moderate		Inter Info	[1]
D0578		Enzalutamide	C21H16F4N4O2S	15951529	Moderate		Inter Info	[1]
D0628		Etravirine	C20H15BrN6O	193962	Moderate		Inter Info	[1]
D0639		Felbamate	C11H14N2O4	3331	Moderate		Inter Info	[1]
D0872		Ivosidenib	C28H22ClF3N6O3	71657455	Moderate		Inter Info	[1]
D0953		Lorlatinib	C21H19FN6O2	71731823	Moderate		Inter Info	[1]
D0958		Lumacaftor	C24H18F2N2O5	16678941	Moderate		Inter Info	[27], [8]
D1040		Methylphenobarbital	C13H14N2O3	8271	Moderate		Inter Info	[27], [8]
D1078		Mitotane	C14H10Cl4	4211	Moderate		Inter Info	[1]
D1099		Nafcillin	C21H22N2O5S	8982	Moderate		Inter Info	[1]
D1198		Oxcarbazepine	C15H12N2O2	34312	Moderate		Inter Info	[1]
D1265		Phenobarbital	C12H12N2O3	4763	Moderate		Inter Info	[1]
D1340		Primidone	C12H14N2O2	4909	Moderate		Inter Info	[1]
D1399		Rifabutin	C46H62N4O11	135398743	Moderate		Inter Info	[1]
D1401		Rifapentine	C47H64N4O12	135403821	Moderate		Inter Info	[1]
D1433		Rufinamide	C10H8F2N4O	129228	Moderate		Inter Info	[13], [37]
D1493		Somapacitan	C54H95N13O20S2	129894493	Moderate		Inter Info	[27], [8]
D1502		St. John's Wort	NA	NA	Moderate		Inter Info	[1]
D1687		Vemurafenib	C23H18ClF2N3O3S	42611257	Moderate		Inter Info	[1]
D0741		Griseofulvin	C17H17ClO6	441140	Moderate		Inter Info	[1]
D1248		Pentobarbital	C11H18N2O3	4737	Moderate		Inter Info	[1]
D1453		Secobarbital	C12H18N2O3	5193	Moderate		Inter Info	[1]
D1494		Somatotropin	NA	NA	Moderate		Inter Info	[27], [8]
D0106		Armodafinil	C15H15NO2S	9690109	Minor		Inter Info	[42], [43], [44], [45], [46]
D1081		Modafinil	C15H15NO2S	4236	Minor		Inter Info	[42], [43], [44], [45], [46]
Pharmacodynamic additive effects
	Increased risk of hepatotoxicity					Drug Num: 23
Drug ID		Drug Name	Formula	Pubchem ID	Severity Level		Interaction Detail	REF
D0900		Leflunomide	C12H9F3N2O2	3899	Major		Inter Info	[2], [3], [4]
D0944		Lomitapide	C39H37F6N3O2	9853053	Major		Inter Info	[5]
D1073		Mipomersen	C230H324N67O122P19S19	118984467	Major		Inter Info	[6]
D1258		Pexidartinib	C20H15ClF3N5	25151352	Major		Inter Info	[7]
D1556		Teriflunomide	C12H9F3N2O2	54684141	Major		Inter Info	[2], [3], [4]
D0114		Asparaginase Escherichia coli	NA	NA	Moderate		Inter Info	[9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]
D0113		Asparaginase Erwinia chrysanthemi	NA	NA	Moderate		Inter Info	[9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]
D0149		Bedaquiline	C32H31BrN2O2	5388906	Moderate		Inter Info	[22]
D0199		Brentuximab vedotin	NA	NA	Moderate		Inter Info	[23]
D0232		Calaspargase pegol	NA	NA	Moderate		Inter Info	[9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]
D0248		Cannabidiol	C21H30O2	644019	Moderate		Inter Info	[13], [24]
D0357		Clofarabine	C10H11ClFN5O3	119182	Moderate		Inter Info	[25]
D0789		Idelalisib	C22H18FN7O	11625818	Moderate		Inter Info	[26]
D1025		Methotrexate	C20H22N8O5	126941	Moderate		Inter Info	[13], [28]
D1106		Naltrexone	C20H23NO4	5360515	Moderate		Inter Info	[29]
D1239		Peginterferon beta-1a	NA	NA	Moderate		Inter Info	[30], [31], [32], [33]
D1389		Remdesivir	C27H35N6O8P	121304016	Moderate		Inter Info	[12], [13], [34], [35], [36]
D1615		Trabectedin	C39H43N3O11S	108150	Moderate		Inter Info	[13], [38]
D0584		Epirubicin	C27H29NO11	41867	Moderate		Inter Info	[12], [13], [39]
D0826		Interferon beta-1a	NA	NA	Moderate		Inter Info	[30], [31], [32], [33]
D0827		Interferon beta-1b	NA	NA	Moderate		Inter Info	[30], [31], [32], [33]
D1234		Pegaspargase	C14H19NO	436058	Moderate		Inter Info	[9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]
D1589		Tioguanine	C5H5N5S	2723601	Moderate		Inter Info	[40], [41]

References
1	Product Information. Cancidas (caspofungin) Merck & Co, Inc, West Point, PA.
2	Canadian Pharmacists Association.
3	EMEA "EMEA public statement on leflunomide (ARAVA) - severe and serious hepatic reactions.".
4	Product Information. Arava (leflunomide). Hoechst Marion-Roussel Inc, Kansas City, MO.
5	Product Information. Juxtapid (lomitapide). Aegerion Pharmaceuticals Inc, Cambridge, MA.
6	Product Information. Kynamro (mipomersen). Genzyme Corporation, Cambridge, MA.
7	Product Information. Turalio (pexidartinib). Daiichi Sankyo, Inc., Parsippany, NJ.
8	Product Information. Cancidas (caspofungin) Merck &amp Co, Inc, West Point, PA.
9	Al-Nawakil C, Willems L, Mauprivez C, et.al "Successful treatment of l-asparaginase-induced severe acute hepatotoxicity using mitochondrial cofactors." Leuk Lymphoma 55 (2014): 1670-4. [PMID: 24090500]
10	Bodmer M, Sulz M, Stadlmann S, Droll A, Terracciano L, Krahenbuhl S "Fatal liver failure in an adult patient with acute lymphoblastic leukemia following treatment with L-asparaginase." Digestion 74 (2006): epub. [PMID: 16988508]
11	Cerner Multum, Inc "ANVISA Bulario Eletrnico.".
12	Cerner Multum, Inc. "Australian Product Information.".
13	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
14	Christ TN, Stock W, Knoebel RW "Incidence of asparaginase-related hepatotoxicity, pancreatitis, and thrombotic events in adults with acute lymphoblastic leukemia treated with a pediatric-inspired regimen." J Oncol Pharm Pract 24 (2018): 299-308. [PMID: 28355969]
15	Jenkins R, Perlin E "Severe hepatotoxicity from Escherichia coli L-asparaginase." J Natl Med Assoc 79 (1987): 775-9. [PMID: 3305969]
16	Lu G, Karur V, Herrington JD, Walker MG "Successful treatment of pegaspargase-induced acute hepatotoxicity with vitamin B complex and L-carnitine" Proc (Bayl Univ Med Cent) 29 (2016): 46-7. [PMID: 26722167]
17	Product Information. Asparlas (calaspargase pegol). Servier, Boston, MA.
18	Product Information. Elspar (asparaginase). Merck & Co, Inc, West Point, PA.
19	Product Information. Erwinaze (asparaginase Erwinia chrysanthemi). EUSA Pharma, Newtown, PA.
20	Product Information. Oncaspar (pegaspargase). Rhone-Poulenc Rorer, Collegeville, PA.
21	Burke PW, Aldoss I, Lunning MA, et.al "High-grade PEGylated asparaginase-related hepatotoxicity occurrence in a pediatric-inspired adult acute lymphoblastic leukemia regimen does not necessarily predict recurrent hepatotoxicity in subsequent cycles." Blood 122 (2013): 2671. [PMID: 29407583]
22	Product Information. Sirturo (bedaquiline). Janssen Pharmaceuticals, Titusville, NJ.
23	Product Information. Adcetris (brentuximab vedotin). Seattle Genetics Inc, Bothell, WA.
24	Product Information. Epidiolex (cannabidiol). Greenwich Biosciences Inc, Carlsbad, CA.
25	Product Information. Clolar (clofarabine). sanofi-aventis, Bridgewater, NJ.
26	Product Information. Zydelig (idelalisib). Gilead Sciences, Foster City, CA.
27	Patel S, Robinson R, Burk M "Hypertensive crisis associated with St. John's Wort." Am J Med 112 (2002): 507-8. [PMID: 11959071]
28	Product Information. Methotrexate (methotrexate). Lederle Laboratories, Wayne, NJ.
29	Product Information. ReVia (naltrexone). DuPont Pharmaceuticals, Wilmington, DE.
30	Product Information. Avonex (interferon beta-1a). Biogen, Cambridge, MA.
31	Product Information. Betaseron (interferon beta-1b). Berlex, Richmond, CA.
32	Product Information. Plegridy (peginterferon beta-1a). Biogen Idec Inc, Cambridge, MA.
33	Product Information. Rebif (interferon beta-1a). Serono Laboratories Inc, Norwell, MA.
34	European Medicines Agency "Summary on compassionate use. Remdesivir Gilead.".
35	Gilead Sciences, Inc "About Remdesivir.".
36	US Food and Drug Administration "Fact sheet for health care providers emergency use authorization (EUA) of remdesivir (GS-5734TM)".
37	Product Information. Banzel (rufinamide). Eisai Inc, Teaneck, NJ.
38	Product Information. Yondelis (trabectedin). Janssen Pharmaceuticals, Titusville, NJ.
39	Product Information. Ellence (epirubicin) Pharmacia and Upjohn, Kalamazoo, MI.
40	Product Information. Aubagio (teriflunomide). Genzyme Corporation, Cambridge, MA.
41	Product Information. Tabloid (thioguanine). Prasco Laboratories, Cincinnati, OH.
42	Doherty MM, Charman WN "The mucosa of the small intestine: how clinically relevant as an organ of drug metabolism?" Clin Pharmacokinet 41 (2002): 235-53. [PMID: 11978143]
43	Product Information. Nuvigil (armodafinil). Cephalon Inc, West Chester, PA.
44	Product Information. Provigil (modafinil). Cephalon, Inc, West Chester, PA.
45	Robertson P Jr, Hellriegel ET, Arora S, Nelson M "Effect of modafinil on the pharmacokinetics of ethinyl estradiol and triazolam in healthy volunteers." Clin Pharmacol Ther 71 (2002): 46-56. [PMID: 11823757]
46	Robertson P, Decory HH, Madan A, Parkinson A "In vitro inhibition and induction of human hepatic cytochrome P450 enzymes by modafinil." Drug Metab Dispos 28 (2000): 664-71. [PMID: 10820139]

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