(For this reason, many toxic and easily digestible products such as rat poison contain an emetic. This presents no problem for the effectiveness of the rodenticide as rodents are unable to vomit.) Inducing vomiting can remove the substance before it is absorbed into the body. Emetics can be divided into two categories, those which produce their effect by acting on the vomiting center in the medulla, and those which act directly on the stomach itself. Some emetics, such as ipecac, fall into both categories; they initially act directly on the stomach, while their further and more vigorous effect occurs by stimulation of the medullary center.Salt water and mustard water, which act directly on the stomach, have been used since ancient times as emetics. Care must be taken with salt, as excessive intake can potentially be harmful.Copper sulfate was also used in the past as an emetic. It is now considered too toxic for this use.Hydrogen peroxide is used as an emetic in veterinary practice. Self-induced
Eating disorders (anorexia nervosa or bulimia nervosa)
To eliminate an ingested poison (some poisons should not be vomited as they may be more toxic when inhaled or aspirated; it is better to ask for help before inducing vomiting)
Some people who engage in binge drinking induce vomiting to make room in their stomachs for more alcohol consumption.
Its currently approved therapeutic indications by both organisations include the empirical therapy of presumed fungal infections in febrile, neutropenic adult patients and for salvage therapy in patients treatment of invasive aspergillosis in adult patients whose disease is refractory to, or who are intolerant of, other antifungal agents (i.e., conventional or lipid formulations of amphotericin B and/or itraconazole). Additionally, the FDA approval includes indication for the treatment of candidemia and some specific Candida infections (intra-abdominal abscesses, peritonitis, pleural cavity infections, and esophagitis) and the EMEA approval includes indication for the treatment of general invasive candidiasis in adult patients. Metabolism
Slowly metabolized by peptide hydrolysis and N-acetylation in liver. Therefore, in case of liver impairment the dose needs to be reduced. Caspofungin also undergoes spontaneous chemical degradation to an open-ring peptide compound, L-747969. Additional metabolism involves hydrolysis into constitutive amino acids and their derivatives, including dihydroxyhomotyrosine and N-acetyl-dihydroxyhomotyrosine. Clinical efficacy
About 36% of patients refractory to other therapies responded well to caspofungin therapy, while even 70% of patients intolerant to other therapies were classified as responders. Direct comparative studies to other drugs in the treatment of invasive aspergillosis have so far not been undertaken. Contraindications
Known hypersensitivity to caspofungin acetate or any other ingredient contained in the formulation contraindicate its use. Warnings
Hepatic effectsThe concomitant use of caspofungin and cyclosporine in healthy volunteers led to a more frequent increase of liver enzymes (ALT=SGPT and AST=SGOT) than noted with cyclosporine alone. Combination treatment is only indicated if the potential benefit for the patient outweighs the potential risk.