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Caspofungin

    Brands

    DEA Class; Rx

    Common Brand Names; Cancidas

    • Antifungals, Systemic; 
    • Antifungals, Echinocandin

    IV echinocandin antifungal
    Used for aspergillosis, candidemia, esophageal candidiasis, and empiric treatment in febrile neutropenia
    Fever and infusion-related reactions common

    Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections
    Indicated for treatment of esophageal candidiasis
    Indicated for invasive aspergillosis in patients refractory to or intolerant of other therapies (eg, amphotericin B, itraconazole)
    Empirical therapy for presumed fungal infections in febrile, neutropenic patients
    Based on the limited data, an echinocandin drug (eg, anidulafungin, caspofungin, micafungin) is recommended by the CDC as initial therapy for treatment of C auris infections

    Hypersensitivity to drug or components of the formulation

    • Varies with condition
    • Anaphylaxis reported during administration of Cancidas
    • Infused vein complications/ phlebitis (20-35%)
    • Fever (6-30%)
    • Diarrhea (6-27%)
    • Shivering (9-23%)
    • Rash (4-23%)
    • Increased serum alkaline phosphatase (9-22%)
    • Hypotension (3-20%)
    • Respiratory failure (2-20%)
    • Incr transaminases (2-18%)
    • Septic shock (11% to 14% )

    Anaphylaxis reported, discontinue and administer appropriate treatment; possible histamine-mediated adverse reactions, including rash, facial swelling, angioedema, pruritus, sensation of warmth or bronchospasm

    Do not use dextrose diluents

    Do not use with cyclosporine (unless benefits outweigh risks)

    Not for bolus administration

    Can cause abnormalities in hepatic enzyme levels

    Cyclosporine may increase AUC of caspofungin by approximately 35%

    Hepatic effects: Abnormalities in LFTs and isolated cases of clinically significant hepatic dysfunction, hepatitis, or hepatic failure

    Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), some with a fatal outcome, reported; discontinue therapy at first sign or symptom of hypersensitivity reaction and administer appropriate treatment

    There are insufficient human data to establish whether there is a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes in pregnant women

    There are no data on presence of drug in human milk, effects on breast-fed child, or on milk production

    Adults

    70 mg/day IV; doses up to 150 mg/day IV have been recommended for cardiovascular infections.

    Geriatric

    70 mg/day IV; doses up to 150 mg/day IV have been recommended for cardiovascular infections.

    Adolescents

    70 mg/m2/day IV, not to exceed 70 mg IV.

    Children

    70 mg/m2/day IV, not to exceed 70 mg IV.

    Infants

    >= 3 months: 70 mg/m2/day IV, not to exceed 70 mg IV.
    < 3 months: Safety and efficacy have not been established; however, doses up to 25 mg/m2/day IV are used off-label.

    Neonates

    Safety and efficacy have not been established; however, doses up to 25 mg/m2/day IV are used off-label.

    Caspofungin acetate

    powder for injection

    • 50mg/vial
    • 70mg/vial