Echinocandin Antifungal
Pregnancy: Avoid — limited data; potential teratogenicity in animal studies
Caspofungin
Brand names: Cancidas
Adult dose
Dose: Loading: 70 mg IV on day 1. Maintenance: 50 mg IV OD. Invasive candidiasis or severe disease: 70 mg OD may be continued.
Route: IV infusion (over 1 hour)
Frequency: Once daily
Max: 70 mg/day
For invasive candidiasis, Candida oesophagitis, invasive aspergillosis (salvage after azole failure). Excellent safety profile vs azoles. Not active against Cryptococcus or Fusarium.
Paediatric dose
Route: IV
Frequency: Once daily
Max: 70 mg/day
Concentration: 10 mg/m²/ml
BNF for Children: BSA-based dosing — ≥3 months: loading 70 mg/m² IV day 1, then 50 mg/m²/day OD (max 70 mg/day). Weight-based calculator does not apply — requires BSA calculation. Mix in NaCl 0.9% or Hartmann's only (precipitates in dextrose). Source: BNF for Children 2024; IDSA Candidiasis Guidelines
Dose adjustments
Renal
No dose adjustment required (not renally cleared)
Hepatic
Reduce maintenance to 35 mg OD in moderate hepatic impairment (Child-Pugh 7–9). No data in severe impairment.
Clinical pearls
- Echinocandins: active against Candida and Aspergillus (not Cryptococcus) — mechanism is inhibition of cell wall glucan synthesis
- IDSA Candida guidelines: echinocandin first-line for candidaemia and invasive candidiasis in most patients
- Excellent safety profile — minimal drug interactions vs azoles; preferred in liver failure patients
- Reconstitute with water; dilute in NaCl or LR — NOT 5% dextrose (precipitation)
Contraindications
- Hypersensitivity to echinocandins
Side effects
- Fever
- Phlebitis at infusion site
- Nausea
- Elevated LFTs
- Hypokalemia
- Histamine-like reaction (flushing, facial swelling — rare)
- Rash
Interactions
- Ciclosporin — increased caspofungin exposure (elevated LFTs — monitor)
- Rifampicin/tacrolimus — consider increasing caspofungin to 70 mg/day (enzyme inducers reduce levels)
Monitoring
- LFTs (especially with ciclosporin)
- Serum potassium
- Signs of treatment response (cultures, imaging)
- Infusion site
Reference: BNFc; BNF; IDSA Candida Guidelines 2016; ESCMID Candida Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways