Echinocandin Antifungal Pregnancy: Should not be used during pregnancy unless clearly necessary; animal studies have shown developmental toxicity and caspofungin crosses the placental barrier in animals. Women receiving caspofungin should not breast-feed.

Caspofungin

Brand names: Cancidas

Caspofungin is an intravenous echinocandin antifungal used for invasive candidiasis, invasive aspergillosis refractory to or intolerant of other therapy, and empirical treatment of presumed fungal infection in febrile neutropenia.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: A single 70 mg loading dose on Day 1, followed by 50 mg daily thereafter

Route: Intravenous infusion (over approximately 1 hour)

Frequency: Once daily

Max: In patients weighing more than 80 kg, after the initial 70 mg loading dose, caspofungin 70 mg daily is recommended

Should be initiated by a physician experienced in the management of invasive fungal infections. No dosage adjustment based on gender or race. Elderly (65 years or more): no systematic dosage adjustment required. When co-administering with certain inducers of metabolic enzymes, an increase in the daily dose to 70 mg following the 70 mg loading dose should be considered. Give as a single daily infusion; do not use diluents containing dextrose.

Paediatric dose

Route: Intravenous infusion (over approximately 1 hour)

Frequency: Once daily

Max: Loading dose not to exceed an actual dose of 70 mg; daily dose not to exceed an actual dose of 70 mg

Paediatric patients 12 months to 17 years: dosing based on body surface area (Mosteller formula), NOT per kg. A single 70 mg/m2 loading dose (max actual 70 mg) on Day 1, followed by 50 mg/m2 daily (max actual 70 mg daily). If the 50 mg/m2 daily dose is well tolerated but response inadequate, may increase to 70 mg/m2 daily (max actual 70 mg). Safety/efficacy not sufficiently studied in neonates and infants below 12 months; caution advised. Limited data suggest 25 mg/m2 daily in neonates/infants under 3 months and 50 mg/m2 daily in young children 3 to 11 months can be considered.

Dose adjustments

Renal

No dosage adjustment is necessary based on renal impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Phlebitis (common local injection-site reaction)
Headache (common)
Hypokalaemia (common)
Haemoglobin decreased / haematocrit decreased / white blood cell count decreased (common)
Pyrexia and diarrhoea (most common per US labelling, incidence 10% or greater)

Interactions

Ciclosporin — increases the AUC of caspofungin; transient increases in ALT/AST reported; close monitoring of liver enzymes should be considered when used concomitantly
Tacrolimus — standard monitoring of tacrolimus trough concentrations and appropriate dosage adjustments recommended
Rifampicin — potent CYP3A4 inducer; adults on rifampin should receive 70 mg caspofungin daily
Other inducers of hepatic CYP enzymes (e.g. efavirenz, nevirapine, phenytoin, carbamazepine, dexamethasone) — consider increasing the daily dose to 70 mg

Clinical monograph

How it works

It inhibits synthesis of beta-(1,3)-D-glucan, an essential component of the fungal cell wall, leading to osmotic instability and fungal cell death.

Prescribing in practice

The maintenance dose should be increased when co-administered with certain enzyme inducers such as rifampicin, as these lower caspofungin exposure (consult the SPC).
Dose adjustment is required in moderate hepatic impairment, and transaminase elevations can occur during treatment.
It has limited or no activity against Cryptococcus and some moulds, so it is not suitable for those infections.

Monitoring

Monitor liver function tests during treatment and observe for infusion-related and hypersensitivity reactions.

Counselling the patient

This antifungal is given by a drip into a vein, usually once daily.
Tell the team about any flushing, rash or itching during the infusion.
Report yellowing of the skin or eyes or dark urine, which can indicate liver effects.

Evidence & guidelines

Caspofungin was shown to be effective and well tolerated in invasive candidiasis in a pivotal comparative randomised trial.

Reference: IDSA Candida Guidelines 2016; ESCMID Candida Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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