Caspofungin

Background

• Echinocandin antifungal

Mechanism of Action

• Like all echinocandins, inhibits β-D-glucan synthase

Spectrum of Activity

• Active against Candida, Aspergillus

Pharmacokinetics and Pharmacodynamics

• Only 2% excreted unchanged in the kidney

Dosing

• Caspofungin 70 mg IV over 1 hour followed by 50 mg IV daily
• May be increased to 70 mg daily with cytochrome P450 3A4 inducers such as rifampin, nevirapine, efavirenz, carbamazepine, dexamethasone, and phenytoin

Pediatric Dosing

• Casponfungin 70 mg/m² IV followed by 50 mg/m² IV daily

Hepatic Dosing

• Reduce to 70 mg IV load followed by 35 mg IV daily in cases of moderate or severe hepatic impairment (Child-Pugh class B or C)

Renal Dosing

• No specific recommendations

Obesity Dosing

• 70 mg IV q24h

Safety

Adverse Drug Events

• Generally very safe with few adverse effects
• Most common adverse effects are infusion reaction with rash, pruritus, warmth
• Sometimes fevers, chills, nausea, vomiting, rash, abdominal pain, headache, and diarrhea
• Occasional modest liver enzyme elevations
• Reversible thrombocytopenia

Monitoring

• Consider liver enzymes
• No specific recommendations