Caspofungin

Restricted
Restricted

C. diff Risk

Low

Oral Bioavailability

NA

Approximate Cost

$$$

Dosing

Adult

70 mg IV x 1, then 50 mg IV daily

Renal

No adjustment necessary

Hepatic

Adult, moderate (Child-Pugh score B-C)
70 mg IV x 1, then 35 mg IV daily

General Information

Acceptable Uses

Aspergillosis

  • Infusional toxicity or acute renal failure on ABLC and intolerance to voriconazole defined as serious hepatotoxicity, persistent visual disturbance, or allergic reaction.

  • Refractory disease for use in combination with voriconazole or ABLC for definite or probable invasive pulmonary aspergillosis in patients who are refractory to voriconazole or ABLC alone (ID consult advised

Candidiasis

  • Treatment of invasive candidiasis due to C. glabrata or C. krusei

  • Treatment of invasive candidiasis in patients who are NOT clinically stable due to candidemia or have received prior long-term azole therapy.

  • Alternative treatment of recurrent esophageal candidiasis

  • Alternative treatment of endocarditis

Neutropenic Fever

  • Caspofungin can be used for neutropenic fever in patients who are not suspected to have aspergillosis or zygomycosis

Unacceptable Uses

Aspergillosis

  • Caspofungin alone or in combination with other antifungal agents is not recommended for empiric therapy in patients with CT findings suggestive of aspergillosis (e.g., possible aspergillosis) without plans for diagnostic studies

  • Caspofungin does not have good in vitro activity against zygomycoses (Mucor, Rhizopus, Cunninghamella, etc.)

Candidiasis

  • Caspofungin has poor penetration into the CNS and urinary tract. It should be avoided for infections involving those sites. Positive urine cultures for resistant Candida in catheterized patients usually represent colonization and should not be treated with caspofungin.

  • Monotherapy for zygomycoses (Mucor, Rhizopus, etc.)

Common Usage

Therapy of suspected and confirmed invasive fungal infections, particularly Candidiasis and Aspergillosis

Drug Monitoring

Laboratory

  • Liver enzymes at baseline and every 1-2 weeks

Adverse Effects

  • Infusion-related reactions (rash, pruritis)

  • Phlebitis

  • Headache

  • Nausea and vomiting

  • Elevations in hepatic enzymes

Additional Information

Caspofungin has poor urinary penetration. It should not be used for treatment of Candida urinary tract infections, with select exceptions. Consult ID for advice.

Pharmacology

Antimicrobial class: Echinocandin

Pregnancy category: C

Average serum half life: 15 hours

Biliary penetration: Therapeutic

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Poor