C. diff Risk


Oral Bioavailability


Approximate Cost




70 mg IV x 1, then 50 mg IV daily


No adjustment necessary


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

General Information

Acceptable Uses


  • 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


  • 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


  • 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.)


  • 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


  • 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.


Antimicrobial class: Echinocandin

Pregnancy category: C

Average serum half life: 15 hours

CSF penetration: Poor

Urine penetration: Poor

Lung penetration: Therapeutic

Biliary penetration: Therapeutic