Caspofungin

C difficile risk
Low
Oral Bioavailability
N/A
Cost
$$$

Spectrum Of Activity

Dosing

No adjustment necessary

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

Moderate impairment (Child-Pugh class B): 70 mg on day 1 (where recommended), followed by 35 mg once daily (manufacturer's labeling; Mistry 2007); however, pharmacokinetic data suggest that this dose reduction may result in suboptimal drug exposure (Gustot 2018)

Severe impairment (Child-Pugh class C): There are no dosage adjustments provided in the manufacturer's labeling. Subsequent pharmacokinetic data suggest that degree of impairment (Child-Pugh class B or C) does not further decrease clearance of caspofungin and patients with severe impairment can be dosed the same as patients with moderate impairment (Gustot 2018).

70 mg IV x 1, then 50 mg IV daily

General Information

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

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.)

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

Laboratory

  • Liver enzymes at baseline and every 1-2 weeks

  • Infusion-related reactions (rash, pruritis)

  • Phlebitis

  • Headache

  • Nausea and vomiting

  • Elevations in hepatic enzymes

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

Biliary penetration: Therapeutic

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Poor