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
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
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.)
Therapy of suspected and confirmed invasive fungal infections, particularly Candidiasis and Aspergillosis
Infusion-related reactions (rash, pruritis)
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