Caspofungin - Non-formulary

C difficile risk
Oral Bioavailability


70mg IV once, then 50mg IV q24h
No adjustment needed for renal impairment

70 mg IV x 1, then 35 mg IV daily

No Recommendation

General Information

Primary Indication(s)

  • Empiric antifungal for severely ill patients with invasive Candida infection or patients at risk of fluconazole resistance (e.g. receiving fluconazole prophylaxis)

  • Empiric yeast therapy for febrile neutropenia

  • Fungal endocarditis


  • An option for invasive Aspergillosis infections, but amphotericin or voriconazole is usually preferred

  • Periodic Liver enzymes, renal function, CBC with differential

  • Elevations in hepatic enzymes

  • Infusion-related reactions (rash, pruritis)

  • Phlebitis

  • Headache

  • GI upset, diarrhea

  • Pruritis, fever (most common in pediatrics)

  • Cyclosporin and tacrolimus

  • In patients on concomitant use of prolonged dexamethasone or other enzyme inducers (phenytoin, rifampin), consider increase dose to 70mg daily (especially if not responding).

Caspofungin has poor vitreous, CNS and urinary penetration. It should not be used for treatment of Candida urinary tract infections

Antimicrobial class: Echinocandin

Biliary penetration: Therapeutic

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Poor