caspofungin
Brand: Cancidas
Prototype Drug
Drug Class: echinocandin antifungal
Drug Family: antifungal
Subclass: first-in-class echinocandin
Organ Systems: infectious-disease
Mechanism of Action
Inhibits 1,3-beta-D-glucan synthase, blocking synthesis of beta-glucan — a critical component of the fungal cell wall absent in mammalian cells; fungicidal against Candida, fungistatic against Aspergillus; mammalian selectivity explains excellent tolerability.
fungal 1,3-beta-D-glucan synthase
Indications
- invasive candidiasis/candidemia (first-line)
- esophageal candidiasis
- invasive aspergillosis (salvage therapy)
- empiric antifungal therapy in febrile neutropenia
Contraindications
- echinocandin hypersensitivity
Adverse Effects
Common
- fever
- nausea
- elevated liver enzymes
- phlebitis
Serious
- hepatotoxicity
- anaphylaxis (rare)
- histamine-mediated infusion reactions (facial flushing, rash)
Pharmacokinetics (ADME)
| Absorption | IV only (poor oral bioavailability) |
| Distribution | widely distributed; highly protein-bound |
| Metabolism | spontaneous chemical degradation and N-acetylation (not CYP-mediated primarily) |
| Excretion | fecal (41%) and urinary (35%) |
| Half-life | 9–11 hours |
| Onset | immediate (IV) |
| Peak | end of infusion |
| Duration | 24 hours |
| Protein Binding | 97% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| cyclosporine | increases caspofungin AUC ~35%; increased hepatotoxicity risk; use with caution and monitor LFTs | moderate |
| rifampin | induction increases caspofungin metabolism; increase maintenance dose to 70 mg daily | major |
| tacrolimus | caspofungin reduces tacrolimus trough levels ~20%; monitor TDM | moderate |
Nursing Considerations
- Administer IV over 1 hour; incompatible with dextrose-containing solutions — use only 0.9% NaCl or Ringer's lactate as diluent.
- Loading dose 70 mg on day 1, then 50 mg daily (increase to 70 mg if rifampin or other enzyme inducers are co-administered).
- Monitor LFTs weekly; hepatotoxicity is the primary concern with extended therapy.
- Echinocandins are generally well-tolerated with minimal drug interactions compared to azoles — a major advantage in polypharmacy patients.
Clinical Pearls
- Echinocandins target the fungal cell wall's beta-glucan synthase — a structure absent in mammalian cells — providing exceptional selective toxicity and a very favorable adverse effect profile.
- Caspofungin is fungicidal against Candida but only fungistatic against Aspergillus, partly explaining why azoles (which are fungicidal against Aspergillus) are preferred for invasive aspergillosis treatment.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.