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Caspofungin

Generic Medicine Info
Indications and Dosage
Intravenous
Invasive candidiasis
Adult: 70 mg as loading dose on Day 1, followed by 50 mg once daily thereafter. In patients weighing >80 kg: 70 mg once daily. All doses are given via slow IV infusion over approx 1 hour. Treatment duration is based on clinical and microbiological response. Antifungal therapy should generally continue for at least 14 days after the last positive culture. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Child: 3 months to 17 years 70 mg/m2 as loading dose on Day 1, followed by 50 mg/m2 once daily thereafter. Dose may be increased to 70 mg/m2 once daily if the lower dose is tolerated, but clinical response is inadequate. Max: 70 mg daily. All doses are given via slow IV infusion over approx 1 hour. Treatment duration is based on clinical and microbiological response. Antifungal therapy should generally continue for at least 14 days after the last positive culture. Treatment recommendations or approved starting age of use may vary among countries (refer to specific product guidelines).

Intravenous
Empiric therapy for febrile neutropenic patients
Adult: For empiric treatment of presumed fungal infections: 70 mg as loading dose on Day 1, followed by 50 mg once daily thereafter. In patients weighing >80 kg: 70 mg once daily. All doses are given via slow IV infusion over approx 1 hour. Treatment duration is based on patient's clinical response. Continue empirical therapy until resolution of neutropenia. For patients found to have a fungal infection, treatment should be for at least 14 days and should continue for at least 7 days after neutropenia and clinical symptoms are resolved. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Child: 3 months to 17 years For empiric treatment of presumed fungal infections: 70 mg/m2 as loading dose on Day 1, followed by 50 mg/m2 once daily thereafter. Dose may be increased to 70 mg/m2 once daily if the lower dose is tolerated, but clinical response is inadequate. Max: 70 mg daily. All doses are given via slow IV infusion over approx 1 hour. Treatment duration is based on patient's clinical response. Continue empirical therapy until resolution of neutropenia. For patients found to have a fungal infection, treatment should be for at least 14 days and should continue for at least 7 days after neutropenia and clinical symptoms are resolved. Treatment recommendations or approved starting age of use may vary among countries (refer to specific product guidelines).

Intravenous
Invasive aspergillosis
Adult: In patients who are refractory to or intolerant of other therapies (e.g. amphotericin B, lipid formulations of amphotericin B, itraconazole): 70 mg as loading dose on Day 1, followed by 50 mg once daily thereafter. In patients weighing >80 kg: 70 mg once daily. All doses are given via slow IV infusion over approx 1 hour. Treatment duration is based on the severity of patient's underlying disease, clinical response, and recovery from immunosuppression. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Child: 3 months to 17 years In patients who are refractory to or intolerant of other therapies (e.g. amphotericin B, lipid formulations of amphotericin B, itraconazole): 70 mg/m2 as loading dose on Day 1, followed by 50 mg/m2 once daily thereafter. Dose may be increased to 70 mg/m2 once daily if the lower dose is tolerated, but clinical response is inadequate. Max: 70 mg daily. All doses are given via slow IV infusion over approx 1 hour. Treatment duration is based on the severity of patient's underlying disease, clinical response, and recovery from immunosuppression. Treatment recommendations or approved starting age of use may vary among countries (refer to specific product guidelines).

Intravenous
Oesophageal candidiasis
Adult: 50 mg once daily via slow IV infusion over approx 1 hour, continued for 7-14 days after resolution of symptoms. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Child: 3 months to 17 years 70 mg/m2 as loading dose on Day 1, followed by 50 mg/m2 once daily thereafter. Dose may be increased to 70 mg/m2 once daily if the lower dose is tolerated, but clinical response is inadequate. Max: 70 mg daily. All doses are given via slow IV infusion over approx 1 hour. Continue treatment for 7-14 days after resolution of symptoms. Treatment recommendations or approved starting age of use may vary among countries (refer to specific product guidelines).
Special Patient Group
Patients taking CYP enzyme inducers (e.g. rifampicin, efavirenz, nevirapine, phenytoin, dexamethasone, carbamazepine):
Adult: 70 mg once daily via slow IV infusion over approx 1 hour.
Child: 70 mg/m2 once daily via slow IV infusion over approx 1 hour. Max: 70 mg daily.
Hepatic Impairment
Moderate (Child-Pugh score 7-9): 70 mg as loading dose on Day 1, followed by 35 mg once daily thereafter. Treatment recommendations may vary among countries and between individual products (refer to specific product guidelines).
Reconstitution
Powder for solution for infusion: Reconstitute vial labelled as containing 50 mg and 70 mg caspofungin with 10.5 mL sterile water for inj, NaCl 0.9%, bacteriostatic water for inj with methylparaben and propylparaben, or bacteriostatic water for inj with benzyl alcohol 0.9% to provide a concentration of 5.2 mg/mL and 7.2 mg/mL, respectively. Gently mix until a clear solution is obtained. Further dilute the appropriate volume of the reconstituted solution with 250 mL of NaCl 0.9%, 0.45%, or 0.225%, or lactated Ringer's solution. Alternatively, the volume of reconstituted solution may be added to a reduced volume of the diluents to a final concentration not exceeding 0.5 mg/mL. Instructions on reconstitution may vary among countries or between individual products. Refer to specific product guidelines.
Incompatibility
Incompatible with diluents containing glucose.
Contraindications
Hypersensitivity.
Special Precautions
Patient with history of allergic skin reactions. Patient taking CYP enzyme inducers. Moderate hepatic impairment. Neonates and children. Pregnancy and lactation.
Adverse Reactions
Significant: Increased hepatic transaminases; anaphylaxis, histamine-mediated reactions (e.g. rash, facial swelling, bronchospasm), and other hypersensitivity reactions. Rarely, hepatic dysfunction (e.g. hepatitis, hepatic failure).
Cardiac disorders: Tachycardia.
Gastrointestinal disorders: Nausea, diarrhoea, vomiting.
General disorders and administration site conditions: Pyrexia, chills, infusion site reaction (e.g. pruritus, pain, swelling).
Investigations: Decreased blood albumin, Hb, haematocrit, and WBC count; increased serum alkaline phosphatase, bilirubin, and glucose; increased or decreased phosphorus (particularly in children).
Metabolism and nutrition disorders: Hypokalaemia, hypomagnesaemia.
Musculoskeletal and connective tissue disorders: Arthralgia.
Nervous system disorders: Headache.
Respiratory, thoracic and mediastinal disorders: Dyspnoea.
Skin and subcutaneous tissue disorders: Pruritus, erythema, hyperhidrosis.
Vascular disorders: Phlebitis, flushing, hypotension.
Potentially Fatal: Stevens-Johnson syndrome, toxic epidermal necrolysis.
Monitoring Parameters
Monitor LFT during therapy. Assess for signs and symptoms of anaphylaxis, rash, and histamine-related reactions.
Drug Interactions
Decreased serum concentration with rifampicin or other CYP enzyme inducers (e.g. efavirenz, nevirapine, phenytoin, dexamethasone, carbamazepine). Concomitant use with ciclosporin may result in increased serum concentration of caspofungin and transient increases in hepatic enzymes. May reduce the blood concentration of tacrolimus.
Action
Description:
Overview: Caspofungin is an echinocandin antifungal with activity against Aspergillus and Candida species.
Mechanism of Action: Caspofungin inhibits the synthesis of β(1,3)-D-glucan, an essential component of the cell wall of many fungi.
Pharmacodynamics: Resistance of Candida to caspofungin has been associated with specific mutations in FKS1 and/or FKS2 genes, which have been associated with poor clinical outcomes. The increase in the chitin content of fungal cell walls has also been associated with reduced susceptibility of Candida species to caspofungin, although the clinical significance of this phenomenon is not fully known. The incidence of caspofungin resistance in Candida may differ by species or region. In Aspergillus species, the mechanism of resistance has not been established. Reports of drug resistance in various clinical isolates of Candida and Aspergillus species are rare.
Pharmacokinetics:
Distribution: Distributed in the gastrointestinal tract, lung, liver, and spleen. Plasma protein binding: Approx 97% to albumin.
Metabolism: Slowly metabolised via hydrolysis and N-acetylation; also undergoes spontaneous degradation with subsequent metabolism to component amino acids.
Excretion: Via urine (41%; mainly as metabolites, approx 1% as unchanged drug); faeces (35%; mainly as metabolites). Elimination half-life: 9-11 hours (β-phase); 40-50 hours (γ-phase).
Chemical Structure

Chemical Structure Image
Caspofungin

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 16119814, Caspofungin. https://pubchem.ncbi.nlm.nih.gov/compound/Caspofungin. Accessed Feb. 24, 2026.

Storage
Intact vial: Store between 2-8°C. Reconstituted solution: May store at ≤25°C for up to 24 hours. Diluted infusion solution: May store at ≤25°C for up to 24 hours or between 2-8°C for up to 48 hours.
MIMS Class
Antifungals
ATC Classification
J02AX04 - caspofungin ; Belongs to the class of other systemic antimycotics.
References
Hope WW, Castagnola E, Groll AH et al. ESCMID* Guideline for the Diagnosis and Management of Candida Diseases 2012: Prevention and Management of Invasive Infections in Neonates and Children Caused by Candida spp. Clin Microbiol Infect. 2012 Dec;18(Suppl. 7):38-52. doi: 10.1111/1469-0691.12040. Accessed 17/12/2025. PMID: 23137136

Alchemy Health Limited. Caspofungin 50 mg and 70 mg Powder for Concentrate for Infusion data sheet 24 March 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 07/08/2025.

Brayfield A, Cadart C (eds). Caspofungin Acetate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/08/2025.

Cancidas for Injection (Merck Sharp & Dohme [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 07/08/2025.

Cancidas Injection, Powder, Lyophilized, for Solution (Merck Sharp & Dohme LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 17/12/2025.

Caspofungin 50 mg Powder for Concentrate for Solution for Infusion (Flynn Pharma Ltd). MHRA. https://products.mhra.gov.uk. Accessed 07/08/2025.

Caspofungin 70 mg Powder for Concentrate for Solution for Infusion (Tillomed Laboratories Limited). MHRA. https://products.mhra.gov.uk. Accessed 17/12/2025.

Caspofungin Acetate. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/08/2025.

Caspofungin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 17/12/2025.

Caspofungin. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 17/12/2025.

Caspofungin. UpToDate Lexidrug, Pediatric and Neonatal Lexi-Drugs Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 17/12/2025.

Joint Formulary Committee. Caspofungin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/08/2025.

Paediatric Formulary Committee. Caspofungin. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 07/08/2025.

Disclaimer: This information is independently developed by MIMS based on Caspofungin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2026 MIMS. All rights reserved. Powered by MIMS.com
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