Drug reference

Caspofungin

Echinocandin antifungal · Antifungal

Also known as Caspofungin acetate, Cancidas, Casporex

START

70 mg IV load day 1, then 50 mg IV once daily

TYPICAL MAX

70 mg/day

STOP IF

Serious hypersensitivity or significant hepatotoxicity

WATCH

LFTs, infusion reactions, response/cultures

CDSCO approvedSchedule HATC J02AX04

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1h · infusion
PEAK: 1h · end of infusion
t½: 10h · beta t½
DURATION: 1d · once-daily

EXCRETION

Hepatic hydrolysis; renal + faecal, low unchanged

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Use only if benefit outweighs risk — animal embryotoxicity; limited human data

FDA category + note

Top interactionssee all 12 →

CarbamazepineSevereDatabaseDDInter
CiclosporinSevereDatabaseKimi deep-research + Cla
DexamethasoneSevereDatabaseDDInter
EfavirenzSevereDatabaseDDInter

Available in India

51 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Non-competitive inhibition of 1,3-beta-D-glucan synthase, disrupting fungal cell-wall synthesis → osmotic lysis; fungicidal against Candida, fungistatic against Aspergillus. No human cell-wall target → favourable safety.

Indications

Invasive candidiasis / candidaemiaEmpirical therapy of febrile neutropeniaInvasive aspergillosis refractory/intolerant to other therapyOesophageal candidiasis

Dosing

Adult: 70 mg IV loading dose day 1, then 50 mg IV once daily; 70 mg/day maintenance if <80 kg inadequate response or with enzyme inducers.
Pediatric: 70 mg/m² loading then 50 mg/m² daily (max 70 mg).
Renal adjustment: No adjustment (not renally cleared).
Hepatic adjustment: Moderate hepatic impairment (Child-Pugh 7–9): 35 mg/day maintenance after standard 70 mg load. Severe: no data.
Geriatric: No specific adjustment.
Max dose: 70 mg/day

Pharmacokinetics

Onset

IV; antifungal effect over days

Peak effect

End of 1-h infusion

Duration

Once-daily

Half-life

Beta ~9–11 h (distribution-dominated PK)

Bioavailability

100% IV

Protein binding

~97% (albumin)

Metabolism

Slow hepatic hydrolysis/N-acetylation (non-CYP)

Excretion

Renal and faecal (low unchanged)

Contraindications

Hypersensitivity to caspofungin or echinocandins

Side effects

Common

Infusion-related (fever, phlebitis, histamine-like flushing)HeadacheNauseaRaised hepatic transaminases

Serious

Hepatotoxicity
Anaphylaxis/serious hypersensitivity
Severe skin reactions (rare)

Pregnancy & lactation

Pregnancy

Use only if benefit outweighs risk — animal embryotoxicity; limited human data

Lactation

Unknown excretion; caution

Drug interactions

Carbamazepine

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Ciclosporin

Severe

Database

Increased caspofungin AUC + raised transaminases

Use only if benefit outweighs risk; monitor LFTs

Source: Kimi deep-research + Cla

Dexamethasone

Severe

Database

Drug interaction classified as: metabolism.

Source: DDInter

Efavirenz

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Fosphenytoin

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Leflunomide

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Lomitapide

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Mipomersen

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Nelfinavir

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Nevirapine

Severe

Database

Drug interaction classified as: metabolism

Source: DDInter

Pexidartinib

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Phenytoin

Severe

Database

Drug interaction classified as: metabolism.

Source: DDInter

Related guidelines

Invasive candidiasis

IDSA · Infectious Diseases · 2016

Invasive aspergillosis

IDSA · Infectious Diseases · 2016

Gastro-oesophageal reflux disease

ISG · Gastroenterology · 2022

Empirical antimicrobial use in common syndromes

ICMR · Infectious Diseases · 2019

Community-acquired pneumonia

ICMR · Pulmonology · 2022

Other Echinocandin antifungal drugs

echinocandins

0 brands

Ask House about Caspofungin

Continue into a citation-backed clinical answer with the drug context already attached.

Open in workspace Ask House about this drug

Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19