Dosing & Uses
Dosage Forms & Strengths
powder for injection
- 50mg/vial
- 70mg/vial
Candida Infections
Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections
Day 1 loading dose: 70 mg IV infused over 1 hr (as a single dose)
Maintenance: 50 mg IV qDay infused over 1 hr
Continue antifungal therapy for at least 14 days after last positive culture; patients who remain persistently neutropenic may warrant longer course of therapy pending resolution of neutropenia
Esophageal Candidiasis
Indicated for treatment of esophageal candidiasis
50 mg IV qDay infused over 1 hr, continue for 7-14 days after symptom resolution
Loading dose not necessary, has not been studied with this indication
May consider suppressive oral therapy in patients with HIV infection because of the risk of oropharyngeal candidiasis relapse
Invasive Aspergillosis
Indicated for invasive aspergillosis in patients refractory to or intolerant of other therapies (eg, amphotericin B, itraconazole)
Day 1 loading dose: 70 mg IV infused over 1 hr (as a single dose)
Maintenance: 50 mg IV qDay infused over 1 hr
Duration of treatment should be based upon the severity of the underlying disease, recovery from immunosuppression, and clinical response.
Febrile Neutropenia
Empirical therapy for presumed fungal infections in febrile, neutropenic patients
Day 1 loading dose: 70 mg IV infused over 1 hr
Maintenance: 50 mg IV qDay infused over 1 hour; if well tolerated but not achieving adequate response, may increase to 70 mg IV qDay
Duration of treatment should be based on clinical response; continue empirical therapy until resolution of neutropenia
If fungal infection is confirmed, continue therapy for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved
Candida auris (Off-label)
Based on the limited data, an echinocandin drug (eg, anidulafungin, caspofungin, micafungin) is recommended by the CDC as initial therapy for treatment of C auris infections
Day 1 loading dose: 70 mg/m² IV
Day 2 and thereafter: 50 mg/m² IV qDay
Dosage Modifications
Coadministration with strong CYP inducers (rifampin): 70 mg IV qDay
Coadministration with other drug clearance inducers: Consider increasing to 70 mg IV qDay
Hepatic impairment
- Mild (Child-Pugh 5-6): No dosage adjustment necessary
- Moderate (Child-Pugh 7-9): Load 70 mg IV, then 35 mg IV qDay
- Severe (Child-Pugh >9): Safety and efficacy not established
Dosage Forms & Strengths
powder for injection
- 50mg/vial
- 70mg/vial
Candida Infections
Includes candidemia and other Candida infections including intra-abdominal abscesses, peritonitis, and pleural space infections
Dosing based on patient’s body surface area
<3 months: Safety and efficacy not established; limited data suggest off-label dose of 25 mg/m²/dose IV once daily
≥3 months
- Day 1 loading dose: 70 mg/m² IV infused over 1 hr
- Maintenance: 50 mg/m² IV qDay infused over 1 hr
- If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay
- Not to exceed 70 mg qDay
- Continue antifungal therapy for at least 14 days after last positive culture; patients who remain persistently neutropenic may warrant longer course of therapy pending resolution of neutropenia
Esophageal Candidiasis
Dosing based on patient’s body surface area
<3 months: Safety and efficacy not established
≥3 months
- Day 1 loading dose: 70 mg/m² IV infused over 1 hr
- Maintenance: 50 mg/m² IV qDay infused over 1 hr
- If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay
- Not to exceed 70 mg qDay
- Continue antifungal therapy for 7-14 days after symptoms resolution
Invasive Aspergillosis
Dosing based on patient’s body surface area
<3 months: Safety and efficacy not established
≥3 months
- Day 1 loading dose: 70 mg/m² IV infused over 1 hr
- Maintenance: 50 mg/m² IV qDay infused over 1 hr
- If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay
- Not to exceed 70 mg qDay
- Duration of treatment should be based upon the severity of the underlying disease, recovery from immunosuppression, and clinical response
Febrile Neutropenia
Empirical therapy for presumed fungal infections in febrile, neutropenic patients
Dosing based on patient’s body surface area
<3 months: safety and efficacy not established
≥3 months
- Day 1 loading dose: 70 mg/m² IV infused over 1 hr
- Maintenance: 50 mg/m² IV qDay infused over 1 hr
- If well tolerated but not achieving adequate response, may increase to 70 mg/m² IV qDay
- Not to exceed 70 mg qDay
Duration of treatment should be based on clinical response; continue empirical therapy until resolution of neutropenia
If fungal infection is confirmed, continue therapy for a minimum of 14 days; treatment should continue for at least 7 days after both neutropenia and clinical symptoms are resolved
Candida auris (Off-label)
Neonates and infants <2 months
- In exceptional circumstances, where CNS involvement has been definitively ruled out, may consider use of caspofungin or micafungin with caution; the CDC recommends amphotericin B deoxycholate as initial treatment of choice
- 25 mg/m²/day IV
≥2 months
- Based on the limited data, an echinocandin drug (eg, anidulafungin, caspofungin, micafungin) is recommended by the CDC as initial therapy for treatment of C auris infections in adults and children aged ≥2 months
- Day 1 loading dose: 70 mg/m² IV
- Day 2 and thereafter: 50 mg/m² IV qDay
Dosage Modifications
Coadministration with CYP inducers (eg rifampin): Consider 70 mg/m² IV qDay, not to exceed 70 mg qDay
Hepatic impairment: Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (5)
- cyclosporine
cyclosporine will increase the level or effect of caspofungin by Other (see comment). Avoid or Use Alternate Drug. may increase plasma concentrations of OATP substrates
- eluxadoline
caspofungin increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .
- leniolisib
leniolisib will increase the level or effect of caspofungin by Other (see comment). Avoid or Use Alternate Drug. Leniolisib, an OATP1B1 and OATP1B3 inhibitor, may increase systemic exposure of these substrates
- Saccharomyces boulardii
caspofungin decreases effects of Saccharomyces boulardii by unspecified interaction mechanism. Avoid or Use Alternate Drug. Systemic or oral antifungals may decrease activity of probiotic.
- trofinetide
trofinetide will increase the level or effect of caspofungin by Other (see comment). Avoid or Use Alternate Drug. Trofinetide (an OATP131 and OATP13B inhibitor) may increase plasma levels of OATP131 or OATP13B substrates. Avoid coadministration with sensitive substrates.
Monitor Closely (20)
- apalutamide
apalutamide will decrease the level or effect of caspofungin by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces OATP1B1 and may decrease systemic exposure of drugs that are OATP1B1 substrates.
- atorvastatin
caspofungin increases toxicity of atorvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.
- carbamazepine
carbamazepine decreases levels of caspofungin by increasing metabolism. Use Caution/Monitor.
- deflazacort
caspofungin and deflazacort both decrease serum potassium. Use Caution/Monitor.
- dichlorphenamide
dichlorphenamide and caspofungin both decrease serum potassium. Use Caution/Monitor.
- encorafenib
encorafenib will increase the level or effect of caspofungin by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a OATP1B1 inhibitor) may increase the concentration and toxicities of OATP1B1 substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.
- fluvastatin
caspofungin increases toxicity of fluvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.
- fostemsavir
fostemsavir will increase the level or effect of caspofungin by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.
- glecaprevir/pibrentasvir
caspofungin will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. Use Caution/Monitor. Caution when coadministering glecaprevir/pibrentasvir with OATP1B1/OATP1B3 inhibitors
- letermovir
caspofungin increases levels of letermovir by decreasing metabolism. Use Caution/Monitor. Coadminstration of letermovir, an OATP1B1/3 substrate, with OATP1B1/3 inhibitors may increase letermovir plasma concentrations.
letermovir increases levels of caspofungin by Other (see comment). Use Caution/Monitor. Comment: Letermovir, an OATP1B1/3 inhibitor may increase plasma concentrations of coadministered OATP1B1/3 substrates. - pitavastatin
caspofungin increases toxicity of pitavastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.
- pravastatin
caspofungin increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.
- rifampin
rifampin decreases levels of caspofungin by increasing metabolism. Use Caution/Monitor.
- rosuvastatin
caspofungin increases toxicity of rosuvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.
- sacubitril/valsartan
caspofungin will increase the level or effect of sacubitril/valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure
- simvastatin
caspofungin will increase the level or effect of simvastatin by Other (see comment). Use Caution/Monitor. OATP1B1 inhibitors may increase risk of myopathy
- sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol
caspofungin and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.
- sofosbuvir/velpatasvir
sofosbuvir/velpatasvir increases levels of caspofungin by Other (see comment). Use Caution/Monitor. Comment: Velpatasvir inhibits OATP1B1, OATP1B3, and OATP2B1 transporters. .
- valsartan
caspofungin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure
- voclosporin
voclosporin, caspofungin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
Minor (9)
- dexamethasone
dexamethasone decreases levels of caspofungin by increasing metabolism. Minor/Significance Unknown.
- efavirenz
efavirenz decreases levels of caspofungin by increasing metabolism. Minor/Significance Unknown.
- ethotoin
ethotoin decreases levels of caspofungin by increasing metabolism. Minor/Significance Unknown.
- fosphenytoin
fosphenytoin decreases levels of caspofungin by increasing metabolism. Minor/Significance Unknown.
- nelfinavir
nelfinavir decreases levels of caspofungin by increasing metabolism. Minor/Significance Unknown.
- nevirapine
nevirapine decreases levels of caspofungin by increasing metabolism. Minor/Significance Unknown.
- phenytoin
phenytoin decreases levels of caspofungin by increasing metabolism. Minor/Significance Unknown.
- tacrolimus
caspofungin decreases levels of tacrolimus by unspecified interaction mechanism. Minor/Significance Unknown.
- voclosporin
voclosporin will increase the level or effect of caspofungin by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.
Adverse Effects
Varies with condition
Anaphylaxis reported during administration of Cancidas
>10%
Infused vein complications/ phlebitis (20-35%)
Fever (6-30%)
Diarrhea (6-27%)
Shivering (9-23%)
Rash (4-23%)
Increased serum alkaline phosphatase (9-22%)
Hypotension (3-20%)
Respiratory failure (2-20%)
Incr transaminases (2-18%)
Septic shock (11% to 14% )
1-10% (selected)
Pleural effusion (9%)
Respiratory distress (up to 8%)
Abdominal pain
Nausea
Vomiting
Anemia
Decreased Hgb
Neutropenia
Chills
Hypokalemia
Dizziness
Erythema
Facial edema, flushing
Hematuria
Hyperbilirubinemia
Increased serum creatinine
Induration
Myalgia
Pain
Paresthesia
Pruritus
Sepsis
Tachycardia
<1%
Erythema multiforme
Stevens-Johnson syndrome
Pancreatitis
Hepatic necrosis
Liver failure
Anaphylaxis
Nephrotoxicity
Renal impairment
Postmarketing Reports
Blood and lymphatic system disorders: Anemia, coagulopathy, febrile neutropenia, neutropenia, thrombocytopenia
Cardiac disorders: Arrhythmia, atrial fibrillation, bradycardia, cardiac arrest, myocardial infarction, tachycardia
Gastrointestinal disorders: Abdominal distension, abdominal pain upper, constipation, dyspepsia
General disorders and administration site conditions: Asthenia, fatigue, infusion site pain/pruritus/swelling, mucosal inflammation, peripheral edema
Hepatobiliary disorders: Hepatic failure, hepatomegaly, hepatotoxicity, hyperbilirubinemia, jaundice
Infections and infestations: Bacteremia, sepsis, urinary tract infection Metabolic and nutrition disorders: Anorexia, decreased appetite, fluid overload, hypomagnesemia, hypercalcemia, hyperglycemia, hypokalemia
Musculoskeletal, connective tissue, and bone disorders: Arthralgia, back pain, pain in extremity
Nervous system disorders: Convulsion, dizziness, somnolence, tremor
Psychiatric disorders: Anxiety, confusional state, depression, insomnia
Renal and urinary disorders: Hematuria, renal failure
Respiratory, thoracic, and mediastinal disorders: Dyspnea, epistaxis, hypoxia, tachypnea
Skin and subcutaneous tissue disorders: Erythema, petechiae, skin lesion, skin exfoliation, urticaria; toxic epidermal necrolysis
Vascular disorders: Flushing, hypertension, phlebitis
Warnings
Contraindications
Hypersensitivity to drug or components
Cautions
Do not use dextrose diluents
Do not use with cyclosporine (unless benefits outweigh risks)
Not for bolus administration
Cyclosporine may increase AUC of caspofungin by approximately 35%
Anaphylaxis reported, discontinue and administer appropriate treatment; possible histamine-mediated adverse reactions, including rash, facial swelling, angioedema, pruritus, sensation of warmth or bronchospasm
Cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), some with a fatal outcome, reported; discontinue use at first sign or symptom of a hypersensitivity reaction and administer appropriate treatment
Some adult and pediatric patients with serious underlying conditions receiving multiple concomitant medications with this drug, isolated cases of clinically significant hepatic dysfunction, hepatitis, and hepatic failure reported; a causal relationship has not been established; monitor patients who develop abnormal liver function tests during therapy for evidence of worsening hepatic function and evaluated for risk/benefit of continuing therapy
Drug interactions overview
- Elevated liver enzymes reported in patients receiving this medication and cyclosporine concomitantly; only use concomitantly with cyclosporine in patients for whom potential benefit outweighs potential risk; patients who develop abnormal liver enzymes during concomitant therapy, should be monitored, and risk/benefit of continuing therapy evaluated
Pregnancy & Lactation
Pregnancy
There are insufficient human data to establish whether there is a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes in pregnant women
Animal data
- In animal studies, drug caused embryofetal toxicity, including increased resorptions, increased peri-implantation loss, and incomplete ossification at multiple fetal sites when administered intravenously to pregnant rats and rabbits during organogenesis at doses up to 0.8 and 2 times the clinical dose, respectively; advise patients of potential risk to fetus; estimated background risk of major birth defects and miscarriage for indicated population is unknown; all pregnancies have a background risk of birth defect, loss, or other adverse outcomes
Lactation
There are no data on presence of drug in human milk, effects on breast-fed child, or on milk production
Drug was found in milk of lactating, drug-treated rats; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from drug or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Echinocandin; inhibits fungal cell wall synthesis
Distribution
Protein Bound: 97% to albumin
Metabolism
Slowly, via hydrolysis and N-acetylation as well as by spontaneous degradation with subsequent metabolism to component amino acids
Elimination
Half-life: 9-11 hr (beta phase); 40-50 hr (gamma phase)
Excretion: 41% urine; 35% feces
Administration
IV Incompatibilities
Do not mix with dextrose-containing solutions or coadminister with other medications
IV Preparation
Reconstitute vial (70 mg for loading dose or 50 mg for daily dose) with 10.5 mL NS, SWI or BWI-may be stored for up to 1 hr at 25°C (or less)
Mix gently to obtain clear soln-discard if particulate or discolored
Transfer 10 mL of reconstituted solution to 250 mL NS, 1/2NS 1/4NS or LR
Use infusion soln within 24 hr if stored at room temp or within 48 hr if refrigerated at 2-8°C
If 70 mg vials are not available for preparation of the loading dose, reconstitute two 50 mg vials & transfer 14 mL to 250 mL NS, 1/2NS, 1/4NS or LR
For 35 mg, reconstitute a 50 mg vial w/ 10 mL & transfer 7 mL to 250 mL (or 100 mL if medically necessary) infusion soln
IV Administration
Infuse IV slowly over 1 hr
Storage
Store vials at 2-8°C (36-46°F)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| caspofungin intravenous - | 70 mg vial |  | |
| caspofungin intravenous - | 50 mg vial |  | |
| caspofungin intravenous - | 70 mg vial |  | |
| caspofungin intravenous - | 70 mg vial |  | |
| caspofungin intravenous - | 50 mg vial |  | |
| caspofungin intravenous - | 70 mg vial |  | |
| Cancidas intravenous - | 50 mg vial |  | |
| Cancidas intravenous - | 70 mg vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
caspofungin intravenous
CASPOFUNGIN - INJECTION
(KAS-poe-FUN-jin)
COMMON BRAND NAME(S): Cancidas
USES: Caspofungin is used to treat a variety of fungal infections. Caspofungin belongs to a class of drugs known as echinocandins. It works by stopping the growth of fungi.
HOW TO USE: This medication is given by injection into a vein as directed by your doctor, usually once a day over 1 hour. The dosage and length of treatment are based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). In children, the dosage is also based on their body size.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid.Learn how to store and discard medical supplies safely.Infusion reactions may happen while you are receiving the drug. Tell your doctor right away if you have symptoms such as fever, chills, shortness of breath, flushing, or dizziness.Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition does not get better or if it gets worse.
SIDE EFFECTS: See also How to Use section.Swelling/redness/irritation at the injection site, nausea/vomiting, diarrhea, or headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: signs of liver disease (such as nausea/vomiting that doesn't stop, loss of appetite, dark urine, stomach/abdominal pain, yellowing eyes/skin), swelling ankles/feet/hands, fast/irregular heartbeat, muscle cramps.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using caspofungin, tell your doctor or pharmacist if you are allergic to it; or to other echinocandin antifungal drugs (such as anidulafungin, micafungin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Lab and/or medical tests (such as liver/kidney function, potassium blood levels) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised August 2021. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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Adding plans allows you to:
- View the formulary and any restrictions for each plan.
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