Caspofungin
General Information
Echinocandin
Restricted formulary antimicrobial: For details see OUH netFormulary
Standard dose
| Caspofungin IV dose | |
| Body weight up to 80 kg |
Loading dose: 70mg iv od for 1 day Maintenance dose: 50mg iv od |
|
Body weight 80kg or more |
Loading dose: 70mg iv od for 1 day Maintenance dose: 70mg iv od |
| Patient also taking enzyme inducers* (Regardless of weight) |
Loading dose: 70mg iv od for 1 day Maintenance dose: 70mg iv od |
| Moderate hepatic impairment (Child-Pugh score 7 to 9) (Regardless of weight) |
Loading dose: 70mg iv od for 1 day Maintenance dose: 35 mg iv od |
*Phenytoin, carbamazepine, dexamethasone and rifampicin. This list is not exhaustive, check BNF and SPC for interactions.
Obesity
Discuss with Micro/ID or AMS pharmacy team.
Renal and hepatic impairment
Renal impairment
No dose adjustment necessary
Hepatic impairment
| Caspofungin dose | |
| Mild hepatic impairment (Child-Pugh score 5 to 6) | No dosage adjustment is needed |
| Moderate hepatic impairment (Child-Pugh score 7 to 9) |
Loading dose: 70mg iv od for 1 day Maintenance dose: 35 mg iv od |
| Severe hepatic impairment (Child-Pugh score greater than 9) | Avoid (no data available) |
Notable interactions
Before caspofungin is started see the Summary of Product Characteristics (SPC) for caspofungin for information about interactions, cautions and contraindications.
- When co-administering inducers of metabolic enzymes, an increase in the daily dose of caspofungin should be considered. See dosing section above.
- Ciclosporin can increase caspofungin levels. Monitor LFTs closely.
- Tacrolimus levels may be reduced by caspofungin. Monitor tacrolimus levels.
This is not a complete list. Please see the BNF, Summary of Product Characteristics or speak to a pharmacist.
Pregnancy and breastfeeding
Pregnancy
Discuss with Pharmacy. Avoid unless benefit to mother outweighs risk to foetus. Animal studies have shown developmental toxicity
Breastfeeding
Discuss with Pharmacy.
Additional information
The OUH Antifungal Patient Information Leaflet can be found HERE
References
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Flynn Pharma Ltd. Summary of product characteristics. Caspofungin 70mg powder for concentrate for solution for infusion. [online]. Last revision of the text: 6/1/23. Accessed via: https://www.medicines.org.uk/emc#gref Accessed: 23/3/25.
- Flynn Pharma Ltd. Summary of product characteristics. Caspofungin 50mg powder for concentrate for solution for infusion. [online]. Last revision of the text: 6/1/23. Accessed via: https://www.medicines.org.uk/emc#gref Accessed: 23/3/25.
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The Renal Drug Database. Caspofungin. Last revision of the text: 24/9/24. Accessed via renaldrugdatabase.com Accessed: 23/3/25.
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Sanford Guide. Caspofungin [Internet] Last revision of the text: 3/2/25
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Sanford Guide. Obesity dosing adjustment [Internet] Last revision of the text: 23/2/25
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British National Formulary. Caspofungin. Available via https://bnf.nice.org.uk/drug/caspofungin.html Accessed: 23/3/25.