Caspofungin acetate is a semi-synthetic, parenteral echinocandin antifungal agent. It is a potent inhibitor of β-(1,3)-D-glucan synthesis, an essential component of the fungal cell wall of many pathogenic fungi, including Candida and Aspergillus species. It is fungicidal against Candida and fungistatic against Aspergillus. In the Indian context, it is a critical second-line or salvage therapy for invasive fungal infections, particularly in immunocompromised patients, and is often used in tertiary care hospitals.
Adult: Loading dose: 70 mg IV on Day 1. Maintenance dose: 50 mg IV once daily thereafter. Infuse slowly over approximately 1 hour.
Note: 1. Reconstitute the 50 mg or 70 mg vial with 10.5 mL of 0.9% Sodium Chloride Injection, Sterile Water for Injection, or Bacteriostatic Water for Injection with methylparaben and propylparaben. 2. Gently mix to dissolve; the resulting solution will be clear and colorless. 3. Further dilute in 250 mL of 0.9% Sodium Chloride Injection, 0.45% Sodium Chloride Injection, or Lactated Ringer's Injection. 4. Administer by slow intravenous infusion over approximately 1 hour. Do not co-infuse with other medications. Store reconstituted solution at or below 25°C and use within 24 hours.
Caspofungin noncompetitively inhibits the enzyme β-(1,3)-D-glucan synthase complex. This enzyme is responsible for the synthesis of β-(1,3)-D-glucan, a critical polysaccharide component of the cell wall of many fungi. Inhibition leads to depletion of this essential structural polymer, resulting in osmotic instability, cell lysis, and death.
Pregnancy: Pregnancy Category C. Animal studies have shown fetal toxicity (skeletal anomalies). No adequate and well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus.
Driving: Caspofungin is unlikely to affect the ability to drive or use machines. However, patients experiencing side effects like dizziness or headache should exercise caution.
| Cyclosporine | Increases caspofungin AUC by ~35% and transient increases in ALT/AST. Mechanism unknown. | Moderate |
| Tacrolimus | Caspofungin may reduce tacrolimus AUC by ~20%; monitor tacrolimus levels. | Moderate |
| Rifampin | Decreases caspofungin trough concentrations by ~30%. Increase caspofungin maintenance dose to 70 mg daily. | Significant |
| Carbamazepine, Phenytoin, Dexamethasone | Other potent enzyme inducers may reduce caspofungin concentrations. Consider increasing caspofungin maintenance dose to 70 mg daily. | Moderate |
| Amphotericin B | No significant PK interaction. Combination therapy may be used clinically for certain infections. | None |