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, which is absent in mammalian cells. It is indicated for the treatment of invasive candidiasis, empirical therapy for presumed fungal infections in febrile neutropenic patients, and invasive aspergillosis in patients refractory to or intolerant of other therapies. In the Indian context, it is a critical second-line or salvage therapy for severe systemic fungal infections, particularly in immunocompromised patients in tertiary care settings.
Adult: Day 1: Single 70 mg loading dose by IV infusion. Maintenance: 50 mg daily thereafter. Duration depends on clinical response and neutropenia recovery.
Note: Reconstitute the 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. Swirl gently to dissolve. Do not shake. The resulting solution (approx. 7 mg/mL) must then be diluted in 250 mL of 0.9% Sodium Chloride Injection, 0.45% Sodium Chloride Injection, 0.225% Sodium Chloride Injection, or Lactated Ringer's Injection. Administer by slow intravenous infusion over approximately 1 hour. Do not co-infuse with other medications. The diluted solution can be stored for up to 24 hours at room temperature or 48 hours refrigerated (2-8°C).
Caspofungin noncompetitively inhibits the enzyme β-(1,3)-D-glucan synthase, a complex integral to the fungal cell wall synthesis. This inhibition disrupts the formation of β-(1,3)-D-glucan polymers, which are critical for maintaining cell wall integrity, osmotic stability, and cell shape.
Pregnancy: Pregnancy Category C. Animal studies have shown fetal toxicity (skeletal anomalies). There are no adequate and well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus.
Driving: Unlikely to affect ability to drive and use machines, as it is administered in a hospital setting. However, patients may experience side effects like dizziness or headache.
| Cyclosporine | Increases caspofungin AUC by ~35%; transient increases in ALT and AST observed. Monitor liver function. | Moderate |
| Tacrolimus | Caspofungin reduces tacrolimus AUC by ~20% and Cmax by ~16%. Monitor tacrolimus blood levels and adjust dose. | Moderate |
| Rifampin | Decreases caspofungin trough concentrations by ~30%. Consider increasing caspofungin maintenance dose to 70 mg daily. | Moderate |
| Carbamazepine, Phenytoin, Dexamethasone | Inducers of drug clearance may reduce caspofungin concentrations. Consider increasing caspofungin maintenance dose to 70 mg daily. | Moderate |
| Amphotericin B | No significant pharmacokinetic interaction. Can be used in combination therapy for refractory cases. | Minor |