Infectious Disease Compendium

Caspofungin (Cancidas®)

Dosing

CrCl Formula

CrCl > 80: 70-mg loading dose should be administered on Day 1, followed by 50 mg qd IV. Rifampin reduces caspofungin concentrations by 30%. Patients on rifampin should receive 70 mg of caspofungin qd.

CrCl 80-50: No dosage adjustment is necessary.

CrCl 50-10: No dosage adjustment is necessary.

CrCl < 10: No dosage adjustment is necessary. However, do need to decrease dose for liver failure.

Hemodialysis:

Peritoneal dialysis:

Important side effects

Facial swelling, fever, headache, increased lft's, thrombophlebitis, nausea, vomiting, pruritus, rash.

Important drug interactions

Carbamazepine, cyclosporin, dexamethasone, efavirenz (decreases caspofungin blood levels), nelfinavir (decreases caspofungin blood levels), nevirapine (decreases caspofungin blood levels), phenytoin, rifampin (Rifampin reduces caspofungin concentrations by 30%. Patients on rifampin should receive 70 mg of caspofungin qd.), tacrolimus.

Rants and Screeds

Pearls

Treatment of choice

Use for

Aspergillus (salvage therapy) and Candida. Prophylaxis for neutropenic fever.

In neutropenics, there may be greater breakthrough when treated with caspofungin (PubMed).

Don't use for

Urinary tract infections, cryptococcus, Zygomycetes.

Class

Echinocandin.