Caspofungin

Summary

Caspofungin is the first approved echinocandin antifungal agent, used for treating invasive candidiasis, invasive aspergillosis refractory to or intolerant of other therapies, and empirical therapy for presumed fungal infections in febrile neutropenic patients. It is a semisynthetic lipopeptide derived from pneumocandin B0.

Mechanism of Action

Non-competitive inhibition of beta-1,3-D-glucan synthase (Fks subunit), disrupting fungal cell wall synthesis by reducing glucan polymer formation, leading to osmotic instability and fungal cell death

Routes of Administration

Goals & Uses

• Treatment of invasive aspergillosisAntifungalHigh
• Antifungal prophylaxis in high-risk patientsProphylaxisModerate
• Treatment of invasive candidiasisAntifungalHigh
• Treatment of esophageal candidiasisAntifungal TherapyHigh
• Empirical antifungal therapy in febrile neutropeniaAntifungal Prophylaxis/empirical TherapyHigh

Contraindications

• Concomitant use with cyclosporine (relative)Drug InteractionModerate
• Hypersensitivity to caspofungin or any echinocandinAllergyHigh

Adverse Effects

• Elevated liver enzymes (AST/ALT)HepatotoxicityCommon
• HypokalemiaElectrolyteCommon
• AnaphylaxisImmunologicRareSevere life-threatening allergic reaction
• Nausea/vomitingGastrointestinalUncommon
• Infusion-related reactions (flushing, rash, pruritus)Infusion ReactionUncommon
• FeverSystemicCommonElevated body temperature

Drug Interactions

• RifampinModerate
• CyclosporineModerate
• Efavirenz/Nevirapine/Carbamazepine/Phenytoin/DexamethasoneModerate
• TacrolimusModerate

Population Constraints

• Pregnancy (Category C)ReproductiveRelative
• Pediatric patients under 3 monthsAgeRelative
• Severe hepatic impairment (Child-Pugh >9)HepaticRelative
• BreastfeedingReproductiveRelative

Regulatory Status

• European UnionApprovedApproved: Invasive candidiasis in adults and pediatric patients, Invasive aspergillosis (salvage), Empirical therapy in febrile neutropenic patientsEMA approved; centrally authorized product
• United StatesApprovedApproved: Invasive candidiasis (adults and pediatric patients ≥3 months), Invasive aspergillosis refractory/intolerant to other therapies, Empirical therapy for presumed fungal infections in febrile neutropenic patients, Esophageal candidiasisFDA approved January 2001; brand name Cancidas (Merck). Generic formulations available.
• United KingdomApprovedApproved: Invasive candidiasis, Invasive aspergillosis (refractory/intolerant), Empirical antifungal therapy in febrile neutropenic patientsApproved by MHRA post-Brexit; consistent with EMA indications

FDA approved in 2001 (Cancidas, Merck). EMA approved. Indicated for adults and pediatric patients (3 months and older). Available as IV formulation only.

Evidence & Sources

No sources recorded yet.