Caspofungin doses
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caspofungin dosing adults pediatric hepatic impairment 2024
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Here is a complete dosing reference for caspofungin:
Caspofungin (Cancidas) - Dosing Reference
Route & Administration
- IV infusion only, given over 1 hour
- Do NOT mix with dextrose-containing solutions
- Do NOT give as IV bolus
Adult Doses
| Indication | Loading Dose (Day 1) | Maintenance Dose |
|---|---|---|
| Invasive candidiasis (candidemia) | 70 mg IV | 50 mg IV once daily |
| Invasive aspergillosis | 70 mg IV | 50 mg IV once daily |
| Empiric therapy (febrile neutropenia) | 70 mg IV | 50 mg IV once daily |
| Esophageal candidiasis | None | 50 mg IV once daily |
- If no clinical response, the daily dose may be increased to 70 mg (also applies when co-administered with CYP inducers)
- Maximum daily dose: 70 mg
- Typical treatment duration: 2-4 weeks (occasionally longer for invasive disease; 7-14 days after symptom resolution for esophageal candidiasis)
Pediatric Doses (age ≥ 3 months)
| Phase | Dose |
|---|---|
| Loading dose (Day 1) | 70 mg/m² IV (max 70 mg) |
| Maintenance | 50 mg/m² IV once daily (max 70 mg) |
- If inadequate response, may increase maintenance to 70 mg/m²/day (not to exceed 70 mg)
Dose Adjustments
Hepatic Impairment (Adults):
| Child-Pugh Score | Adjustment |
|---|---|
| Mild (5-6) | No adjustment needed |
| Moderate (7-9) | Reduce maintenance to 35 mg/day (still give 70 mg loading dose on Day 1) |
| Severe (>9) | No clinical data; use with caution |
- No hepatic impairment data available for pediatric patients
Renal Impairment:
- No dose adjustment required, including in hemodialysis patients (not removed by dialysis)
Drug Interactions Requiring Dose Increase to 70 mg/day:
- Rifampin (reduces caspofungin levels ~30%)
- Efavirenz, nevirapine, phenytoin, dexamethasone, carbamazepine (CYP inducers - consider increase)
Drug Interactions Requiring Caution:
- Cyclosporine: increases caspofungin exposure; monitor liver enzymes - avoid or use with caution
- Tacrolimus: caspofungin reduces tacrolimus levels ~20%; monitor and adjust tacrolimus dose
Pharmacokinetics Summary
- Half-life: 9-11 hours
- Protein binding: ~97% (albumin)
- Metabolism: chemical degradation, hydrolysis, N-acetylation (not CYP-dependent)
- Excretion: 41% urine, 35% feces over 27 days; only ~2% excreted unchanged in urine
Sources: Goldman-Cecil Medicine; Katzung's Basic & Clinical Pharmacology 16e; Washington Manual of Medical Therapeutics; FDA label (caspofungin acetate for injection)
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