[Photo of caspofungin (Cancidas)] 
KEY POINTS
- Caspofungin (Cancidas) is an echinocandin antifungal drug
- Other echinocandins are micafungin (Mycamine) and anidulafungin (Eraxis)
- Echinocandins work by inhibiting 1,3-beta-D-glucan synthesis, a component of the fungal cell wall
- Has been associated with a paradoxical effect, where at higher doses there is less antifungal activity
- Echinocandins have activity versus a variety of yeasts, including Candida albicans, Candida glabrata, and Candida krusei
- A class generally reserved for fluconazole-resistant Candida species
- In adults caspofungin is typically given as a 70mg loading dose on day 1, then 50mg daily maintenance dose thereafter
- Loading dose does not require dose adjustment for Child-Pugh Class B hepatic dysfunction, but the maintenance dose does
- Adjustment for Child-Pugh Class C hepatic dysfunction not provided by package insert
- No adjustments for renal function listed in package insert
- Caspofungin and anidulafungin have loading doses, micafungin does not
- Relatively few drug-drug interactions
- Generally well tolerated
- Does not achieve therapeutic levels in the cerebral spinal fluid
RESOURCES
- Caspofungin Package Insert
- IDSA Candidiasis Guideline 2016
- Clin Infect Dis 2015 Supplement on Echinocandins
- Recent Insights into the Paradoxical Effect of Echinocandins (JoF 2018)
- We can do better: a fresh look at echinocandin dosing (JAC 2018)
