Caspofungin Dosage

Medically reviewed by Drugs.com. Last updated on Aug 7, 2023.

Usual Adult Dose for Febrile Neutropenia

Loading dose: 70 mg IV on Day 1
Maintenance dose: 50 mg IV once a day thereafter

• If the 50 mg dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg IV once a day

Comments:

• Treatment duration should be based on the patient's clinical response; empirical therapy should continue until resolution of neutropenia.
• In general, patients found to have a fungal infection should be treated for at least 14 days after the last positive culture and continue for at least 7 days after both neutropenia and clinical symptoms are resolved.

Use: As empirical therapy for presumed fungal infections in febrile, neutropenic patients

Usual Adult Dose for Candidemia

Loading dose: 70 mg IV on Day 1
Maintenance dose: 50 mg IV once a day thereafter

Comments:

• Treatment duration should be based on the patient's clinical and microbiological response; in general, antifungal therapy should continue for at least 14 days after the last positive culture.
• Patients who remain persistently neutropenic may require longer therapy pending resolution of the neutropenia.
• This drug has not been studied in endocarditis, osteomyelitis, and meningitis due to Candida.

Uses: For the treatment of candidemia and the following Candida infections: intraabdominal abscesses, peritonitis, and pleural space infections

Usual Adult Dose for Esophageal Candidiasis

50 mg IV once a day
Duration of therapy: 7 to 14 days after symptom resolution

Comments:

• A 70 mg loading dose has not been studied with this indication.
• This drug has not been approved for treatment of oropharyngeal candidiasis (higher relapse rate).
• Due to the risk of relapse of oropharyngeal candidiasis in patients with HIV infections, suppressive oral therapy could be considered.

Use: For the treatment of esophageal candidiasis

Usual Adult Dose for Aspergillosis - Invasive

Loading dose: 70 mg IV on Day 1
Maintenance dose: 50 mg IV once a day thereafter

Comments:

• Treatment duration should be based on the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.
• This drug has not been studied as initial therapy for invasive aspergillosis.

Use: For the treatment of invasive aspergillosis in patients refractory to/intolerant of other therapies

Usual Pediatric Dose for Febrile Neutropenia

3 months or older:

• Loading dose: 70 mg/m2 IV on Day 1
• Maintenance dose: 50 mg/m2 IV once a day thereafter
• If the 50 mg/m2 dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg/m2 IV once a day

Maximum dose (loading and maintenance): 70 mg/dose

Comments:

• The maximum loading dose and daily maintenance dose should not exceed 70 mg, regardless of patient's calculated dose.
• Treatment duration should be based on the patient's clinical response; empirical therapy should continue until resolution of neutropenia.
• In general, patients found to have a fungal infection should be treated for at least 14 days after the last positive culture and continue for at least 7 days after both neutropenia and clinical symptoms are resolved.

Use: As empirical therapy for presumed fungal infections in febrile, neutropenic patients

Usual Pediatric Dose for Candidemia

3 months or older:

• Loading dose: 70 mg/m2 IV on Day 1
• Maintenance dose: 50 mg/m2 IV once a day thereafter
• If the 50 mg/m2 dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg/m2 IV once a day

Maximum dose (loading and maintenance): 70 mg/dose

Comments:

• The maximum loading dose and daily maintenance dose should not exceed 70 mg, regardless of patient's calculated dose.
• Treatment duration should be based on the patient's clinical and microbiological response; in general, antifungal therapy should continue for at least 14 days after the last positive culture.
• Patients who remain persistently neutropenic may require longer therapy pending resolution of the neutropenia.
• This drug has not been studied in endocarditis, osteomyelitis, and meningitis due to Candida.

Uses: For the treatment of candidemia and the following Candida infections: intraabdominal abscesses, peritonitis, and pleural space infections

Usual Pediatric Dose for Esophageal Candidiasis

3 months or older:

• Loading dose: 70 mg/m2 IV on Day 1
• Maintenance dose: 50 mg/m2 IV once a day thereafter
• If the 50 mg/m2 dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg/m2 IV once a day

Maximum dose (loading and maintenance): 70 mg/dose
Duration of therapy: 7 to 14 days after symptom resolution

Comments:

• The maximum loading dose and daily maintenance dose should not exceed 70 mg, regardless of patient's calculated dose.
• This drug has not been approved for treatment of oropharyngeal candidiasis (higher relapse rate).
• Due to the risk of relapse of oropharyngeal candidiasis in patients with HIV infections, suppressive oral therapy could be considered.

Use: For the treatment of esophageal candidiasis

Usual Pediatric Dose for Aspergillosis - Invasive

3 months or older:

• Loading dose: 70 mg/m2 IV on Day 1
• Maintenance dose: 50 mg/m2 IV once a day thereafter
• If the 50 mg/m2 dose is well tolerated but clinical response is inadequate: May increase dose to 70 mg/m2 IV once a day

Maximum dose (loading and maintenance): 70 mg/dose

Comments:

• The maximum loading dose and daily maintenance dose should not exceed 70 mg, regardless of patient's calculated dose.
• Treatment duration should be based on the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.
• This drug has not been studied as initial therapy for invasive aspergillosis.

Use: For the treatment of invasive aspergillosis in patients refractory to/intolerant of other therapies

Renal Dose Adjustments

Renal dysfunction: No adjustment recommended.

Liver Dose Adjustments

Adult patients:

• Mild liver dysfunction (Child-Pugh score 5 to 6): No adjustment recommended.
• Moderate liver dysfunction (Child-Pugh score 7 to 9):
• Loading dose (where appropriate): 70 mg IV on Day 1
• Maintenance dose: 35 mg IV once a day
• Severe liver dysfunction (Child-Pugh score greater than 9): Data not available

Pediatric patients:

• Any degree of liver dysfunction: Data not available

Dose Adjustments

Adult patients:

• On rifampin: Should receive caspofungin 70 mg IV once a day
• On other inducers of hepatic CYP450 enzymes (e.g., nevirapine, efavirenz, carbamazepine, dexamethasone, phenytoin): Should consider caspofungin 70 mg IV once a day

Pediatric patients:

• On rifampin: Should receive caspofungin 70 mg/m2 IV once a day
• Maximum dose: 70 mg/dose
• On other inducers of hepatic CYP450 enzymes (e.g., efavirenz, nevirapine, phenytoin, dexamethasone, carbamazepine): Should consider caspofungin 70 mg/m2 IV once a day
• Maximum dose: 70 mg/dose

Precautions

CONTRAINDICATIONS:
Known hypersensitivity (e.g., anaphylaxis) to the active component or any of the ingredients

Safety and efficacy have not been established in patients younger than 3 months.

Consult WARNINGS section for additional precautions.

Dialysis

This drug is not dialyzable; supplementary dosing is not required after hemodialysis.

Other Comments

Administration advice:

• Administer by slow IV infusion over about 1 hour; do not administer by IV bolus injection.
• Do not mix or co-infuse with other agents.

Storage requirements:

• Lyophilized vials: Store refrigerated at 2C to 8C (36F to 46F).
• Reconstituted solution (in vial): May store for up to 1 hour at up to 25C (77F) before preparation of the infusion solution
• Diluted infusion solution (in IV bag/bottle): Must use within 24 hours if stored at up to 25C (77F) or within 48 hours if stored refrigerated at 2C to 8C (36F to 46F).

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

IV compatibility:

• Compatible (reconstitution): 0.9% Sodium Chloride Injection, Sterile Water for Injection, Bacteriostatic Water for Injection with methylparaben and propylparaben, Bacteriostatic Water for Injection with 0.9% benzyl alcohol
• Compatible (dilution): 0.9%, 0.45%, or 0.225% Sodium Chloride Injection; Lactated Ringers Injection
• Compatibility of this drug with other IV substances, additives, or medications has not been established.
• Do not use diluents containing dextrose (alpha-D-glucose); this drug is not stable in such diluents.

Monitoring:

• Hepatic: For evidence of worsening hepatic function in patients who develop abnormal liver function tests (during therapy)

Patient advice:

• Report signs/symptoms of hypersensitivity reaction (including rash, facial swelling, angioedema, pruritus, sensation of warmth, bronchospasm) to healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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