caspofungine

Caspofungin, marketed as Cancidas among others, is an antifungal medication in the echinocandin class. It inhibits the synthesis of beta-(1,3)-D-glucan, an essential component of most fungal cell walls, by non-competitive inhibition of beta-1,3-glucan synthase. Disruption of cell wall integrity leads to osmotic instability and fungal cell death in susceptible organisms.

Indications for caspofungin include invasive candidiasis, including candidemia, and esophageal candidiasis. It is also used as salvage therapy for invasive aspergillosis in patients who are intolerant of or refractory to other antifungal agents. The drug has limited activity against many non-Candida molds and is not reliable against Cryptococcus or Mucorales; its role in aspergillosis is typically for patients who cannot take first-line agents.

Administration and dosing are by intravenous infusion. In adults, a loading dose is followed by daily maintenance dosing; dosing may be adjusted for hepatic impairment and is generally not recommended in severe hepatic impairment. No routine dose adjustment is required for renal impairment. Common adverse effects include fever, infusion-related reactions, rash, and elevated liver enzymes; hepatotoxicity is a notable consideration. Serious hypersensitivity reactions are possible but uncommon.

Drug interactions are limited but can occur; concomitant cyclosporine may increase caspofungin exposure, and rifampin can reduce levels. Safety in pregnancy and lactation is not fully established; use during pregnancy should balance potential benefits and risks. Caspofungin is rapidly distributed and undergoes hepatic metabolism with biliary excretion of metabolites, and it does not rely heavily on cytochrome P450 enzymes for clearance.