kaspofungin

Caspofungin, marketed under the brand Cancidas, is an antifungal medication in the echinocandin class. It is administered by intravenous infusion and is approved for the treatment of invasive candidiasis and candidemia, and for esophageal candidiasis.

Caspofungin works by inhibiting beta-1,3-D-glucan synthase, an enzyme essential for the synthesis of fungal cell wall glucan. This weakens the cell wall, leading to cell death in susceptible fungi. It is fungicidal against most Candida species and has activity against certain molds such as Aspergillus in some settings, but it is not active against Cryptococcus neoformans or most Mucorales.

Dosing and administration vary by infection and population. In adults with candidemia or invasive candidiasis, the typical regimen is a 70 mg loading dose on day 1, followed by 50 mg once daily. For esophageal candidiasis, the recommended dose is 50 mg daily. Hepatic impairment requires dosing adjustments: mild disease usually requires no adjustment; moderate impairment (Child-Pugh B) reduces the daily dose to 35 mg; severe impairment (Child-Pugh C) is generally not recommended. Pediatric use exists with weight-based dosing and label-specific instructions for children aged several months and older.

Pharmacokinetics and safety: Caspofungin is given IV only, with hepatic metabolism and limited renal clearance. It has a half-life of about 9–11 hours and high plasma protein binding. Common adverse effects include fever, nausea, vomiting, headache, and infusion-site reactions; liver enzyme elevations can occur. Serious hypersensitivity and hepatotoxicity are possible but uncommon. Resistance can arise from mutations in the FKS genes encoding beta-1,3-D-glucan synthase; interactions with other drugs are generally limited.

History: Caspofungin was developed by Merck and approved in 2001 for candidemia and invasive candidiasis. It remains a guideline option for certain invasive Candida infections and may be used as salvage therapy in select invasive mold infections.