From the FDA Drug Label
No dosage adjustment is necessary for patients with renal impairment Caspofungin is not dialyzable, thus supplementary dosing is not required following hemodialysis. In adult patients with invasive aspergillosis, candidemia, or other Candida infections (intra-abdominal abscesses, peritonitis, or pleural space infections) who received multiple daily doses of caspofungin 50 mg, there was no significant effect of mild to end-stage renal impairment on caspofungin concentrations.
The recommended dosage of caspofungin in patients with Chronic Kidney Disease (CKD) and impaired renal function is the same as for patients with normal renal function, as no dosage adjustment is necessary for patients with renal impairment 1.
From the Research
Caspofungin dosage does not require adjustment for patients with chronic kidney disease (CKD) or impaired renal function, and the standard adult dosing regimen should be followed: a 70 mg loading dose on day 1, followed by 50 mg daily for maintenance therapy. This is because caspofungin is primarily eliminated through hepatic metabolism rather than renal excretion, with only about 1.4% of the drug excreted unchanged in urine, making kidney function largely irrelevant to its clearance 2, 3.
Key Considerations
- The pharmacokinetics of caspofungin are not significantly altered in patients with renal impairment, as it is primarily metabolized by the liver 4.
- Dose adjustments are necessary for patients with moderate to severe hepatic impairment, where the maintenance dose should be reduced to 35 mg daily while maintaining the standard 70 mg loading dose 5.
- When administering caspofungin, it's essential to infuse it slowly over approximately one hour and monitor for potential side effects such as fever, rash, or infusion-related reactions 6.
- Laboratory monitoring of liver function tests is also recommended during treatment, as hepatic effects can occur regardless of baseline renal function.
Administration and Monitoring
- Infuse caspofungin slowly over approximately one hour to minimize the risk of infusion-related reactions.
- Monitor patients for potential side effects, including fever, rash, or infusion-related reactions.
- Laboratory monitoring of liver function tests is recommended during treatment to detect any potential hepatic effects.