From the Guidelines
The recommended dosage of caspofungin for treatment is a loading dose of 70 mg, followed by 50 mg daily. This dosage is based on the most recent and highest quality study, which is the 2016 update by the Infectious Diseases Society of America 1. The study recommends an echinocandin, such as caspofungin, as initial therapy for candidiasis, with a loading dose of 70 mg and a daily maintenance dose of 50 mg.
Key Considerations
- The dosage is the same for adults, with no adjustment needed for renal impairment.
- For patients with moderate hepatic insufficiency, the maintenance dose should be reduced to 35 mg daily, while keeping the initial loading dose at 70 mg.
- Pediatric patients require a weight-based dosing regimen, with a loading dose of 70 mg/m² (maximum 70 mg) on day 1, followed by 50 mg/m² daily (maximum 70 mg).
- Caspofungin should be administered as a slow intravenous infusion over approximately one hour.
Clinical Context
The duration of therapy with caspofungin depends on the specific fungal infection being treated, clinical response, and resolution of neutropenia, typically ranging from 2 to 6 weeks 1. Caspofungin works by inhibiting the synthesis of beta-(1,3)-D-glucan, an essential component of the fungal cell wall, making it effective against Candida and Aspergillus species while having minimal impact on human cells.
Evidence-Based Recommendation
The recommendation for caspofungin dosage is based on the strongest and most recent evidence available, which prioritizes morbidity, mortality, and quality of life as the outcome 1. This study provides a strong recommendation with moderate-quality evidence for the use of echinocandins, such as caspofungin, as initial therapy for candidiasis.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
2.1 Important Administration Instructions for Use in All Patients Administer caspofungin acetate for injection by slow intravenous (IV) infusion over approximately 1 hour. Do not administer caspofungin acetate for injection by IV bolus administration. 2. 2 Recommended Dosage in Adult Patients [18 years of age and older] The dosage and duration of caspofungin acetate for injection treatment for each indication are as follows: Empirical Therapy for Presumed Fungal Infections in Febrile Neutropenic Patients Administer a single 70-mg loading dose on Day 1, followed by 50 mg once daily thereafter Duration of treatment should be based on the patient's clinical response. Continue empirical therapy until resolution of neutropenia. In general, treat patients found to have a fungal infection for a minimum of 14 days after the last positive culture and continue treatment for at least 7 days after both neutropenia and clinical symptoms are resolved If the 50-mg dose is well tolerated but does not provide an adequate clinical response, the daily dose can be increased to 70 mg. Candidemia and Other Candida Infections Administer a single 70-mg loading dose on Day 1, followed by 50 mg once daily thereafter. Duration of treatment should be dictated by the patient's clinical and microbiological response In general, continue antifungal therapy for at least 14 days after the last positive culture. Patients with neutropenia who remain persistently neutropenic may warrant a longer course of therapy pending resolution of the neutropenia. Esophageal Candidiasis The dose is 50 mg once daily for 7 to 14 days after symptom resolution. A 70-mg loading dose has not been studied for this indication Because of the risk of relapse of oropharyngeal candidiasis in patients with HIV infections, suppressive oral therapy could be considered [see Clinical Studies (14. 3)]. Invasive Aspergillosis Administer a single 70-mg loading dose on Day 1, followed by 50 mg once daily thereafter. Duration of treatment should be based upon the severity of the patient's underlying disease, recovery from immunosuppression, and clinical response.
The recommended dosage of caspofungin for treatment is as follows:
- Empirical Therapy: 70-mg loading dose on Day 1, followed by 50 mg once daily thereafter.
- Candidemia and Other Candida Infections: 70-mg loading dose on Day 1, followed by 50 mg once daily thereafter.
- Esophageal Candidiasis: 50 mg once daily for 7 to 14 days after symptom resolution.
- Invasive Aspergillosis: 70-mg loading dose on Day 1, followed by 50 mg once daily thereafter. The dosage may be adjusted based on the patient's clinical response and hepatic impairment. 2
From the Research
Caspofungin Dosage
The recommended dosage of caspofungin, an antifungal medication, varies based on the patient's condition and the severity of the infection. Here are some key points to consider:
- The standard dosage for adults is 70 mg IV on day 1, followed by 50 mg daily 3.
- For patients with moderate hepatic insufficiency, a dosage reduction to 35 mg daily is recommended after the initial 70-mg loading dose 4.
- No dosage adjustment is necessary for patients with mild hepatic insufficiency 4.
- In pediatric patients with allogeneic hematopoietic stem cell transplantation, a loading dose of 70 mg/m2 followed by a maintenance dose of 50 mg/m2 is recommended 5.
- For certain types of invasive candidiasis, such as endocarditis, osteomyelitis, or septic arthritis, a higher dose of 100 mg daily may be used, with possible escalation up to 150 mg daily 6.
Special Considerations
Some special considerations for caspofungin dosage include:
- Body surface area and aspartate aminotransferase levels can affect caspofungin clearance in pediatric patients 5.
- The probability of target attainment (PTA) of caspofungin regimen may vary depending on the Candida species and minimum inhibitory concentration (MIC) 5.
- Caspofungin has been shown to be effective and safe in patients with less common forms of invasive candidiasis, including peritonitis, abdominal abscesses, and chronic disseminated candidiasis 6.