CANCIDAS
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CANCIDAS (CANCIDAS).
Caspofungin inhibits the synthesis of β-(1,3)-D-glucan, an essential component of the fungal cell wall, by noncompetitive inhibition of the enzyme β-(1,3)-D-glucan synthase, leading to osmotic instability and cell death.
| Metabolism | Caspofungin undergoes slow hepatic metabolism via hydrolysis and N-acetylation, with minor contribution from cytochrome P450 enzymes; it is not a substrate for CYP3A4. |
| Excretion | Renal excretion of unchanged drug is minimal (approximately 1% of dose). The primary route of elimination is biliary/fecal, with about 70% of a radiolabeled dose recovered in feces over 14 days, mostly as metabolites. Urinary excretion accounts for about 10% of total radioactivity, primarily as metabolites. |
| Half-life | The terminal elimination half-life is approximately 40–50 hours in adults. A multi-exponential decline is observed; the beta half-life is 9–11 hours, and the gamma (terminal) half-life is 40–50 hours. This supports once-daily dosing after a loading dose. |
| Protein binding | Approximately 96% bound to albumin. |
| Volume of Distribution | The volume of distribution at steady state is approximately 0.5 L/kg, indicating extensive distribution into tissues, including the liver, spleen, and lung. |
| Bioavailability | Not applicable; CANCIDAS is administered only as an intravenous infusion. Oral bioavailability is negligible (<1%) due to poor absorption. |
| Onset of Action | Intravenous administration: antifungal effect begins within 24 hours of the first dose, based on pharmacokinetic-pharmacodynamic modeling and time to steady-state. |
| Duration of Action | The clinical effect persists for the dosing interval (24 hours) due to the long terminal half-life. Concentrations remain above the minimum effective concentration for most Candida species throughout the day. |
| Action Class | Fungal cell wall synthesis inhibitor (Echiocandins) |
| Brand Substitutes | Capsain 50mg Injection, Hospicasp 50mg Injection, Casjol 50 Injection, Casogyn 50mg Injection, Casponova 50mg Injection, Guficap 70mg Injection, Caspledge 70mg Injection, Capsain 70mg Injection, Canducid 70mg Injection, Candidal 70mg Injection |
70 mg IV once, followed by 50 mg IV once daily thereafter.
| Dosage form | POWDER |
| Renal impairment | No dose adjustment required for any degree of renal impairment. |
| Liver impairment | Child-Pugh class A: no adjustment; Child-Pugh class B: reduce maintenance dose to 35 mg IV once daily after initial 70 mg loading dose; Child-Pugh class C: insufficient data; use with caution. |
| Pediatric use | Neonates (<3 months): 25 mg/m² IV once daily; Children (3 months to 17 years): 70 mg/m² IV on day 1, then 50 mg/m² IV once daily thereafter; maximum daily dose 70 mg regardless of calculated dose. |
| Geriatric use | No dose adjustment required based on age alone; monitor renal function and adjust if hepatic impairment present. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CANCIDAS (CANCIDAS).
| Breastfeeding | It is not known whether caspofungin is excreted in human breast milk. Caution should be exercised when administered to a nursing woman. The M/P ratio has not been determined. |
| Teratogenic Risk | Caspofungin (CANCIDAS) is classified as FDA Pregnancy Category C. Animal studies have shown embryotoxicity and skeletal abnormalities at clinically relevant doses. There are no adequate and well-controlled studies in pregnant women. Use during the first trimester should be avoided unless clearly needed; risks in second and third trimesters are less defined but potential fetal harm cannot be ruled out. |
■ FDA Black Box Warning
None.
| Serious Effects |
Known hypersensitivity to caspofungin or any component of the formulation.
| Precautions | Hepatic dysfunction (elevated liver enzymes, hepatic failure); anaphylaxis and hypersensitivity reactions; possible tumor lysis syndrome; monitoring of hepatic function recommended; use with caution in patients with moderate hepatic impairment (reduce dose); concomitant use with cyclosporine increases risk of hepatotoxicity. |
| Food/Dietary | No significant food interactions. CANCIDAS is administered intravenously, so oral intake does not affect absorption. However, patients should maintain a balanced diet to support immune function. |
Loading safety data…
| Fetal Monitoring | Monitor maternal liver function tests (ALT, AST, alkaline phosphatase) and renal function. In pregnant patients, consider fetal ultrasound for growth and anatomy if exposure occurs during first trimester. Observe for signs of infusion-related reactions (e.g., histamine-mediated symptoms) in the mother. |
| Fertility Effects | Animal studies have shown no significant effects on fertility in male and female rats at doses up to 5 mg/kg/day. Human data are lacking. No known adverse effects on human fertility. |
| Clinical Pearls |
| CANCIDAS (caspofungin) is an echinocandin antifungal used for invasive aspergillosis refractory to or intolerant of other therapies, candidemia, and other Candida infections. It has a unique mechanism inhibiting β-(1,3)-D-glucan synthase. Dose adjustment required in moderate hepatic impairment (Child-Pugh score 7-9), but no adjustment in renal impairment. Monitor for infusion-related reactions; premedicate if needed. Drug interactions: induces CYP3A4, but less potent than other azoles; monitor cyclosporine levels (transient ALT/AST elevations reported). Not effective against Cryptococcus, Fusarium, or Zygomycetes. Check liver function tests regularly. |
| Patient Advice | Take this medication exactly as prescribed by your doctor. · Report any signs of liver problems such as yellowing of skin or eyes, dark urine, or abdominal pain. · Tell your doctor if you experience fever, chills, or flushing during infusion. · Do not stop taking this medication without consulting your doctor. · Inform your doctor about all other medicines you take, including over-the-counter drugs and herbal supplements. |