C difficile risk
Oral Bioavailability


Defined criteria for use and/or important safety considerations. See below for more information.

70 mg IV on day 1, then 50 mg IV q24h

150 mg IV q24h

Consider dose increase, especially if not responding to standard dosing.70 mg IV q24h

Child-Pugh B (score of 7-9)70 mg IV on day 1, then 35 mg IV q24h

Child-Pugh C (score of 10-15)No recommendation

No renal adjustment required

General Information

Primary Indication(s)

  • Empiric antifungal for severely ill patients with invasive Candida infection or patients at risk of fluconazole resistance (e.g. receiving fluconazole prophylaxis)

  • Empiric yeast therapy for febrile neutropenia

  • Fungal endocarditis


  • An option for invasive Aspergillosis infections, but amphotericin or voriconazole is usually preferred

  • The echinocandins have poor urine penetration and should generally not be used for urinary infections.

  • Should not be used for CNS infections

Periodic liver function tests, renal function tests, CBC with differential

  • Increased liver enzymes

  • GI upset, diarrhea

  • Pruritis, fever (most common in pediatrics)

  • Potent enzyme inducers (e.g. rifampin): may decrease caspofungin exposure (see Dosing)

  • Cyclosporine: may increase caspofungin exposure and increased ALT/AST

  • Tacrolimus: caspofungin may decrease tacrolimus levels

Antimicrobial class: Echinocandin

CSF penetration: Poor

Urine penetration: Poor

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