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Pharmacology · Echinocandins

Caspofungin !

Intravenous echinocandin that blocks the fungal cell wall. Used for candidaemia, oesophageal candidiasis and as rescue in aspergillosis.

Updated 2026-11-01

  • Class: Echinocandins
  • Enzyme: β-1,3-D-glucan synthase (Fks1 catalytic subunit)
  • ATC code: J02AX04

Cryo-electron microscopy structure of the yeast (Saccharomyces cerevisiae) glucan synthase Fks1 with caspofungin bound; the drug's peptide ring is modelled as a short chain and A1CHR is its fatty tail.

Target in 3D: β-1,3-D-glucan synthase (Fks1 catalytic subunit). PDB structure 9PE1 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Caspofungin inhibits the synthesis of β-1,3-D-glucan, an essential component of the cell wall of Candida and Aspergillus, by blocking the glucan synthase complex in the fungal membrane. Mammalian cells have no β-1,3-D-glucan. It kills Candida and acts on the growing tips of Aspergillus hyphae.

  1. Caspofungin binds the glucan synthase (Fks1) in the fungal membrane
  2. β-1,3-D-glucan chains are no longer built
  3. The cell wall weakens and Candida bursts

Pharmacokinetics

Absorption
Intravenous only.
Distribution
Highly protein-bound; it does not penetrate the CSF.
Metabolism
Slow hydrolysis and N-acetylation plus spontaneous degradation; not a CYP substrate or inhibitor of note. The dose is lowered in moderate liver impairment.
Half-life
Main phase of about 9 to 11 hours.

Indications

Adverse effects

Common

  • Diarrhoea
  • Fever and chills
  • Raised ALT, AST and alkaline phosphatase
  • Low potassium
  • Rash, chills and low blood pressure (more often in children)

Contraindications

  • Hypersensitivity to any component

Key interactions

Cyclosporine
Raises caspofungin exposure and has caused transient rises of ALT and AST; liver tests are monitored.
Tacrolimus
Caspofungin lowers tacrolimus levels; trough levels are monitored.
Rifampicin and other inducers (efavirenz, nevirapine, phenytoin, dexamethasone, carbamazepine)
Lower caspofungin levels; a higher daily dose is used.

What is monitored

  • Liver tests
  • Potassium
  • Signs of hypersensitivity during the infusion

Administration and safety

  • Slow intravenous infusion only; never as an IV bolus.
  • Do not use diluents containing dextrose (glucose).
  • Do not mix or co-infuse with other drugs.
  • Check the order for dose changes in moderate liver impairment or with enzyme inducers.

Nursing care

  • Observe for flushing, rash, facial swelling, itching or wheeze during the infusion; stop and report.
  • Check the IV site for pain or phlebitis.
  • Follow liver tests and potassium; report jaundice or dark urine.

Pregnancy and breastfeeding

Based on animal data it may cause fetal harm; human data are lacking.

Test yourself

Think of the answer, then tap the question to see it.

Which component of the fungus does caspofungin target?

The cell wall: it blocks β-1,3-D-glucan synthesis.

Which diluent must not be used for caspofungin?

Any dextrose (glucose)-containing solution.

A patient on caspofungin starts rifampicin for tuberculosis. What changes?

Rifampicin lowers caspofungin levels, so a higher daily dose of caspofungin is used.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - CASPOFUNGIN ACETATE injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); Caspofungin Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2019); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 61 (McGraw Hill, 2023).

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Representative model, for educational purposes only.