[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Echinocandins](https://durgical.com/en/pharmacology/classes/echinocandins/) › Caspofungin [Pharmacology](https://durgical.com/en/pharmacology/) · [Echinocandins](https://durgical.com/en/pharmacology/classes/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](https://durgical.com/en/pharmacology/classes/echinocandins/) - Enzyme: β-1,3-D-glucan synthase (Fks1 catalytic subunit) - ATC code: J02AX04 ✂**β-1,3-D-glucan synthase (Fks1 catalytic subunit)**Caspofungin ⓘ 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](https://www.rcsb.org/structure/9PE1) · Drag to rotate · pinch to zoom ## 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. - Caspofungin binds the glucan synthase (Fks1) in the fungal membrane - β-1,3-D-glucan chains are no longer built - 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 - Empirical therapy of presumed fungal infection in febrile neutropenic patients. [Febrile neutropenia →](https://durgical.com/en/conditions/febrile-neutropenia/) - Candidaemia and intra-abdominal, peritoneal and pleural Candida infections. [Candidiasis: oral, oesophageal and invasive →](https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/) - Oesophageal candidiasis. [Infectious and pill-induced oesophagitis (Candida, HSV, CMV) →](https://durgical.com/en/conditions/infectious-and-pill-induced-oesophagitis/) - Invasive aspergillosis refractory to or intolerant of other therapies. [Aspergillosis →](https://durgical.com/en/conditions/aspergillosis/) ## 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) ### Serious (rare, important) - Anaphylaxis and histamine-type reactions (rash, facial swelling, itching, warmth, bronchospasm) - Hepatitis or liver failure (isolated cases) - Stevens-Johnson syndrome and toxic epidermal necrolysis ## 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. ## Memory aid «CASPO breaks the CASTLE wall»: no wall in human cells, so it is gentle; no CSF, so no Cryptococcus. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/caspofungin/) ## Related drugs - [Micafungin](https://durgical.com/en/pharmacology/micafungin/) - [Fluconazole](https://durgical.com/en/pharmacology/fluconazole/) - [Amphotericin B](https://durgical.com/en/pharmacology/amphotericin-b/) ## Related conditions - [Febrile neutropenia](https://durgical.com/en/conditions/febrile-neutropenia/) - [Candidiasis: oral, oesophageal and invasive](https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/) - [Infectious and pill-induced oesophagitis (Candida, HSV, CMV)](https://durgical.com/en/conditions/infectious-and-pill-induced-oesophagitis/) - [Aspergillosis](https://durgical.com/en/conditions/aspergillosis/) [← Back to the class: Echinocandins](https://durgical.com/en/pharmacology/classes/echinocandins/) 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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=08fb61ee-a05a-4ce1-934c-8cd26c5733db) (DailyMed (U.S. National Library of Medicine), 2026); [Caspofungin Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a615001.html) (MedlinePlus (U.S. National Library of Medicine), 2019); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 61 (McGraw Hill, 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/caspofungin/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/caspofungin/