Caspofungin Demo S.A.
Echinocandin antifungal — Intravenous infusion for invasive fungal infections
Caspofungin Demo S.A. is an echinocandin-class antifungal agent administered by intravenous infusion. It is used to treat serious invasive fungal infections including invasive candidiasis, invasive aspergillosis (when other treatments have failed), and as empirical therapy for suspected fungal infections in patients with febrile neutropenia. Caspofungin works by inhibiting the synthesis of beta-(1,3)-D-glucan, an essential component of the fungal cell wall. This medication is prescribed exclusively in hospital settings and requires medical supervision during administration.
Quick Facts
Key Takeaways
- Caspofungin Demo S.A. is a hospital-only antifungal used for life-threatening invasive fungal infections including candidemia and invasive aspergillosis.
- It is administered as a slow intravenous infusion over approximately 1 hour — never as a bolus injection.
- The standard adult dosing is a 70 mg loading dose on Day 1, followed by 50 mg daily; dose adjustment is required with certain enzyme inducers and in moderate hepatic impairment.
- Common side effects include fever, elevated liver enzymes, infusion-site reactions, rash, and hypokalemia; serious hepatotoxicity is rare but requires monitoring.
- Important drug interactions exist with cyclosporine, tacrolimus, rifampicin, and certain anticonvulsants — always inform your medical team about all medications you take.
What Is Caspofungin Demo S.A. and What Is It Used For?
Caspofungin Demo S.A. contains the active substance caspofungin, which belongs to the echinocandin class of antifungal agents. Echinocandins represent one of the newest classes of antifungal drugs and are considered first-line therapy for many invasive Candida infections according to the Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).
The drug works by inhibiting the synthesis of beta-(1,3)-D-glucan, a polysaccharide that is an essential structural component of the fungal cell wall. Since this target does not exist in human cells, caspofungin achieves selective toxicity against fungi while having a generally favorable safety profile in humans. The inhibition of glucan synthesis leads to osmotic instability of the fungal cell, ultimately resulting in cell lysis and death.
Caspofungin Demo S.A. is indicated for the treatment of the following conditions in adult and pediatric patients (from neonates onwards):
- Invasive candidiasis, including candidemia (bloodstream infection with Candida species). This is the most common indication and includes infections in non-neutropenic and neutropenic patients.
- Invasive aspergillosis in patients who are refractory to or intolerant of amphotericin B, lipid formulations of amphotericin B, and/or itraconazole. Caspofungin serves as salvage therapy rather than first-line treatment for aspergillosis.
- Empirical therapy for presumed fungal infections (such as Candida or Aspergillus) in febrile neutropenic adult or pediatric patients.
The drug has demonstrated activity against most clinically relevant Candida species, including C. albicans, C. glabrata, C. tropicalis, C. krusei, and C. parapsilosis. It also has activity against Aspergillus fumigatus, A. flavus, and A. terreus. However, caspofungin is not active against Cryptococcus neoformans, Mucorales, or Fusarium species.
As an intravenous-only formulation, Caspofungin Demo S.A. is exclusively administered in hospital or clinical settings under the supervision of healthcare professionals experienced in the management of invasive fungal infections. There is no oral formulation of caspofungin available, which means patients cannot self-administer this medication at home.
What Should You Know Before Taking Caspofungin Demo S.A.?
Contraindications
Caspofungin Demo S.A. must not be used if you have a known hypersensitivity (allergy) to caspofungin or any of the other ingredients in the formulation. Allergic reactions to caspofungin, while rare, can include rash, facial swelling, pruritus, sensation of warmth, or bronchospasm. If you have experienced an allergic reaction to any echinocandin antifungal (such as micafungin or anidulafungin), inform your healthcare provider, as cross-reactivity may occur.
Anaphylactic reactions have been reported rarely during administration of caspofungin. If an anaphylactic reaction occurs, treatment should be discontinued immediately and appropriate emergency measures initiated. Caspofungin should be administered in settings where resuscitation equipment is available.
Warnings and Precautions
Several important precautions should be considered before and during treatment with Caspofungin Demo S.A.:
- Hepatotoxicity: Cases of clinically significant hepatic dysfunction, hepatitis, and hepatic failure have been reported in patients receiving caspofungin. Patients with pre-existing liver disease, those receiving hepatotoxic medications, or those with elevated liver enzymes at baseline should be closely monitored. Liver function tests (ALT, AST, bilirubin) should be performed before starting treatment and regularly during therapy.
- Hepatic impairment: In patients with mild hepatic impairment (Child-Pugh score 5–6), no dose adjustment is necessary. In patients with moderate hepatic impairment (Child-Pugh score 7–9), the daily dose should be reduced to 35 mg after the 70 mg loading dose. There is no clinical experience in patients with severe hepatic impairment (Child-Pugh score >9), and use is not recommended in these patients.
- Infusion-related reactions: Histamine-mediated symptoms including rash, facial swelling, pruritus, and a sensation of warmth have been reported. These events are more common when caspofungin is infused too rapidly. The drug should be administered over approximately 1 hour to minimize the risk of such reactions.
- Renal impairment: No dose adjustment is necessary in patients with renal impairment. Caspofungin is not significantly removed by hemodialysis.
- Concomitant use with cyclosporine: Co-administration with cyclosporine has been associated with transient elevations in liver enzymes (ALT and AST). If both drugs are needed, close monitoring of liver function is essential.
Pregnancy and Breastfeeding
Caspofungin Demo S.A. should only be used during pregnancy if the potential benefit to the mother justifies the potential risk to the fetus. Animal reproductive studies have shown that caspofungin crosses the placental barrier and has caused developmental toxicity in rats and rabbits at doses comparable to clinical exposure. However, there are no adequate and well-controlled studies in pregnant women. The decision to use caspofungin during pregnancy should be made by a specialist after careful risk-benefit assessment.
It is not known whether caspofungin is excreted in human breast milk. In animal studies, caspofungin was detected in the milk of lactating rats. As a precautionary measure, women receiving caspofungin should not breastfeed during treatment. The decision to discontinue breastfeeding or to discontinue/abstain from therapy should take into account the benefit of breastfeeding for the child and the benefit of therapy for the mother.
Fertility: Animal studies have shown no effects on fertility at clinically relevant doses. However, there are no data on the effects of caspofungin on human fertility.
How Does Caspofungin Demo S.A. Interact with Other Drugs?
Drug interactions with caspofungin are generally limited compared to azole antifungals because caspofungin is not significantly metabolized by the cytochrome P450 system and does not inhibit or induce major CYP enzymes. However, several clinically important interactions do exist and must be carefully managed.
Major Interactions
| Drug | Effect | Clinical Action |
|---|---|---|
| Cyclosporine | Increases caspofungin AUC by ~35%; transient elevation of hepatic ALT and AST observed in healthy volunteers | Co-administration should be carefully evaluated. Monitor liver function tests closely if used together. |
| Tacrolimus | Caspofungin reduces tacrolimus AUC by ~20% and Cmax by ~16% | Monitor tacrolimus blood levels and adjust dose accordingly. |
| Rifampicin | Potent enzyme inducer; may reduce caspofungin plasma concentrations | Increase caspofungin maintenance dose to 70 mg daily (after the 70 mg loading dose). |
Minor Interactions and Dose Adjustments
| Drug | Effect | Clinical Action |
|---|---|---|
| Phenytoin | Enzyme inducer; may decrease caspofungin levels | Consider increasing caspofungin to 70 mg daily. |
| Carbamazepine | Enzyme inducer; may decrease caspofungin levels | Consider increasing caspofungin to 70 mg daily. |
| Dexamethasone | Enzyme inducer; may decrease caspofungin levels | Consider increasing caspofungin to 70 mg daily. |
| Efavirenz / Nevirapine | Non-nucleoside reverse transcriptase inhibitors; may reduce caspofungin levels | Consider increasing caspofungin to 70 mg daily. |
| Amphotericin B | No clinically significant pharmacokinetic interaction | No dose adjustment required. Combination may be used when clinically appropriate. |
Unlike azole antifungals, caspofungin does not significantly interact with the CYP450 enzyme system. It does not inhibit CYP1A2, CYP2A6, CYP2C9, CYP2C19, CYP2D6, CYP2E1, or CYP3A4. This means it has fewer drug interactions than many other antifungal agents. However, always provide your medical team with a complete list of all medications, supplements, and herbal products you are taking.
What Is the Correct Dosage of Caspofungin Demo S.A.?
Caspofungin Demo S.A. is always administered by a healthcare professional in a hospital or clinical setting. The powder must be reconstituted with sterile water and then further diluted with sodium chloride 0.9% or Ringer’s lactate solution before intravenous infusion. The infusion should be given slowly over approximately 1 hour. It must never be given as a bolus injection.
Adults
Standard Adult Dosing
- Loading dose (Day 1): 70 mg as a single intravenous infusion
- Maintenance dose (Day 2 onwards): 50 mg once daily as a single intravenous infusion
- Duration: Treatment duration is guided by the patient’s clinical and microbiological response. For invasive candidiasis, treatment should continue for at least 14 days after the last positive culture and resolution of signs and symptoms.
Dose Adjustment with Enzyme Inducers
When co-administered with rifampicin, phenytoin, carbamazepine, dexamethasone, or efavirenz/nevirapine, the maintenance dose should be increased to 70 mg daily (after the standard 70 mg loading dose on Day 1).
Hepatic Impairment (Adults)
- Mild (Child-Pugh 5–6): No dose adjustment needed.
- Moderate (Child-Pugh 7–9): Loading dose 70 mg on Day 1, then 35 mg daily.
- Severe (Child-Pugh >9): No clinical data available; use is not recommended.
Children (3 months to 17 years)
Pediatric Dosing (Based on Body Surface Area)
- Loading dose (Day 1): 70 mg/m² (maximum 70 mg)
- Maintenance dose (Day 2 onwards): 50 mg/m² daily (maximum 70 mg/day)
If the 50 mg/m² dose is well tolerated but does not provide an adequate clinical response, the dose may be increased to 70 mg/m² daily (maximum 70 mg/day).
Neonates and Infants (<3 months)
Neonatal Dosing
Limited data suggest that a dose of 25 mg/m² daily may achieve exposures similar to the adult 50 mg dose. In some clinical settings, higher doses have been explored. Neonatal dosing should be determined by a specialist experienced in treating invasive fungal infections in this population.
Elderly Patients
No dose adjustment is required based on age alone. In clinical trials, a sufficient number of patients aged 65 years and over were treated with caspofungin to determine that no overall differences in safety or efficacy were observed between these patients and younger adults. However, elderly patients are more likely to have hepatic impairment or reduced organ function, so appropriate dose adjustments should be considered based on individual patient assessment.
Missed Dose
Because caspofungin is administered by healthcare professionals in a clinical setting, missed doses are uncommon. If a dose is inadvertently missed, it should be administered as soon as possible. The next dose should then be given at the regularly scheduled time. Do not double the dose to compensate for a missed dose.
Overdose
In clinical studies, the highest single dose tested was 210 mg in adult volunteers, which was generally well tolerated. Caspofungin is not dialyzable, meaning hemodialysis will not remove it from the body. There is no specific antidote for caspofungin overdose. Treatment should be supportive, with monitoring of vital signs and liver function. In case of suspected overdose, contact your local poison control center or emergency medical services immediately.
What Are the Side Effects of Caspofungin Demo S.A.?
Like all medicines, Caspofungin Demo S.A. can cause side effects, although not everybody gets them. The side effects are grouped below by how frequently they occur. Most adverse reactions observed in clinical trials were mild to moderate in severity and did not require discontinuation of treatment.
If you experience any of the side effects listed below, or any other unusual symptoms, inform your healthcare team immediately. Some side effects can be serious and require prompt medical attention.
Very Common (affects more than 1 in 10 patients)
Frequency: >10%
- Fever (pyrexia)
- Decreased hemoglobin
- Elevated liver enzymes (ALT, AST)
- Decreased serum albumin
- Hypokalemia (low potassium)
Common (affects 1 to 10 in 100 patients)
Frequency: 1–10%
- Headache
- Nausea and vomiting
- Diarrhea
- Abdominal pain
- Rash, pruritus (itching), erythema (skin redness)
- Infusion-site reactions (phlebitis, pain, swelling)
- Elevated alkaline phosphatase and bilirubin
- Tachycardia (rapid heart rate)
- Flushing
- Dyspnea (shortness of breath)
- Hypomagnesemia (low magnesium)
- Hypocalcemia (low calcium)
- Anemia, thrombocytopenia
- Chills, fatigue
Uncommon (affects 1 to 10 in 1,000 patients)
Frequency: 0.1–1%
- Hepatotoxicity (clinically significant liver damage)
- Jaundice
- Peripheral edema
- Tremor
- Insomnia
- Hypertension / hypotension
- Bronchospasm
- Urticaria (hives)
Rare (affects fewer than 1 in 1,000 patients)
Frequency: <0.1%
- Anaphylaxis / anaphylactic shock
- Stevens-Johnson syndrome (SJS)
- Toxic epidermal necrolysis (TEN)
- Hepatic failure
- Severe hepatic necrosis
Contact your healthcare team immediately if you experience: severe skin rash with blistering or peeling, difficulty breathing, swelling of the face or throat, yellowing of the skin or eyes (jaundice), dark urine, or signs of a severe allergic reaction. These symptoms may indicate a rare but serious side effect that requires urgent treatment.
The safety profile of caspofungin has been evaluated in clinical trials involving more than 3,000 patients. The most common reason for discontinuation was elevated liver enzymes, which occurred in approximately 2% of patients. In post-marketing surveillance, additional rare adverse reactions have been identified, emphasizing the importance of ongoing pharmacovigilance.
Patients should also be aware that many side effects observed in clinical trials may be related to the underlying serious illness rather than the medication itself. Invasive fungal infections typically occur in immunocompromised patients who are often receiving multiple medications simultaneously, making it difficult to attribute individual symptoms to a specific drug.
How Should You Store Caspofungin Demo S.A.?
Proper storage of Caspofungin Demo S.A. is essential to maintain the stability and efficacy of the medication. Since this is a hospital-use medication, storage is typically managed by pharmacy or nursing staff, but understanding the requirements is important for all healthcare professionals involved in its handling.
- Unopened vials: Store in a refrigerator at 2–8°C. Keep the vials in the original carton to protect from light.
- Reconstituted concentrate: After reconstituting the powder with sterile water for injection, the concentrate may be stored at 25°C or below for up to 24 hours prior to further dilution.
- Diluted infusion solution: Once diluted in sodium chloride 0.9%, 0.45%, or 0.225%, or Ringer’s lactate, the solution should be used within 24 hours at 25°C or below, or within 48 hours if refrigerated at 2–8°C.
- Do not freeze either the reconstituted concentrate or the diluted infusion solution.
- Do not use the medication after the expiry date stated on the vial and carton.
- Visual inspection: The reconstituted and diluted solution should be clear and colorless. Do not use if the solution is cloudy, discolored, or contains particulate matter.
Caspofungin must not be mixed with or infused simultaneously with solutions containing glucose (dextrose), as it is physically incompatible with glucose-containing diluents. Always use sodium chloride or Ringer’s lactate solutions for dilution.
As with all medications, keep Caspofungin Demo S.A. out of the reach of children. Do not dispose of medications via wastewater or household waste — follow local guidelines for proper disposal of pharmaceutical waste to help protect the environment.
What Does Caspofungin Demo S.A. Contain?
Understanding the full composition of Caspofungin Demo S.A. is important, particularly for patients with known allergies or sensitivities to specific excipients. The following table provides a complete breakdown of the product’s contents:
| Component | Type | Function |
|---|---|---|
| Caspofungin (as acetate) | Active ingredient | Echinocandin antifungal agent — inhibits fungal cell wall synthesis |
| Sucrose | Excipient | Bulking agent / lyoprotectant (protects the drug during freeze-drying) |
| Mannitol (E421) | Excipient | Bulking agent / tonicity adjuster |
| Glacial acetic acid | Excipient | pH adjustment |
| Sodium hydroxide | Excipient | pH adjustment |
The powder is white to off-white in appearance. Each vial contains 50 mg of caspofungin (as caspofungin acetate). When reconstituted with 10.5 mL of sterile water for injection, the resulting concentrate has a concentration of approximately 5 mg/mL of caspofungin. This concentrate must then be further diluted before intravenous infusion.
Sucrose content: Each 50 mg vial contains approximately 39 mg of sucrose. This is a negligible amount and is not considered clinically significant for patients with diabetes mellitus or hereditary fructose intolerance, although healthcare providers should be aware of this content.
Sodium content: This medicine contains less than 1 mmol sodium (23 mg) per vial, meaning it is essentially sodium-free. This is relevant for patients on controlled-sodium diets.
Frequently Asked Questions About Caspofungin Demo S.A.
Caspofungin Demo S.A. is an echinocandin antifungal used to treat three main conditions: (1) invasive candidiasis, including bloodstream infections caused by Candida species; (2) invasive aspergillosis in patients who cannot tolerate or have not responded to other antifungal therapies; and (3) empirical therapy for presumed fungal infections in febrile neutropenic patients. It is administered exclusively by intravenous infusion in hospital settings.
Caspofungin belongs to the echinocandin class, which works by a unique mechanism — inhibiting fungal cell wall synthesis rather than targeting the cell membrane (like azoles and amphotericin B). This unique mechanism means echinocandins have fewer drug interactions than azoles and less nephrotoxicity than amphotericin B. However, echinocandins are only available as intravenous formulations and have a narrower spectrum of activity.
Caspofungin must be administered as an intravenous infusion over approximately 1 hour, which typically requires a hospital or clinical setting. However, in some cases, outpatient parenteral antimicrobial therapy (OPAT) services may allow for home administration under the supervision of trained healthcare professionals. This would require proper infrastructure for IV access and monitoring. Discuss this option with your healthcare team if extended treatment is needed.
Treatment duration depends on the type and severity of the infection and the patient’s clinical response. For invasive candidiasis, treatment should continue for at least 14 days after the last positive blood culture and resolution of signs and symptoms. For empirical therapy in febrile neutropenia, treatment is typically continued until neutropenia resolves. The treating physician will determine the appropriate duration based on individual circumstances.
Yes, caspofungin has important interactions with several medications. Cyclosporine can increase caspofungin levels and raise liver enzymes. Enzyme inducers such as rifampicin, phenytoin, carbamazepine, and dexamethasone may reduce caspofungin levels, requiring a higher maintenance dose of 70 mg daily. Caspofungin can also reduce tacrolimus levels by about 20%. However, compared to azole antifungals, caspofungin has relatively few drug interactions because it does not significantly affect the CYP450 enzyme system.
Caspofungin should only be used during pregnancy when the potential benefit justifies the potential risk to the fetus. Animal studies have shown developmental toxicity, but there are no adequate studies in pregnant women. The decision to use caspofungin during pregnancy should be made by a specialist after careful assessment of the risks and benefits. Breastfeeding is not recommended during treatment because it is unknown whether the drug passes into human breast milk.
References
This article is based on the following peer-reviewed sources and authoritative medical guidelines:
- European Medicines Agency (EMA). Caspofungin Summary of Product Characteristics (SmPC). Available from: www.ema.europa.eu. Accessed January 2026.
- Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America (IDSA). Clinical Infectious Diseases. 2016;62(4):e1–e50. doi:10.1093/cid/civ933
- Cornely OA, Bassetti M, Calandra T, et al. ESCMID Guideline for the Diagnosis and Management of Candida Diseases 2012: Non-neutropenic Adult Patients. Clinical Microbiology and Infection. 2012;18(Suppl 7):19–37.
- Patterson TF, Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the IDSA. Clinical Infectious Diseases. 2016;63(4):e1–e60.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List (2023). Geneva: WHO; 2023.
- British National Formulary (BNF). Caspofungin. Available from: bnf.nice.org.uk. Accessed January 2026.
- U.S. Food and Drug Administration (FDA). Cancidas (caspofungin acetate) Prescribing Information. Available from: www.accessdata.fda.gov. Accessed January 2026.
- Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. New England Journal of Medicine. 2002;347(25):2020–2029. doi:10.1056/NEJMoa021585
Editorial Team
This article has been written, reviewed, and approved by the iMedic Medical Editorial Team. Our team consists of licensed physicians, clinical pharmacists, and medical writers with expertise in infectious disease and clinical pharmacology.
iMedic Medical Editorial Team — specialists in infectious disease and clinical pharmacology with documented academic credentials and clinical experience.
iMedic Medical Review Board — independent review according to IDSA, ESCMID, EMA, and FDA guidelines. GRADE evidence framework applied.
Evidence standard: Level 1A — based on systematic reviews, meta-analyses, and randomized controlled trials. All medical claims are supported by peer-reviewed sources cited in the references section above.
Conflict of interest: None. iMedic has no commercial funding, pharmaceutical sponsorship, or advertising relationships.