Caspofungin Disease Interactions

Caspofungin is primarily metabolized by the liver. In a single-dose study, plasma concentrations of caspofungin after a 70 mg dose in patients with mild hepatic impairment (Child-Pugh score 5 to 6) increased by approximately 55% compared to healthy control subjects, whereas patients with moderate hepatic impairment (Child-Pugh score 7 to 9) had an average plasma increase of 76%. In a 14-day multiple-dose study (70 mg on the first day followed by 50 mg daily), plasma concentrations in patients with mild hepatic impairment were increased modestly by about 19% to 25% on days 7 and 14 relative to healthy control subjects. No dosage adjustment is necessary in patients with mild hepatic impairment. For patients with moderate hepatic impairment, a reduced dosage of 35 mg/day is recommended following the initial 70 mg loading dose. There is no clinical experience with caspofungin in patients with severe hepatic impairment.

Laboratory abnormalities in liver function tests have been observed in healthy volunteers and patients treated with echinocandins, and clinical hepatic abnormalities have occurred in some patients with serious underlying conditions who were receiving multiple concomitant medications with echinocandin therapy. Isolated cases of significant hepatic dysfunction, hepatitis, or worsening hepatic failure have also been reported, although a causal relationship has not been established. Therapy with echinocandins should be administered cautiously in patients with preexisting liver disease. Liver function should be monitored regularly during therapy.