Skip to Content

Cancidas Side Effects

Generic Name: caspofungin

Note: This document contains side effect information about caspofungin. Some of the dosage forms listed on this page may not apply to the brand name Cancidas.

In Summary

More frequent side effects include: pruritus. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to caspofungin: intravenous powder for solution

Along with its needed effects, caspofungin (the active ingredient contained in Cancidas) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking caspofungin:

More Common

  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • blue lips, fingernails, or skin
  • blurred vision
  • changes in skin color
  • chest pain
  • confusion
  • cough
  • cracked lips
  • decreased urine
  • diarrhea
  • difficult or troubled breathing
  • difficulty with swallowing
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • dry mouth
  • fever
  • headache
  • increased thirst
  • irregular heartbeat
  • irregular, fast, slow, or shallow breathing
  • loss of appetite
  • mood changes
  • muscle pain or cramps
  • nausea
  • nervousness
  • numbness or tingling in your hands, feet, or lips
  • pain or redness at the injection site
  • pain, tenderness, or swelling of the foot or leg
  • pale skin
  • pounding in the ears
  • rapid weight gain
  • seizures
  • slow or fast heartbeat
  • sneezing
  • sore throat
  • sores, ulcers, or white spots on the lips, tongue, or inside the mouth
  • sweating
  • tightness in the chest
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • unusual weight gain or loss
  • vomiting

Less Common

  • Bloody urine
  • decreased frequency or amount of urine
  • increased blood pressure
  • lower back or side pain
  • weight gain
  • yellow eyes or skin

Incidence Not Known

  • Black, tarry stools
  • bladder pain
  • bleeding gums
  • blood in the urine or stools
  • bloody nose
  • chest pain or discomfort
  • clay-colored stools
  • cloudy urine
  • constipation
  • dark urine
  • decreased appetite
  • depression
  • drowsiness
  • fever with or without chills
  • flushed, dry skin
  • frequent urge to urinate
  • fruit-like breath odor
  • general feeling of tiredness or weakness
  • incoherent speech
  • increased hunger
  • increased urination
  • indigestion
  • itching
  • light-colored stools
  • metallic taste
  • muscle spasms (tetany) or twitching seizures
  • muscle weakness
  • no blood pressure or pulse
  • noisy, rattling breathing
  • pain or discomfort in the arms, jaw, back, or neck
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • pinpoint red spots on the skin
  • rapid weight gain
  • rash
  • right upper abdominal or stomach pain and fullness
  • shakiness in the legs, arms, hands, or feet
  • stomach pain, continuous
  • stomach pain or tenderness
  • stopping of heart
  • trembling or shaking of the hands or feet
  • troubled breathing at rest
  • ulcers, sores, or white spots in the mouth
  • unconsciousness
  • unexplained weight loss
  • unpleasant breath odor
  • vomiting of blood
  • weakness
  • weight loss

Some side effects of caspofungin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More Common

  • Flushing, redness of the skin
  • unusually warm skin

Incidence Not Known

  • Back pain
  • belching
  • blistering, peeling, or loosening of the skin
  • bloated or feeling of fullness
  • bumps on the skin
  • difficulty in moving
  • dry, red, hot, or irritated skin
  • fear
  • flaking and falling off of the skin
  • heartburn
  • hives or welts
  • indigestion
  • joint or muscle pain
  • lack or loss of strength
  • muscle pain or stiffness
  • pressure in the stomach
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • redness of the skin
  • sleepiness or unusual drowsiness
  • small red or purple spots on the skin
  • stomach discomfort, upset, or pain
  • swelling of the abdominal or stomach area
  • trouble sleeping

For Healthcare Professionals

Applies to caspofungin: intravenous powder for injection


Gastrointestinal side effects have included diarrhea (up to 27%), vomiting (up to 17%), nausea (up to 15%), and abdominal pain (up to 9%). Anorexia, abdominal distension, upper abdominal pain, constipation, and dyspepsia have been reported in less than 5% of patients. Pancreatitis has been reported during postmarketing experience.[Ref]


Other side effects have included fever (up to 40%), infusion-related adverse reactions (defined as a systemic event, such as flushing, fever, chills, hypotension, hypertension, tachycardia, dyspnea, tachypnea, rash, or anaphylaxis; up to 35%), chills (up to 23%), septic shock (up to 14%), aspergillosis (13%), peripheral edema (up to 11%), sepsis (up to 7%), mucosal inflammation (up to 6%), flu-like illness, malaise, pain, and warm sensation. Asthenia, fatigue, edema, flushing, and bacteremia have been reported in less than 5% of patients. Swelling has been reported during postmarketing experience.[Ref]


Metabolic side effects have included decreased blood potassium (up to 23%), increased blood alkaline phosphatase (up to 22%), hypokalemia (up to 10%), decreased blood albumin (up to 8.6%), decreased blood magnesium (up to 7%), increased blood glucose (6%), decreased total serum protein (3.1%), and elevated serum calcium (1.1%). Decreased appetite, fluid overload, hypomagnesemia, hypercalcemia, and hyperglycemia have been reported in less than 5% of patients.[Ref]


A 68-year-old male experienced reversible severe thrombocytopenia coincident with caspofungin (the active ingredient contained in Cancidas) therapy. He was admitted for shortness of breath, coughing, abdominal pain, and intermittent fever, which had persisted for 10 days. Two blood cultures obtained on admission revealed Candida albicans. He was given caspofungin 70 mg for 1 day, then 50 mg per day. One week after receiving caspofungin therapy, his platelet count dropped precipitously from 136 x 10(3)/mm3 to 24 x 10(3)/mm3, reaching a nadir at 3 x 10(3)/mm3 in 2 days. Caspofungin was discontinued, and his platelet count returned to a level above 150 x 10(3)/mm3 within 10 days.[Ref]

Hematological side effects have included decreased hemoglobin (up to 21%), decreased hematocrit (up to 18%), decreased white blood cell count (up to 12%), anemia (up to 11%), eosinophilia (2.3% to 3.2%), decreased platelets (1.5% to 3.1%), and hypoalbuminemia (common). Thrombocytopenia, coagulopathy, febrile neutropenia, and neutropenia have been reported in less than 5% of patients.[Ref]


Respiratory side effects have included respiratory failure (up to 20%), cough (up to 11%), pneumonia (up to 11%), pleural effusion (9%), dyspnea (up to 9%), and rales (7%). Tachypnea, epistaxis, and hypoxia have been reported in less than 5% of patients. Pulmonary edema, adult respiratory distress syndrome, and pulmonary infiltrates have been reported infrequently.[Ref]


Cardiovascular side effects have included hypotension (up to 20%), tachycardia (up to 8%), and hypertension (up to 6%). Arrhythmia, atrial fibrillation, bradycardia, cardiac arrest, and myocardial infarction have been reported in less than 5% of patients.[Ref]


Reported elevations in ALT and AST were accompanied by the use of cyclosporine in some of the patients enrolled in the clinical trials.[Ref]

Hepatic side effects have included elevations in ALT (up to 18%), AST (up to 17%), blood bilirubin (up to 13%), and conjugated bilirubin (up to 8%). Hepatic failure, hepatomegaly, hepatotoxicity, hyperbilirubinemia, and jaundice have been reported in less than 5% of patients. Isolated cases of clinically significant hepatic dysfunction and hepatitis have also been reported. Hepatic necrosis has been reported during postmarketing experience.[Ref]


Local side effects have included phlebitis (up to 25%), thrombophlebitis (11.3% to 15.7%), and infused vein complications (1.5% to 12%). Infusion site pain, infusion site pruritus, and infusion site swelling have been reported in less than 5% of patients.[Ref]


Dermatological side effects have included rash (up to 23%), pruritus (up to 7%), decubitus ulcer (up to 5%), erythema (up to 5%), induration (3.1%), and sweating (1.3%). Petechiae, skin lesion, and urticaria have been reported in less than 5% of patients. At least one case of toxic epidermal necrolysis has been reported. Erythema multiforme, Stevens-Johnson syndrome, and skin exfoliation have been reported during postmarketing experience.[Ref]

Nervous system

Nervous system side effects have included headache (up to 15%) and paresthesia (1.3% to 3.1%). Convulsion, dizziness, somnolence, and tremor have been reported in less than 5% of patients.[Ref]


Renal side effects have included increased blood creatinine (up to 11%), increased blood urea nitrogen (up to 9%), nephrotoxicity (3%), and renal failure (less than 5%). Clinical renal events, regardless of causality, have been reported in 13% of patients. Clinically significant renal dysfunction has been reported during postmarketing experience.[Ref]


Hypersensitivity side effects have included anaphylaxis and possible histamine-mediated symptoms (including reports of rash, facial swelling, angioedema, pruritus, sensation of warmth, or bronchospasm).[Ref]


Genitourinary side effects have included urine positive for red blood cells (10%) and an increase in urine white blood cells (7.7%), protein (1.2% to 4.9%), and red blood cells (1.1% to 3.8%). Urinary tract infection and hematuria have been reported in less than 5% of patients.[Ref]


Psychiatric side effects have included anxiety, confusional state, depression, and insomnia in less than 5% of patients.


Musculoskeletal side effects have included myalgia (3.1%) and musculoskeletal pain (1.3%). Arthralgia, back pain, and pain in extremity have been reported in less than 5% of patients.[Ref]


1. "Product Information. Cancidas (caspofungin)" Merck & Co, Inc, West Point, PA.

2. Maertens J, Raad I, Petrikkos G, et al. "Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy." Clin Infect Dis 39 (2004): 1563-71

3. Cappelletty D, Eiselstein-McKitrick K "The echinocandins." Pharmacotherapy 27 (2007): 369-88

4. Walsh TJ, Teppler H, Donowitz GR, et al. "Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia." N Engl J Med 351 (2004): 1391-402

5. Thompson GR 3rd, Cadena J, Patterson TF "Overview of antifungal agents." Clin Chest Med 30 (2009): 203-15, v

6. Lynch J, Wong-Beringer A "Caspofungin: a potential cause of reversible severe thrombocytopenia." Pharmacotherapy 24 (2004): 1408-11

7. Villanueva A, Arathoon EG, Gotuzzo E, Berman RS, DiNubile MJ, Sable CA "A Randomized Double-Blind Study of Caspofungin versus Amphotericin for the Treatment of Candidal Esophagitis." Clin Infect Dis 33 (2001): 1529-35

8. Keating GM, Jarvis B "Caspofungin." Drugs 61 (2001): 1121-9

9. Kauffman CA "New antifungal agents." Semin Respir Crit Care Med 25 (2004): 233-9

10. Lee MC, Ni YW, Wang CH, Lee CH, Wu TW "Caspofungin-induced severe toxic epidermal necrolysis." Ann Pharmacother 44 (2010): 1116-8

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.