Caspofungin: veterinary dose and monograph

At a glance

Drug class

Antifungal

Also known as

Cancidas, Caspofungin acetate

Species with doses

Dogs and Cats

General dose range

1 mg/kg IV q24h — check the species tables for the indication

Routes

IV

Last reviewed

1 October 2026

Indications

• Invasive candidiasis / candidaemia — especially azole-resistant Candida
• Invasive aspergillosis refractory to or intolerant of first-line agents
• Serious fungal infection where azole/amphotericin toxicity or resistance limits options

Caspofungin dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

• Refractory aspergillosis (Aspergillus deflectus) — single case report: Plumb’s 10e p.196 (extra-label, ONE case report): a dog progressing despite voriconazole and amphotericin B lipid complex received 1 mg/kg IV over 1 hour every 24 hours, diluted in 250 mL 0.9% NaCl; after 6 weeks it was given 3 times weekly for 2 months, then on 3 consecutive days every 3 weeks for 4 months. Disease recurred a year later. Papich 5e has no monograph.

Cats

• Sino-orbital aspergillosis — daily: Plumb’s 10e p.196 (extra-label): 1 mg/kg IV once daily for 14 to 22 days, the dose given in 20 mL 0.9% NaCl over 1 hour. Papich 5e has no monograph.
• Sino-orbital aspergillosis — load then 0.75 mg/kg: Plumb’s 10e p.196 (extra-label, pharmacokinetic study): 1 mg/kg IV loading dose, then 0.75 mg/kg IV every 24 hours gave the optimal Cmax:MEC ratio and was used successfully in 2 cats for 2–3 weeks. Alternative with a similar Cmax:MEC: 1 mg/kg IV load, then 1 mg/kg IV every 72 hours.

Birds

• No reference dose for this species: Neither Papich 5e nor Plumb’s 10e (pp.195–197 dose dogs and cats only) gives a caspofungin dose for birds.

Contraindications

Cryptococcosis or mucormycosis (echinocandins are inactive — do not use). Significant hepatic impairment (reduce dose — hepatically cleared). Known hypersensitivity. Reserve for refractory/resistant invasive mycoses (cost/stewardship).

Adverse effects

• Generally well tolerated
• Infusion-related reactions (histamine-mediated — fever, flushing) with rapid infusion
• Hepatic enzyme elevation
• GI upset; injection-site phlebitis

Drug interactions

• Ciclosporin: raises caspofungin levels / hepatic effects — monitor
• CYP inducers (rifampin, phenobarbital): reduce caspofungin levels (may need dose increase)
• Tacrolimus: caspofungin lowers tacrolimus levels
• Fewer interactions than azoles overall

Pregnancy and lactation

Limited data; reserve for life-threatening fungal infection where benefit outweighs risk.

Monitoring

• Liver enzymes (hepatic clearance/hepatotoxicity)
• Infusion-related reactions (temperature, flushing) — infuse slowly
• Clinical/mycological response; confirm the organism is echinocandin-susceptible (NOT Cryptococcus/Mucorales)
• Drug interactions (ciclosporin/tacrolimus, CYP inducers)

Toxicity and overdose

Well tolerated with LOW nephrotoxicity (a key advantage over amphotericin). Main effects: infusion-related histamine reactions (slow the infusion), hepatic enzyme elevation (monitor), and GI upset. Overdose has a fairly wide margin. The clinical "failure" is using it for organisms it doesn't cover (Cryptococcus, Mucorales).

Management: No specific antidote. Supportive care; slow/stop infusion for infusion reactions (antihistamine if needed); monitor and support liver function. Effects are generally manageable.

Clinical pearls

• A modern RESERVE antifungal with a novel cell-wall target — valuable for azole-resistant invasive Candida and refractory aspergillosis, with low nephrotoxicity vs amphotericin
• Knows its lane: NO activity against Cryptococcus or the Mucorales — don't use it for those (choose fluconazole/amphotericin/posaconazole respectively)
• IV only, once daily, slow infusion (histamine reactions); reduce dose in hepatic impairment
• Fewer interactions than azoles — but watch ciclosporin/tacrolimus; expensive and specialist

Mechanism of action

An echinocandin that non-competitively inhibits β-(1,3)-D-glucan synthase, the enzyme that builds β-1,3-glucan — an essential structural polymer of the FUNGAL CELL WALL (absent in mammalian cells). Loss of glucan weakens the wall, causing osmotic lysis and death (fungicidal against Candida, fungistatic against Aspergillus). The unique cell-wall target explains its activity against azole-resistant Candida and its lack of cross-resistance — but also its inactivity against organisms with little β-1,3-glucan (Cryptococcus, Mucorales).

Formulations and products

• IV infusion 50 / 70 mg vial (reconstitute)
• Cancidas — 50 / 70 mg vial, IV infusion (reconstitute) (human-label)

Storage

Vials: REFRIGERATE (2–8 °C); reconstitute/dilute per label and infuse over ~1 h. Protect from light; use promptly after preparation.

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

Other antifungals

• Amphotericin B
• Clotrimazole
• Enilconazole
• Fluconazole
• Griseofulvin
• Itraconazole
• Ketoconazole
• Lime Sulfur (Lime Sulphur Dip)

Frequently asked questions