Dosage reduction in patients with moderately impaired liver function is recommended. No clinical data exist regarding the use of caspofungin in patients with severely impaired liver function. Sensitivity reactionsReactions due to histamine release (rash, facial swelling, pruritus, sensation of warmth and one case of anaphylaxis) have been seen. Health-care providers should carefully watch for these reactions. Drug resistanceIn a few patients with infections caused by Candida albicans, mutants with reduced sensitivity to caspofungin have been noticed. Currently there are no data regarding development of resistance in other fungi than C. albicans. Pregnancy and lactation
Caspofungin has been shown in animal studies to have embroyotoxic properties, and therefore has been assigned to class C. It should only be given to pregnant women if the benefit to the mother clearly outweighs the potential risk to her fetus. The drug is found in the milk of lactating rats, but it is not known whether this is seen in humans. Thus, lactating women should be treated cautiously. Geriatric patients
Ordinarily, no dose adjustments are necessary, however, greater sensitivity of some older individuals cannot be ruled out. Pediatric patients
Caspofungin is FDA approved for pediatric patients 3 months and older. Dosing is based on body surface area (BSA) as calculated by the Mosteller formula. Side effects
Compared to amphotericin B, caspofungin seems to have a relatively low incidence of side effects.
Martin Brady holds the Guinness world record for the slowest heart rate with a certified rate over a minute duration of 27 BPM. Professional cyclist Miguel Indurain had, during his career, a resting heart rate of 28 BPM. See also
Bezold–Jarisch reflex

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