Caspofungin and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine Injection
Caspofungin
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased plasma levels of caspofungin and increased risk of hepatic enzyme elevations
Interaction Deep Dive
CycloSPORINE increased the area under the concentration-time curve of caspofungin in two small clinical studies, and was associated with transient liver enzyme elevations. The combination should be limited to patients for whom the potential benefit outweighs the risk1.
Why it happens (mechanism)
Unknown
Literature reports
3 reports — tap to read
a) CycloSPORINE increased the area under the concentration-time curve (AUC) of caspofungin by approximately 35% in two clinical studies in which study participants received either one 4 mg/kg dose or two 3 mg/kg doses of cycloSPORINE together with caspofungin. No changes were observed in cycloSPORINE plasma levels. Clinical studies involving the coadministration of caspofungin and cycloSPORINE also revealed transient liver transaminase level increases. In a study of 4 healthy subjects who received 70 mg caspofungin days 1 through 10 and two doses of 3 mg/kg (12 hours apart) on day 10, 3 subjects experienced alanine transaminase (ALT) level increases 2 to 3 times the ULN. A separate group of 8 subjects in the same study received two 3 mg/kg doses of cycloSPORINE (12 hours apart) day 1 and 35 mg caspofungin days 1 through 3. Two of the 8 subjects experienced ALT increases slightly above normal on day 2. Aspartate transaminase (AST) levels increased in a similar manner, but of a lesser magnitude 1.
b) Concurrent use of caspofungin and cycloSPORINE was associated with an increase in transaminase levels in a retrospective study of 40 immunocompromised patients, 37 of whom were transplant recipients. They received concomitant therapy with caspofungin and cycloSPORINE for 1 to 290 days (median 17.5 days). Fourteen patients (35%) developed transaminase elevations greater than 5 times the ULN or greater than 3 times the baseline level during concomitant therapy or during the 14-day follow-up period; five of the cases were possibly related to concomitant therapy. Bilirubin elevation was observed in 1 patient and was considered possibly related to concomitant therapy. Clinical evidence of hepatotoxicity or serious hepatic events were not observed in any of the patients in this study 1.
c) No elevations in hepatic enzymes were observed in 4 patients treated with caspofungin and cycloSPORINE in a compassionate use study. Patients who were infected with invasive aspergillosis were treated with caspofungin 50 mg daily and cycloSPORINE for 2 to 56 days. None of the 4 patients in this prospective study experienced increases in hepatic enzymes 1.
Common questions
Can I take Caspofungin and Cyclosporine Injection together?
Increased plasma levels of caspofungin and increased risk of hepatic enzyme elevations Always confirm with your pharmacist or prescriber before making any change.
How serious is the Caspofungin and Cyclosporine Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Caspofungin or Cyclosporine Injection need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: CANCIDAS(TM) IV injection, caspofungin acetate IV injection. Merck and Co Inc, Whitehouse Station, NJ, 2009.
Keep reading about Cyclosporine Injection
Keep reading about Caspofungin
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