Caspofungin, a glucan synthesis inhibitor, is being developed as a parenteral antifungal agent. The pharmacokinetics of caspofungin following 1-h intravenous infusions in healthy men was investigated in four phase I studies. In an alternating two-panel (six men each), rising-single-dose study, plasma drug concentrations increased proportionally with the dose following infusions of 5 to 100 mg. The -phase half-life was 9 to 10 h. The plasma drug clearance rate averaged 10 to 12 ml/min. Renal clearance of unchanged drug was a minor pathway of elimination (ϳ2% of the dose). Multiple-dose pharmacokinetics were investigated in a 2-week, serial-panel (5 or 6 men per panel) study of doses of 15, 35, and 70 mg administered daily; a 3-week, single-panel (10 men) study of a dose of 70 mg administered daily; and a parallel panel study (8 men) of a dose of 50 mg administered daily with or without a 70-mg loading dose on day 1. Moderate accumulation was observed with daily dosing. The degree of drug accumulation and the time to steady state were somewhat dose dependent. Accumulation averaged 24% at 15 mg daily and ϳ50% at 50 and 70 mg daily. Mean plasma drug concentrations were maintained above 1.0 g/ml, a target selected to exceed the MIC at which 90% of the isolates of the most clinically relevant species of Candida were inhibited, throughout therapy with daily treatments of 70 or 50 mg plus the loading dose, while they fell below the target for the first 2 days of a daily treatment of 50 mg without the loading dose. Caspofungin infused intravenously as a single dose or as multiple doses was generally well tolerated. In conclusion, the pharmacokinetics of caspofungin supports the clinical evaluation of once-daily dosing regimens for efficacy against fungal infections.Caspofungin (Cancidas; MK-0991) is an echinocandin that was recently approved by the U.S. Food and Drug Administration for patients with invasive aspergillosis who are refractory to or intolerant of standard therapy. Caspofungin inhibits the synthesis of 1,3--D-glucan, which forms a critical component of many fungal cell walls (3). It has been shown to have potent activity in vitro against many clinically important fungi, including Candida spp. and Aspergillus spp. (2, 7, 9; M. Del Poeta, W. A. Schell, and J. R. Perfect, Abstr. 36th Intersci. Conf. Antimicrob. Agents Chemother., abstr. F33, 1996). In in vivo studies with healthy and immunocompromised animals, prolonged survival in models of disseminated aspergillosis and candidiasis and clearance of Candida spp. from a target organ have been demonstrated with caspofungin treatment (1,5,6 , abstr. 1103, p. 371, 2000).Caspofungin has been developed as a parenteral agent due to its high molecular weight, unfavorable log P (partition coefficient), and extremely poor oral bioavailability in animals. In all the clinical studies, caspofungin has been administered as a constant-rate, 1-h intravenous (i.v.) infusion. This paper describes the results from four phase I studies conducted with healthy male subjects to ...