Micafungin

Aka: Micafungin, Mycamine

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II. Indications

  1. Conditions
    1. Esophageal Candidiasis
    2. Candidemia (systemic Candidiasis, candida peritonitis or abscess)
    3. Candida prophylaxis in Bone Marrow Transplant patients
    4. Invasive Aspergillosis prophylaxis (off-label in adults)
  2. Activity
    1. Candida species (including those resistant to Azole Antifungals)
    2. Aspergillus species (some activity)
    3. Pneumocystis jiroveci

III. Contraindications

  1. Resistant organisms
    1. Cryptococcus species
    2. Trichosporon species
    3. Dimorphic Fungi (e.g. Coccidioides, Blastomyces, Histoplasma)

IV. Mechanism

  1. Echinocandin (Cyclic Lipopeptide)
    1. Inhibits synthesis of beta-(1,3)-D-Glucan a key cell wall component
    2. Semi-synthetic derived from the fungus Coleophama empedri

V. Medications

  1. Micafungin intravenous infusion 50 mg, single use vials
    1. Diluted solution must be protected from light
    2. Mixing with other agents may cause Micafungin to precipitate
      1. Flush infusion line with Normal Saline before infusion

VI. Dosing: Adult

  1. General
    1. Flush IV line with Normal Saline before infusion
  2. Esophageal Candidiasis
    1. Infuse 150 mg IV (over 1 hour) daily
  3. Candidemia (systemic Candidiasis, candida peritonitis or abscess)
    1. Infuse 100 mg IV (over 1 hour) daily
  4. Candida prophylaxis in Bone Marrow Transplant patients
    1. Infuse 50 mg IV (over 1 hour) daily
  5. Invasive Aspergillosis prophylaxis (off-label)
    1. Infuse 50 mg IV (over 1 hour) daily

VII. Dosing: Child (age >=4 months old)

  1. General
    1. Flush IV line with Normal Saline before infusion
    2. Micafungin concentrations >1.5 mg/ml should be infused by Central Line
  2. Esophageal Candidiasis
    1. Weight <30 kg: 3 mg/kg (over 1 hour) IV daily
    2. Weight >30 kg: 2.5 mg/kg (max 150 mg, over 1 hour) IV daily
  3. Candidemia (systemic Candidiasis, candida peritonitis or abscess)
    1. Infuse 2 mg/kg (max 100 mg, over 1 hour) IV daily
  4. Candida prophylaxis in Bone Marrow Transplant patients
    1. Infuse 1 mg/kg (max 50 mg, over 1 hour) IV daily

VIII. Adverse Effects

  1. Generally well tolerated
  2. Reported
    1. Nausea or Vomiting
    2. Diarrhea
    3. Headache
    4. Facial Edema
    5. Histamine reactions (Pruritus, Urticaria)
      1. Occurs with more rapid infusions (infuse over 1 hour)
  3. Serious (uncommon to rare)
    1. Anaphylaxis
    2. Hepatotoxicity
    3. Hemolytic Anemia
    4. Thrombocytopenia
    5. Hypokalemia
    6. Renal dysfunction

IX. Safety

  1. Unknown safety in Lactation
  2. Pregnancy Category C
    1. Teratogenic in animals (and insufficient data in humans)

X. Pharmacokinetics

  1. Elimination Half-Life: 11 to 17 hours
  2. Metabolism: Non-CYP Hepatic
    1. Decrease dose in moderate hepatic Impairment
    2. No renal dose adjustment needed
  3. Excretion
    1. Stool
    2. Not removed with Hemodialysis

XI. Drug Interactions

  1. Micafungin increases levels of other drugs
    1. Sirolimus (levels increased 21%)
    2. Nifedipine (levels increased 18%)

XII. Resources

  1. Micafungin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a064c4a7-25ec-4a2c-afc2-703491a4a38b

XIII. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2012) Med Lett Drugs Ther 10(120): 61-8 [PubMed]
  3. (2005) Med Lett Drugs Ther 47(1211): 51-2 [PubMed]

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