Micafungin


Generic Medicine Info
Indications and Dosage
Intravenous
Invasive candidiasis
Adult: 100 mg once daily by infusion over 1 hr for at least 14 days, may increase to 200 mg once daily if clinical response is inadequate. Continue treatment for at least 1 wk after obtaining 2 sequential –ve blood cultures and after resolution of clinical signs and symptoms.
Child: <16 yr ≤40 kg: 2 mg/kg once daily by infusion over 1 hr for at least 14 days; may increase to 4 mg/kg once daily if clinical response is inadequate. Continue treatment for at least 1 wk after obtaining 2 sequential –ve blood cultures and after resolution of clinical signs and symptoms; >40 kg: Same as adult dose.

Intravenous
Oesophageal candidiasis
Adult: 150 mg once daily by infusion over 1 hr for at least 1 wk after resolution of clinical signs and symptoms.
Child: ≥16 yr ≤40kg: 3 mg/kg once daily by infusion over 1 hr; >40 kg: Same as adult dose.

Intravenous
Prophylaxis of candida infection in haematopoietic stem cell transplantation recipients
Adult: 50 mg once daily by infusion over 1 hr for at least 1 wk after neutrophil recovery.
Child: <16 yr ≤40 kg: 1 mg/kg once daily by infusion over 1 hr; >40 kg: Same as adult dose.
Reconstitution
Reconstitute vials labelled as containing micafungin 50 mg or 100 mg w/ 5 mL of NaCl 0.9% or dextrose 5% inj to provide a soln containing approx 10 mg/mL or 20 mg/mL, respectively. Prepare the soln for IV infusion by adding the contents of the appropriate number of reconstituted vials to 100 mL of NaCl 0.9% or dextrose 5% inj.
Incompatibility
Y-site: Incompatible w/ diltiazem, amiodarone, albumin, cisatracurium, epinephrine, insulin (regular), dobutamine, labetalol, vecuronium, midazolam, meperidine, morphine, mycophenolate, nesiritide, nicardipine, ondansetron, octreotide, phenytoin, rocuronium, telavancin.
Contraindications
Hypersensitivity to micafungin or other echinocandins.
Special Precautions
Patient w/ pre-existing risk of malignancy. Severe hepatic impairment. Childn. Pregnancy and lactation.
Adverse Reactions
Nausea, vomiting, diarrhoea, pyrexia, thrombocytopenia, headache, histamine-mediated symptoms (e.g. pruritus, rash, swelling, vasodilation), renal dysfunction or acute renal failure, inj site reactions (e.g. phlebitis, thrombophlebitis). Rarely, haemolysis (e.g. acute intravascular haemolysis, haemolytic anaemia).
Potentially Fatal: Severe hepatic dysfunction, hepatitis or hepatic failure; anaphylaxis and anaphylactoid reactions, including shock.
IV/Parenteral: C
Monitoring Parameters
Monitor liver function.
Drug Interactions
May increase exposure of amphotericin B desoxycholate, sirolimus, nifedipine, itraconazole.
Action
Description: Micafungin prevents the synthesis of 1,3-β-D-glucan, an essential fungal cell wall component, by non-competitively inhibiting 1,3-β-D-glucan synthase. Decreased glucan content results in osmotic instability and cellular lysis.
Pharmacokinetics:
Distribution: Rapidly distributed into body tissues. Volume of distribution: 0.28-0.5 L/kg. Plasma protein binding: >99%, mainly albumin.
Metabolism: Metabolised by arylsulfatase to its catechol form and further metabolised by COMT to the methoxy form; also undergoes some hydroxylation by CYP3A isoenzyme.
Excretion: Mainly via faeces (71%); urine (12%). Mean half-life: 14-17.2 hr.
Chemical Structure

Chemical Structure Image
Micafungin

Source: National Center for Biotechnology Information. PubChem Database. Micafungin, CID=477468, https://pubchem.ncbi.nlm.nih.gov/compound/Micafungin (accessed on Jan. 22, 2020)

Storage
Store at 25°C.
MIMS Class
Antifungals
ATC Classification
J02AX05 - micafungin ; Belongs to the class of other systemic antimycotics.
References
Anon. Micafungin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/01/2016.

Buckingham R (ed). Micafungin Sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/01/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Micafungin Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 06/01/2016.

Mycamine Injection, Powder, Lyophilized, for Solution (Astellas Pharma US, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/01/2016.

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