Micafungin: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the Malaysia prescribing information.

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.

Pregnancy Category (US FDA)

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

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.

Disclaimer: This information is independently developed by MIMS based on Micafungin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2023 MIMS. All rights reserved. Powered by MIMS.com