Micafungin

MYCAMINE

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Pronunciation: mi-ka-FUN-jin

Micafungin ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Micafungin ballicule

What it isEchinocandin inhibiting fungal beta-1,3-glucan synthesis; invasive candidiasis.

Why this oneIts labeled Candida-prophylaxis role in stem-cell transplantation distinguishes it from other echinocandins.

What limits itNo CNS or urinary penetration, so it fails in meningitis and cystitis. Not active against Aspergillus alone.

Micafungin molecular structure (skeletal formula) — Molecular structure: Micafungin

FDA-approved for

candidemia and esophageal candidiasis (2005)

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
Candidemia, acute disseminated candidiasis, Candida peritonitis/abscesses	Adult	100 mg QD	100 mg QD	100 mg QD
Candidemia/disseminated candidiasis/peritonitis/abscesses	Peds ≥4 mo	2 mg/kg QD	2 mg/kg QD	100 mg/day
Candidemia/disseminated (without meningoencephalitis/ocular dissem.)	Peds <4 mo	4 mg/kg QD	4 mg/kg QD
Esophageal candidiasis	Adult	150 mg QD	150 mg QD	150 mg QD
Esophageal candidiasis	Peds ≥4 mo	3 mg/kg QD (≤30 kg); 2.5 mg/kg QD (>30 kg)		150 mg/day
Prophylaxis of Candida in HSCT recipients	Adult	50 mg QD	50 mg QD	50 mg QD
Prophylaxis of Candida in HSCT recipients	Peds ≥4 mo	1 mg/kg QD		50 mg/day

Renal No adjustment needed

Hepatic No adjustment needed

Instructions

IV infusion over 1 hour (more rapid infusion → histamine-mediated reactions); flush existing line with saline first
Do not mix or co-infuse with other medications (precipitates)
Not for use if required dose ≠ 50, 100, or 150 mg — use alternative micafungin formulation

Available strengths

inj 10, 20 mg/mL

Contraindications

Known hypersensitivity to other echinocandins

Cautions

Hypersensitivity: anaphylaxis/anaphylactoid reactions (incl. shock)
Hematologic: acute intravascular hemolysis, hemolytic anemia
Hepatic effects: LFT abnormalities; rare hepatitis/hepatic failure
Renal effects: ↑BUN/creatinine, rare acute renal failure
Infusion/injection-site reactions (histamine-mediated); phlebitis
High sodium load — avoid in CHF, elderly, sodium-restricted patients

Adverse reactions

Diarrhea
Nausea
Vomiting
Abdominal pain
Pyrexia
Thrombocytopenia
Neutropenia
Headache
Peds <4 mo: hypokalemia, acidosis, sepsis, anemia, ↓O2 saturation

Pregnancy May cause fetal harm based on animal data (visceral abnormalities, abortion in rabbits); insufficient human data

Lactation No human data; present in rat milk; weigh benefits against maternal need

Cost

Micafungin (MYCAMINE)

Strength		#/mo	generic $/unit	CostPlus
10 mg/mL	inj	per unit		not offered
20 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Micafungin is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry2019

NO BOXED WARNINGS

Principal riskNo CNS or urinary penetration

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityHepatotoxicity and clinically important CYP/QT interactions; organ toxicity varies markedly by agent.

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