micafungin
Brand: Mycamine
Prototype: caspofungin
Drug Class: echinocandin antifungal
Drug Family: antifungal
Subclass: echinocandin (prophylaxis and treatment)
Organ Systems: infectious-disease
Mechanism of Action
Inhibits 1,3-beta-D-glucan synthase; similar mechanism to caspofungin; preferred for antifungal prophylaxis in HSCT due to once-daily dosing without loading dose and minimal drug interactions.
fungal 1,3-beta-D-glucan synthase
Indications
- invasive candidiasis/candidemia
- esophageal candidiasis
- antifungal prophylaxis in HSCT recipients
Contraindications
- echinocandin hypersensitivity
Adverse Effects
Common
- nausea
- headache
- elevated liver enzymes
- rash
Serious
- hepatotoxicity
- anaphylaxis
- hemolysis
- histamine-related infusion reactions
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | widely distributed; high protein binding |
| Metabolism | arylsulfatase and catechol-O-methyltransferase; minimal CYP involvement |
| Excretion | primarily fecal (71%); renal (15%) |
| Half-life | 14–17 hours |
| Onset | immediate (IV) |
| Peak | end of infusion |
| Duration | 24 hours |
| Protein Binding | >99% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| sirolimus | micafungin increases sirolimus AUC ~21%; monitor sirolimus levels | moderate |
| itraconazole | micafungin increases itraconazole AUC ~22% | minor |
Nursing Considerations
- No loading dose required; simpler dosing than caspofungin.
- Administer IV over 1 hour; protect from light and incompatible with many drugs — use separate IV line.
- Monitor LFTs weekly with extended therapy.
- Micafungin is the preferred echinocandin for antifungal prophylaxis in allogeneic HSCT per many institutional protocols.
Clinical Pearls
- Micafungin has the most minimal drug interactions of all echinocandins and does not require loading dose adjustments, making dosing simpler in the HSCT setting where patients are on multiple medications.
- All three echinocandins (caspofungin, micafungin, anidulafungin) are considered clinically equivalent for invasive candidiasis, with agent selection based on drug interactions, cost, and local formulary.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.