Micafungin

Indications

Micafungin is used for: Candidiasis, Candidemia, Disseminated Candidiasis, Candida Peritonitis & Abscesses

Adult Dose

Intravenos Candidiasis Treatment (esophageal): 150 mg/day IV infusion x10-30 days (mean 15 days) Prophylaxis in hematopoietic stem cell transfer (HSCT) patients: 50 mg/day IV infusion x6-51 days (mean 19 days) Candidemia, Disseminated Candidiasis, Candida Peritonitis & Abscesses 100 mg/day IV infusion x10-47 days (mean 15 days)us

Child Dose

Candida Infections Indicated for candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses, esophageal candidiasis, and prophylaxis of Candida infections in hematopoietic stem cell transplants (HSCT) recipients <4 months: Safety and efficacy not established >4 months: See specific Candida infection below Treatment of Candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses 2 mg/kg IV qDay; not to exceed 100 mg/day Treatment of esophageal candidiasis <30 kg: 3 mg/kg IV qDay >30 kg: 2.5 mg/kg IV qDay; not to exceed 150 mg/day Prophylaxis of Candida infections in HSCT recipients 1 mg/kg IV qDay; not to exceed 50 mg/day

Renal Dose

Administration

IV Preparation Aseptically add 5 mL 0.9% NaCl to vial to obtain 10 mg/mL (50 mg vial) or 20 mg/mL (100 mg vial) Gently swirl to mix, do not shake vigorously or vortex Dilute further by adding reconstituted solution to 100 mL of 0.9% NaCl or D5W IV Administration Flush existing infusion line with 0.9% NaCl before administration Infuse IV over 1 hr

Contra Indications

Hypersensitivity

Precautions

Patient w/ pre-existing risk of malignancy. Severe hepatic impairment. Childn. Pregnancy and lactation. Monitoring Parameters Monitor liver function.

Pregnancy-Lactation

Pregnancy Based on findings from animal studies, may cause fetal harm when administered to pregnant women Human data are insufficient on use in pregnant women to inform a drug-associated risk of adverse developmental outcomes Animal studies In an embryo-fetal toxicity study in pregnant rabbits, IV administration during organogenesis resulted in fetal visceral abnormalities and abortion at 32 mg/kg, a dose equivalent to 4x times the recommended human dose based on body surface area comparisons Visceral abnormalities included abnormal lobation of the lung, levocardia, retrocaval ureter, anomalous right subclavian artery, and dilatation of the ureter Lactation Data are not available regarding the presence of micafungin in human milk, effects on breastfed infants, or effects on milk production Micafungin was present in the milk of lactating rats following IV administration; when a drug is present in animal milk, it is likely that the drug will be present in human milk

Interactions

May increase exposure of amphotericin B desoxycholate, sirolimus, nifedipine, itraconazole.

Adverse Effects

Side effects of Micafungin : 1-10% Abd pain Anemia Headache Diarrhea Increased LFTs Leukopenia Nausea Neutropenia Phlebitis Pruritus Pyrexia Rash Rigors Thrombocytopenia Vomiting Facial swelling Vasodilation <1% Delirium Dizziness Somnolence

Mechanism of Action

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.