Micafungin
MYCAMINE
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.
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
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
NO BOXED WARNINGS
Principal riskNo CNS or urinary penetration
Cost, est. cash$20–$1,500/dose or month
Generic entry2019
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHepatotoxicity and clinically important CYP/QT interactions; organ toxicity varies markedly by agent.
Mechanism of action: Micafungin ballicule
