Micafungin

Products

Micafungin is commercially available as a powder for the preparation of an infusion solution (Mycamine). It was approved in many countries in 2012.

Structure and properties

Micafungin (C56H70N9NaO23S, Mr = 1292.3 g/mol) is a complex molecule obtained as a derivative of a fermentation product of the fungus F-11899. It is present in the drug as micafungin sodium, a photosensitive, hygroscopic, white powder that is soluble in water.

Effects

Micafungin (ATC J02AX05) has fungicidal properties against -yeasts. The effects are based on selective inhibition of the synthesis of 1,3-β-D-glucan, an essential component of the fungal cell wall. This leads to dissolution of the fungi.

Indications

For the treatment of invasive and esophageal candidamycosis. In stem cell transplantation and neutropenia to prevent -infection.

Dosage

According to the SmPC. The drug is administered as an infusion. Micafungin may also be used in neonates and in children.

Contraindications

  • Hypersensitivity

For complete precautions, see the drug label.

Interactions

Micafungin is metabolized by CYP3A and other pathways, although this is not the primary metabolic pathway. There is a low potential for drug-drug interactions metabolized by CYP3A. Patients treated with sirolimus, nifedipine, or itraconazole must be monitored for potential adverse effects of these drugs. Other interactions are possible with amphotericin B deoxycholate.

Adverse effects

The most common possible adverse effects include blood count abnormalities (leukopenia, neutropenia, anemia), metabolic disturbances (hypokalemia, hypomagnesemia, hypocalcemia), headache, phlebitis, nausea, vomiting, diarrhea, abdominal pain, altered liver enzymes, rash, fever, and increased muscle tone. During treatment, liver function must be monitored regularly, as there may be a risk of developing liver tumors with long-term use.