MICAFUNGIN (my-ca-fun′gin) Mycamine Classifications: antiinfective, antibiotic, echinocandin, antifungal Prototype: Caspofungin Pregnancy Category: C

Availability

50 mg vial

Actions

Micafungin is an antifungal agent that inhibits the synthesis of glucan, an essential component of fungal cell walls.

Therapeutic Effects

Micafungin does not allow Candida fungi to replicate.

Uses

Treatment of patients with esophageal candidiasis, and for prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation. Susceptible organisms include C. albicans, C. glabrata, C. krusei, C. parapsilosis, and C. tropicalis.

Unlabeled Uses

Treatment of pulmonary Aspergillus infection

Contraindications

Hypersensitivity to any component in micafungin. Safety and efficacy in children are unknown.

Cautious Use

Hepatic and renal dysfunction; pregnancy (category C); lactation; older adult.

Route & Dosage

Esophageal Candidiasis Adult  IV  150 mg/d over 1 h

Candidiasis Prophylaxis in Patients Undergoing Hematopoietic Stem Cell Transplantation Adult  IV  50 mg/d over 1 h

Administration

Intravenous

PREPARE: IV Infusion: Reconstitute the 50 mg vial with 5 mL NS (without a bacteriostatic agent) to yield 10 mg/mL. Gently swirl, but do not shake, to dissolve. Solution should be clear. For Candida prophylaxis, add contents of one reconstituted vial to 100 mL NS. For esophageal candidiasis, add contents of three reconstituted vials to 100 mL NS. ADMINISTER: IV Infusion: Give slowly over 1 h. Flush existing IV line with NS before/after infusion. Protect IV solution from light. INCOMPATIBILITIES Do not mix or coinfuse with any other medications. Store reconstituted vial and IV solution for up to 24 h at 25° C (77° F). Protect from light.

Adverse Effects (≥1%)

CNS: Headache, dizziness, somnolence. CV: Flushing, hypertension, phlebitis. GI: Nausea, vomiting, diarrhea, abdominal pain. Hematologic/Lymphatic: Anemia, hemolytic anemia, leukemia, neutropenia, thrombocytopenia. Hepatic: Elevated liver enzymes, jaundice. Metabolic: Hypocalcemia, hypokalemia, hypomagnesemia. Skin: Pruritis, rash. Body as a Whole: Injection site pain, pyrexia, rigors.

Interactions

Drug: Micafungin increases levels of sirolimus and nifedipine.

Pharmacokinetics

Distribution: 99% protein bound. Metabolism: Biotransformation primarily in the liver. Elimination: Fecal (major) and renal. Half-Life: 14–17 h.

Nursing Implications

Assessment & Drug Effects

• Monitor for S&S of hypersensitivity during IV infusion; frequently monitor IV site for thrombophlebitis.
• Monitor for S&S of hemolytic anemia (i.e., jaundice).
• Lab tests: Periodic LFTs, kidney function tests, serum electrolytes, and CBC.
• Monitor blood levels of sirolimus or nifedipine with concurrent therapy. If sirolimus or nifedipine toxicity occurs, dosages of these drugs should be reduced.

Patient & Family Education

• Report immediately any of the following: facial swelling, wheezing, difficulty breathing or swallowing, tightness in chest, rash, hives, itching, or sensation of warmth.
• Do not breast feed while taking this drug without consulting physician.