Micafungin Reig Jofre (Micafungin)

Micafungin is an echinocandin antifungal indicated for several serious fungal infections.

• Invasive candidiasis: treatment of bloodstream and deep‑tissue Candida infections, improving survival.
• Esophageal candidiasis: eradication of Candida infection of the esophagus, relieving dysphagia.
• Candida peritonitis: management of intra‑abdominal Candida infection, aiding resolution of peritoneal inflammation.
• Candida meningitis: therapy for fungal meningitis caused by Candida species, supporting central nervous system clearance.

• Micafungin inhibits the enzyme β‑(1,3)‑D‑glucan synthase, which is essential for synthesizing β‑(1,3)‑D‑glucan, a key structural component of the fungal cell wall. By disrupting cell‑wall formation, the drug leads to osmotic instability and fungal cell death, while having limited effect on human cells that lack this pathway.

Micafungin may be associated with a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Fever: transient elevation of body temperature during infusion.
• Phlebitis: irritation or inflammation at the intravenous site.
• Elevated liver enzymes: mild, reversible increases in ALT or AST.
• Nausea: occasional gastrointestinal discomfort.
• Headache: mild to moderate intensity.
• Rash: non‑specific skin eruption.

Serious or Rare Side Effects

• Hypersensitivity reactions: including anaphylaxis, angioedema, or severe skin reactions.
• Hepatic failure: marked elevation of liver enzymes or bilirubin, potentially leading to liver injury.
• Renal impairment: acute kidney injury in susceptible patients.
• Stevens‑Johnson syndrome/toxic epidermal necrolysis: severe mucocutaneous reactions.
• Neutropenia: significant reduction in neutrophil count.
• Hemolytic anemia: rare destruction of red blood cells.

Prior to initiating micafungin therapy, clinicians should consider several precautionary measures to ensure patient safety.

• Renal function: assess baseline and monitor during therapy.
• Hepatic function: monitor liver enzymes regularly.
• Drug interactions: review concomitant medications for potential interactions.
• Pregnancy and lactation: use only if benefits outweigh potential risks.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Micafungin can interact with other medicines, affecting its concentration or safety profile.

Major Interactions (Avoid)

• Cyclosporine: increased micafungin exposure – avoid co‑administration.
• Rifampin: decreased micafungin levels – avoid co‑administration.
• Azole antifungals (e.g., fluconazole): potential additive toxicity – avoid co‑administration.

Moderate Interactions (Monitor Closely)

• Warfarin: monitor INR for altered anticoagulation.
• Statins: observe for signs of myopathy or rhabdomyolysis.
• Carbapenems: assess renal function and adjust dosing if needed.