Micafungin Teva (Micafungin)

Micafungin is indicated for several invasive Candida infections and for prophylaxis in immunocompromised patients.

• Candidemia and invasive candidiasis: treatment of bloodstream and deep‑tissue Candida infections.
• Esophageal candidiasis: eradication of Candida lesions in the esophagus.
• Intra‑abdominal Candida abscesses: resolution of abdominal infections caused by Candida species.
• Prophylaxis in hematopoietic stem cell transplantation: prevention of Candida infection in transplant recipients.

• Micafungin exerts its antifungal activity by selectively inhibiting the enzyme β‑(1,3)‑D‑glucan synthase, which is essential for the synthesis of β‑(1,3)‑D‑glucan, a critical structural component of the fungal cell wall. Disruption of cell‑wall integrity leads to osmotic instability and fungal cell death, while human cells are unaffected because they lack this pathway.

Micafungin may be associated with a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Infusion‑related reactions: flushing, chills, or rigors during administration.
• Fever: transient elevation of body temperature.
• Nausea: mild gastrointestinal upset.
• Headache: mild to moderate intensity.
• Elevated liver enzymes: transient increase in ALT/AST.
• Rash: mild skin erythema.

Serious or Rare Side Effects

• Severe hepatic dysfunction: marked elevation of transaminases or liver failure.
• Anaphylaxis: acute, potentially life‑threatening hypersensitivity reaction.
• Stevens‑Johnson syndrome/toxic epidermal necrolysis: severe skin and mucosal involvement.
• Renal failure: acute kidney injury requiring monitoring.
• Severe hypotension: marked drop in blood pressure during infusion.
• Eosinophilia: significant rise in eosinophil count.

Before initiating Micafungin therapy, clinicians should consider several safety measures.

• Liver function monitoring: assess transaminases before and periodically during treatment.
• Renal function assessment: evaluate creatinine clearance in patients with kidney disease.
• Hypersensitivity evaluation: avoid use in individuals with known allergy to echinocandins.
• Concomitant hepatotoxic drugs: use caution when combined with other agents that affect liver enzymes.
• Severe hepatic impairment: dose adjustment or alternative therapy may be required.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Micafungin can interact with other medicines, influencing its efficacy or safety.

Major Interactions (Avoid)

• Cyclosporine: co‑administration can increase micafungin plasma concentrations, raising toxicity risk.
• Rifampin: strong enzyme induction may markedly reduce micafungin exposure, compromising effectiveness.

Moderate Interactions (Monitor Closely)

• Azole antifungals (e.g., fluconazole): may have additive hepatotoxic potential; monitor liver enzymes.
• Warfarin: micafungin may affect INR; frequent coagulation monitoring is advised.
• Statins (e.g., simvastatin): potential for increased muscle toxicity; assess for myopathy signs.