Mikafungin Teva (Micafungin Sodium)

Micafungin is an echinocandin antifungal used to treat serious fungal infections.

• Invasive candidiasis: effective for bloodstream and deep‑tissue Candida infections.
• Esophageal candidiasis: clears Candida infection of the esophagus.
• Prophylaxis in hematopoietic stem cell transplantation: prevents fungal infections in transplant recipients.

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

Micafungin may cause a range of adverse reactions, from mild to severe.

Common Side Effects

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

Serious or Rare Side Effects

• Severe hepatic failure: marked elevation of liver enzymes with jaundice.
• Anaphylaxis: acute, life‑threatening hypersensitivity reaction.
• Severe hypotension: sudden drop in blood pressure requiring intervention.
• Stevens‑Johnson syndrome: severe mucocutaneous reaction.
• Renal impairment: acute kidney injury.
• Severe neutropenia: marked reduction in neutrophil count.

Before initiating therapy, clinicians should consider several safety measures.

• Liver function monitoring: check ALT/AST before and during treatment.
• Renal function assessment: evaluate creatinine clearance, especially in patients with pre‑existing kidney disease.
• Hypersensitivity caution: discontinue if signs of allergic reaction appear.
• Drug interaction vigilance: review concomitant medications that affect hepatic metabolism.
• Pregnancy and lactation: avoid use unless benefits clearly outweigh potential risks.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Micafungin can interact with other medicines, requiring careful management.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (e.g., rifampin): may markedly reduce micafungin exposure.
• Co‑administration with azole antifungals (e.g., fluconazole): may increase micafungin plasma levels and risk of toxicity.

Moderate Interactions (Monitor Closely)

• Cytochrome P450 substrates (e.g., midazolam): may experience altered metabolism.
• Immunosuppressants (e.g., tacrolimus): monitor blood concentrations.
• Concomitant hepatotoxic drugs: increase risk of liver enzyme elevations.