Micafungin (Mycamine)

Micafungin (Mycamine) is an echinocandin, similar to caspofungin and anidulafungin. It covers a wide range of Candida species causing invasive candidiasis, including C. krusei and C. glabrata.The key distinguishing features compared with caspofungin are simplicity of dosing regimen (no loading dose), storage at room temperature, narrower clinical indication and fewer drug interactions.

Uses
Invasive candidiasis
Oesophageal candidiasis
Prophylaxis of Candida infection in neutropenic patients

Contraindications
Hypersensitivity to echinocandin

Administration
• Invasive candidiasis
IV infusion: 100 mg once daily, given over 1 hour (increase to 200 mg daily if inadequate response) for a minimum of 14 days Weight <40 kg, 2 mg/kg once daily, given over 1 hour (increase to 4 mg/kg daily if inadequate response)

• Oesophageal candidiasis
IV infusion: 150 mg once daily, given over 1 hour for at least one week after resolution of infection Weight <40 kg, 3 mg/kg once daily, given over 1 hour

• Prophylaxis of Candida infection in neutropenic patients IV infusion: 50 mg once daily, given over 1 hour for at least one week after neutrophil recovery Weight <40 kg, 1 mg/kg once daily, given over 1 hour

Reconstitute each vial with 5 ml sodium chloride 0.9% or glucose 5%. Gently rotate vial, without shaking. Add the reconstituted solution to 100 ml sodium chloride 0.9% or glucose 5%. Protect from light. Available in vials containing 50 mg and 100 mg.

How not to use micafungin
Galactose intolerance
Severe hepatic failure
Adverse effects
Headaches
Diarrhoea, nausea and vomiting
Leukopenia, neutropenia, anaemia and thrombocytopenia
Increased creatinine
Hypokalaemia, hypomagnesaemia and hypocalcaemia
Elevated LFTs
Flushing
Rash
Pruritus

Cautions
Hepatic failure (worsening LFTs)
Breast feeding and pregnancy

Organ failure
Renal: no dose adjustment necessary, as negligible renal clearance
Hepatic: avoid in severe liver failure

Renal replacement therapy
Unlikely to be removed by dialysis, therefore no dose adjustment required