micafungin


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micafungin

(my-ka-fun-gin) ,

Mycamine

(trade name)

Classification

Therapeutic: antifungals
Pharmacologic: echinocandins
Pregnancy Category: C

Indications

Esophageal candidiasis.Candidemia/acute disseminated candidiasis/Candidal peritonitis and abscesses.Prophylaxis of Candida infections during hematopoetic stem cell transplantation.

Action

Inhibits synthesis of glucan required for the formation of fungal cell wall.

Therapeutic effects

Death of susceptible fungi.
Active against the following Candida spp.: C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Protein Binding: >99 %.
Metabolism and Excretion: Mostly metabolized; 71% fecal elimination.
Half-life: 15 hr.

Time/action profile

ROUTEONSETPEAKDURATION
IVrapidend of infusion24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: Severe hepatic impairment; Obstetric: Use only if clearly needed; Lactation / Pediatric: Children <4 mo (safety not established).

Adverse Reactions/Side Effects

Gastrointestinal

  • worsening hepatic function/hepatitis

Genitourinary

  • renal impairment

Hematologic

  • hemolysis/hemolytic anemia

Local

  • injection site reactions

Miscellaneous

  • allergic reactions including anaphylaxis (rare) (life-threatening)

Interactions

Drug-Drug interaction

↑ blood levels and risk of toxicity with sirolimus and nifedipine (dose adjustments may be necessary).

Route/Dosage

Intravenous (Adults) Esophageal candidiasis–150 mg daily for 15 days (range 10–30 days); Candidemia/acute disseminated candidiasis/Candida peritonitis and abscesses—100 mg daily for 15 days (range 10–47 days); Prevention of Candida infections in stem cell transplantation—50 mg daily (duration range 6–51 days).
Intravenous (Children ≥4 mo and >30 k g) Esophageal candidiasis–2.5 mg/kg daily (maximum daily dose = 150 mg); Candidemia/acute disseminated candidiasis/Candida peritonitis and abscesses—2 mg/kg daily (maximum daily dose = 100 mg); Prevention of Candida infections in stem cell transplantation—1 mg/kg daily (maximum daily dose = 50 mg)
Intravenous (Children ≥4 mo and ≤30 kg) Esophageal candidiasis–3 mg/kg daily; Candidemia/acute disseminated candidiasis/Candida peritonitis and abscesses—2 mg/kg daily; Prevention of Candida infections in stem cell transplantation—1 mg/kg daily
Intravenous (Neonates) 7–10 mg/kg daily. Higher dose should be used in neonates <27 weeks gestation and those with meningitis.

Availability

Lyophilized powder for injection: 50 mg/vial, 100 mg/vial

Nursing implications

Nursing assessment

  • Assess symptoms of esophageal candidiasis (dysphagia, odynophagia, retrosternal pain) prior to and during therapy.
  • Monitor for signs of anaphylaxis (rash, pruritus, wheezing, laryngeal edema, abdominal pain). Discontinue micafungin and notify health care professional immediately if these occur.
  • Assess for injection site reactions (phlebitis, thrombophlebitis) during therapy. These occur more frequently in patients receiving micafungin via peripheral IV infusion.
  • Lab Test Considerations: May cause ↑ serum alkaline phosphatase, bilirubin, ALT, AST, and LDH levels. If elevations occur, monitor for worsening liver function; may require discontinuation of therapy.
    • May cause ↑ BUN and serum creatinine.
    • May cause leukopenia, neutropenia, thrombocytopenia, and anemia. Monitor for worsening levels; may require discontinuation of therapy.
    • May cause hypokalemia, hypocalcemia, and hypomagnesemia.

Potential Nursing Diagnoses

Risk for infection (Indications)

Implementation

  • Intravenous Administration
  • Intermittent Infusion: Diluent: For Adults: Reconstitute each 50-mg vial with 5 mL of 0.9% NaCl or D5W to achieve concentration of 10 mg/mL. Reconstitute each 100-mg vial with 5 mL of 0.9% NaCl or D5W to achieve concentration of 20 mg/mL. Dissolve by gently swirling vial; do not shake vigorously. Directions for further dilution based on indication for use. For prophylaxis of Candida infections, add 50 mg of micafungin to 100 mL of 0.9% NaCl or D5W. For treatment of esophageal candidiasis, add 150 mg of micafungin to 100 mL of 0.9% NaCl or D5W. Reconstituted vials and infusion are stable for 24 hr at room temperature. Protect diluted solution from light.Concentration: 0.5–1.5 mg/mL.
  • For Children: Determine dose and divide by final concentration (10 or 20 mg/mL). Add withdrawn volume to 0.9% NaCl or D5W in IV bag or syringe. Concentration: 0.5 mg/mL–4 mg/mL. Concentrations >1.5 m g/mL should be administered via central venous catheter to minimize infusion reactions. Discard unused vials.
  • Rate: Flush line with 0.9% NaCl prior to administration. Infuse over 1 hr. More rapid infusions may result in more frequent histamine mediated reactions.
  • Y-Site Compatibility: aminophylline, bumetanide, calcium chloride, calcium gluconate, carboplatin, cyclosporine, dopamine, doripenem, eptifibatide, esmolol, rtoposide, fenoldopam, furosemide, heparin, hydromorphone, lidocaine, lorazepam, magnesium sulfate, mesna, milrinone, nitroglycerin, nitroprusside, norepinephrine, phenylephrine, potassium chloride, potassium phosphates, sodium phosphates, tacrolimus, theophylline, vasopressin
  • Y-Site Incompatibility: amiodarone, cisatracurium, diltiazem, dobutamine, epinephrine, insulin, labetalol, levofloxacin, meperidine, midazolam, morphine, mycophenolate mofetil, nesiritide, nicardipine, octreotide, ondansetron, phenytoin, rocuronium, telavancin, vecuronium

Patient/Family Teaching

  • Inform patient of the purpose of micafungin.
  • Advise patient to notify health care professional immediately if signs of anaphylaxis occur.

Evaluation/Desired Outcomes

  • Resolution of signs and symptoms of esophageal candidiasis, candidemia, acute disseminated candidiasis, candidal peritonitis and abscesses.
  • Prevention of Candida infections during hematopoetic stem cell transplantation.

micafungin

a systemic antifungal.
indications This drug is used in the treatment of esophageal candidiasis and susceptible candida species (Candida albicans, C. glabrata, C. krusei, C. parapsilosis, and C. tropicalis) and in prophylaxis of candida infections in patients undergoing hepatopoietic stem cell transplantation.
contraindications Known hypersensitivity to this drug or to other ecinocandins prohibits its use.
adverse effects Adverse effects of this drug include dizziness, flushing, hypertension, phlebitis, abdominal pain, hypokalemia, hypocalcemia, and hypomagnesemia. Life-threatening side effects include seizures, neutropenia, thrombocytopenia, leukopenia, coagulopathy, anemia, and hemolytic anemia. Common side effects include headache; somnolence; nausea; anorexia; vomiting; diarrhea; increased aspartate aminotransferase, alanine aminotransferase, alkaline phosphate, and blood dehydrogenase; hyperbilirubinemia; rash; pruritus; injection site pain; and rigors.

micafungin

An echinocandin-type antifungal with better pharmacokinetics than amphotericin B and itraconazole.

Indications
Candida species infections: candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses.

Metabolism
Via CYP3A4.

micafungin

An echinocandin antifungal drug active against both Candida and Aspergillus species of fungi. The drug function by inhibiting fungal wall synthesis, an action without relevance for mammalian cells, and is thus of low toxicity. It has been found effective in the management of candidaemia and invasive candidosis.
References in periodicals archive ?
Antifungal drugs were changed to micafungin on day 3 and then to liposomal amphotericin B (5 mg/kg/day) on day 6, and he was extubated later that day.
Treatment, if clinically indicated, includes an echinocandin such as micafungin, anidulafungin, and caspofungin at standard dosing.
AST YS 07 Cards were used as per to manufacturer's instructions, and results were evaluated for activity against fluconazole, voriconazole, caspofungin, micafungin, amphotericin B, and flucytosine.
In Brazil, the following antimicrobials are considered acceptable for use in OPAT: amikacin, gentamicin, ceftriaxone, cefepime, ceftazidime, ceftaroline, ertapenem, linezolid (when formulation for oral use is not available), tigecycline, daptomycin, teicoplanin, vancomycin, amphotericin B (lipid formulations), caspofungin, anidulafungin, micafungin and voriconazole (when formulation for oral use is not available).
Generally, the rate of caspofungin susceptibility to predict anidulafungin and micafungin susceptibility is considered to be above 98% (28).
0 g intravenous (IV) injection every 12 h and micafungin 100 mg IV once a day within POD 7.
1339 Drum J01DH02 Meropenem 21 mg vial 10 1289 1000 Drum 21b J01DH02 Meropenem 500 mg vial drum 10551 22 L04AC02 Basiliximab 20 mg vial 1,128 drum 23 J02AX05 Micafungin 100 mg poramp.
4) Minimum inhibitory concentrations (MIC) were read as the lowest drug concentrations that produced either a 50% (for flucytosine, voriconazole, itraconazole, fluconazole, micafungin, posaconazole, anidulafungin, and caspofungin) or a 100% (amphotericin B) inhibition of growth compared to that of the control wells without antifungal drugs (Table 1).
The antifungal susceptibility test done at Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh by CLSI M38-A2 protocol showed the MIC of amphotericin B, fluconazole, voriconazole, itraconazole, posaconazole, caspofungin, anidulofungin and micafungin to be 0.
They report using amphotericin B suppositories, or vaginal 17% flucytosine, or 800mg oral fluconazole, daily for 2-3 weeks, or oral posaconazole in combination with local nystatin and/or ciclopirox olamine, or micafungin, to treat C.
During the last decade screening of new therapeutic leads resulted in the Echinocandin class of drugs (Anidulafungin, Micafungin and Caspofungin) which mainly inhibit the synthesis of 1,3 -Beta-glucan.
4) The Candida Species sensitivity was observed with Voriconazole, Flucytosine Amphotericin B, Fluconazole, Micafungin and Caspofungin.