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Pregnancy Category: C
Esophageal candidiasis.Candidemia/acute disseminated candidiasis/Candidal peritonitis and abscesses.Prophylaxis of Candida infections during hematopoetic stem cell transplantation.
Inhibits synthesis of glucan required for the formation of fungal cell wall.
Death of susceptible fungi.Active against the following Candida spp.: C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis.
Absorption: IV administration results in complete bioavailability.
Protein Binding: >99 %.
Metabolism and Excretion: Mostly metabolized; 71% fecal elimination.
Half-life: 15 hr.
|IV||rapid||end of infusion||24 hr|
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
- worsening hepatic function/hepatitis
- renal impairment
- hemolysis/hemolytic anemia
- injection site reactions
- allergic reactions including anaphylaxis (rare) (life-threatening)
Drug-Drug interaction↑ blood levels and risk of toxicity with sirolimus and nifedipine (dose adjustments may be necessary).
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.
Lyophilized powder for injection: 50 mg/vial, 100 mg/vial
- 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 DiagnosesRisk for infection (Indications)
- 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
- Inform patient of the purpose of micafungin.
- Advise patient to notify health care professional immediately if signs of anaphylaxis occur.
- 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.
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.
micafunginAn echinocandin-type antifungal with better pharmacokinetics than amphotericin B and itraconazole.
Candida species infections: candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses.