Pharmacologic class: Semisynthetic lipopeptide (echinocandin)
Therapeutic class: Antifungal
Pregnancy risk category C
Inhibits synthesis of 1,3-β-D-glucan, an essential component of fungal cell walls
Powder for reconstitution for infusion (lyophilized): 50-mg and 100-mg single-use vials
Indications and dosages
➣ Candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses
Adults: 100 mg daily by I.V. infusion over 1 hour for 15 days (range, 10 to 47 days)
➣ Esophageal candidiasis
Adults: 150 mg daily by I.V. infusion over 1 hour for 15 days (range, 10 to 30 days)
➣ Prophylaxis of Candida infections in patients undergoing hematopoietic stem-cell transplantation
Adults: 50 mg daily by I.V. infusion over 1 hour for 19 days (range, 6 to 51 days)
• Hypersensitivity to drug, its components, or other echinocandins
Use cautiously in:
• renal or hepatic disease
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• Administer by I.V. infusion only.
• Reconstitute with 5 ml normal saline solution injection (without bacteriostatic agent) or dextrose 5% injection added to 50-mg or 100-mg vial to yield approximately 10 mg/ml or 20 mg/ml, respectively.
• To minimize excessive foaming, gently dissolve powder by swirling vial. Don't shake vigorously.
• Protect diluted solution from light.
• Add reconstituted solution to 100 ml normal saline solution or 100 ml dextrose 5% before infusing.
• Flush existing I.V. line with normal saline solution before infusing drug.
• Infuse over 1 hour. Be aware that more rapid infusion increases risk of histamine-mediated reactions (rash, pruritus, facial swelling, vasodilation).
☞ If serious hypersensitivity (anaphylaxis or anaphylactoid) reaction occurs, immediately discontinue infusion and provide appropriate interventions.
CNS: headache, insomnia, fatigue, rigors, dizziness, anxiety
CV: vasodilation, hypotension, hypertension, bradycardia, tachycardia, phlebitis, flushing, atrial fibrillation
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, anorexia, decreased appetite
Hematologic: anemia, thrombocytopenia, aggravated anemia, neutropenia, febrile neutropenia
Metabolic: fluid retention, fluid overload
Musculoskeletal: back pain
Respiratory: pneumonia, cough, dyspnea
Skin: rash, pruritus, decubitus ulcers, erythema
Other: facial swelling, injection-site reaction, infection, bacteremia, fever, mucosal inflammation, peripheral edema, sepsis, septic shock, hypersensitivity reaction (including anaphylaxis, anaphylactoid reactions, and shock)
Drug-drug. Itraconazole, nifedipine, sirolimus: increased risk of toxicity
Drug-diagnostic tests. ALP, ALT, AST, sodium: increased levels
Calcium, glucose, magnesium, potassium: decreased levels
Liver function tests: abnormal
• If patient develops clinical or laboratory evidence of hematologic abnormalities, abnormal liver function tests, or electrolyte disorders, monitor closely for signs or symptoms that these conditions are getting worse. Risks against benefits of continuing therapy should be considered.
• Instruct patient to contact prescriber if unusual symptoms develop or if preexisting symptoms persist or get worse.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
|IV||rapid||end of infusion||24 hr|
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).
- 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.