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

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 ?
All patients were given micafungin as first-line therapy for an average duration of 22 days.
The difficulty in following this recommendation is illustrated in a randomized trial of treatment of candidemia comparing micafungin with liposomal amphotericin B, (26) in which CVC removal at baseline (before treatment initiation) was required per protocol.
glabrata Isolates with Mutations in fks Genes," combines the results of several in vitro studies of ibrexafungerp against a total of 79 Candida glabrata strains with fks mutations showing that ibrexafungerp maintains potent activity against these echinocandin-resistant strains when compared to caspofungin and micafungin. In five independent studies, the in vitro susceptibility, determined by broth micro-dilution, of C.
Paradoxical growth effects of the echinocandins caspofungin and micafungin. but not of anidulafungin.
The antifungal agents assayed were: amphotericin B (AMB), itraconazole (ITC), voriconazole (VRC), posaconazole (POS), fluconazole (FLU), caspofungin (CAS), micafungin (MFG), anidulafungin (AFG).
Se realizaron 4 busquedas en cada base de datos, utilizando los siguientes terminos MeSH: Echinocandin Candida resistant, Anidulafungin Candida resistance (or resistant), Caspofungin Candida resistance (or resistant), Micafungin Candida Resistance (or resistant).
Echinocandin (caspofungin, anidulafungin, micafungin) or fluconazole is recommended for empirical antifungal therapy.
These include the polyene group that encompasses amphotericin B deoxycholate and its lipid formulations (liposomal amphotericin B, amphotericin B lipid complex, and amphotericin B cholesteryl sulfate complex); the nucleoside analogue flucytosine; the triazoles which include fluconazole and voriconazole; and the most recently developed echinocandin class, which includes caspofungin, micafungin, and anidulafungin.