MICAFUNGIN

MICAFUNGIN (my-ca-fun'gin) Mycamine Classifications: antibiotic; echinocandin, antifungal; Therapeutic: antifungal, echinocandin Prototype: Caspofungin Pregnancy Category: C

Availability

50 mg vial

Action

Micafungin is an antifungal agent that inhibits the synthesis of glucan, an essential component of fungal cell walls. Micafungin does not allow Candida fungi to replicate.

Therapeutic Effect

Has antifungal effects against various species of Candida.

Uses

Treatment of patients with esophageal candidiasis, and for prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation. Susceptible organisms include C. albicans, C. glabrata, C. krusei, C. parapsilosis, and C. tropicalis.

Unlabeled Uses

Treatment of pulmonary Aspergillus infection.

Contraindications

Hypersensitivity to any component in micafungin; pregnancy (category C). Safety and efficacy in children <18 y are unknown.

Cautious Use

Hepatic and renal dysfunction; lactation; older adult.

Route & Dosage

Esophageal Candidiasis Adult: IV 150 mg/d over 1 h x 14 d Candidiasis Prophylaxis in Hematopoietic Stem Cell Transplantation Patients Adult: IV 50 mg/d over 1 h x 18 d

Administration

Intravenous PREPARE: IV Infusion: • Reconstitute the 50 or 100 mg vial with 5 mL NS (without a bacteriostatic agent) to yield 10 mg/mL or 20 mg/mL, respectively. Gently swirl, but do not shake, to dissolve. Solution should be clear.• Add required dose to 100 mL NS.  ADMINISTER: IV Infusion: Give slowly over 1 h. Flush existing IV line with NS before/after infusion. Protect IV solution from light.   INCOMPATIBILITIES Do not mix or infuse with any other medications.

• Store reconstituted vial and IV solution for up to 24 h at 25° C (77° F). Protect from light.

Adverse Effects (≥1%)

CNS: Headache, dizziness, somnolence. CV: Flushing, hypertension, phlebitis. GI: Nausea, vomiting, diarrhea, abdominal pain. Hematologic/Lymphatic: Anemia, hemolytic anemia, leukemia, neutropenia, thrombocytopenia. Hepatic: Elevated liver enzymes, jaundice. Metabolic: Hypocalcemia, hypokalemia, hypomagnesemia. Skin: Pruritus, rash. Body as a Whole: Injection site pain, pyrexia, rigors.

Interactions

Drug: Micafungin increases levels of sirolimus and nifedipine.

Pharmacokinetics

Distribution: 99% protein bound. Metabolism: Biotransformation primarily in the liver. Elimination: Fecal (major) and renal. Half-Life: 14–17 h.

Nursing Implications

Assessment & Drug Effects

• Monitor for S&S of hypersensitivity during IV infusion; frequently monitor IV site for thrombophlebitis.
• Monitor for S&S of hemolytic anemia (i.e., jaundice).
• Lab tests: Periodic LFTs, kidney function tests, serum electrolytes, and CBC.
• Monitor blood levels of sirolimus or nifedipine with concurrent therapy. If sirolimus or nifedipine toxicity occurs, dosages of these drugs should be reduced.

Patient & Family Education

• Report immediately any of the following: facial swelling, wheezing, difficulty breathing or swallowing, tightness in chest, rash, hives, itching, or sensation of warmth.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug