Micafungin

Micafungin is an antifungal medication in the echinocandin class. It inhibits 1,3-beta-D-glucan synthase, an enzyme required for synthesis of the fungal cell wall, producing cell wall damage and fungal death. Micafungin is fungicidal against most Candida species and has limited activity against Aspergillus species.

Indications for micafungin include invasive candidiasis (including candidemia) and esophageal candidiasis, with additional use as prophylaxis against Candida infections in high-risk hematology patients, such as those undergoing hematopoietic stem cell transplantation. It is administered by intravenous infusion and is not available by mouth.

Pharmacokinetics and administration: micafungin is given once daily by IV infusion. In adults, typical dosing ranges from about 50 to 150 mg per day depending on indication, with 100 mg daily commonly used for candidiasis and 150 mg for more extensive disease in some guidelines. It is primarily cleared by the liver, with hepatic metabolism; renal impairment generally does not require dose adjustment. The elimination half-life is on the order of about 15 hours, supporting once-daily dosing.

Safety and adverse effects: common adverse events include fever, nausea, rash, and infusion-related reactions. Elevations in liver enzymes and, less frequently, hepatotoxicity have been reported. Hypersensitivity reactions are possible. Interactions with other drugs are limited due to minimal involvement with major cytochrome P450 pathways. Contraindications include hypersensitivity to micafungin or other echinocandins. As with other antifungals, use during pregnancy or lactation should be guided by risk-benefit assessment.