Mikafungiin

Mikafungiin, more commonly spelled micafungin, is an antifungal medication in the echinocandin class. It is used to treat certain invasive fungal infections caused by Candida species and to prevent Candida infections in specific high-risk patients. Micafungin is administered by intravenous infusion and has no oral form.

Mechanism of action and spectrum: micafungin inhibits the enzyme beta-1,3-D-glucan synthase, which is essential for synthesizing a key component of the fungal cell wall. This weakens the cell wall and leads to fungal cell death. Its activity is strongest against Candida species, including some strains resistant to fluconazole, and it has activity against some Aspergillus species as a second-line option. It shows limited or no activity against Cryptococcus neoformans and most Zygomycetes, and it is not considered a treatment for fungal meningitis due to limited central nervous system penetration.

Clinical uses: indications commonly include treatment of candidemia and other forms of invasive candidiasis, and treatment of esophageal candidiasis. In many regions, micafungin is also approved for prophylaxis of Candida infections in adult patients undergoing hematopoietic stem cell transplantation.

Administration and pharmacokinetics: micafungin is given once daily by IV infusion. Dosing depends on the indication and patient body weight. It is primarily cleared by hepatic metabolism with biliary excretion; the drug has a relatively long half-life, allowing once-daily dosing. Drug interactions are limited, but hepatic impairment may influence dosing and monitoring is recommended.

Safety and resistance: common adverse effects include fever, rash, nausea, and liver enzyme elevations. Hypersensitivity reactions are rare but possible. Fungal resistance can arise from mutations in target enzymes, though it remains relatively uncommon. Micafungin is typically avoided in pregnancy unless clearly indicated, and monitoring is advised in severe liver disease.

History and naming: micafungin was developed by Fujisawa Pharmaceutical and later marketed under the brand name Mycamine after partnerships with other companies in different regions.