micafungin sodium: clinical use

Prescribing considerations

• Reserve for situations where other antifungals are inappropriate, after considering the uncertain clinical relevance of liver tumours observed in rats.
• Obtain fungal cultures and other relevant investigations before treatment where feasible, then review therapy when organism identification and susceptibility information become available.
• Use requires particular risk–benefit scrutiny in severe or chronic liver disease and alongside hepatotoxic or genotoxic therapies.
• More rapid infusion can increase histamine-mediated reactions.
• Experience is limited in very young children, who may be more susceptible to hepatic adverse effects.

Contraindications and cautions

• Hypersensitivity to micafungin, another echinocandin or any product excipient.

Monitoring

• Liver function at baseline and during treatment; reassess promptly if transaminases remain significantly raised.
• Renal function for deterioration or acute kidney injury.
• Full blood count and evidence of haemolysis when clinically indicated.
• Electrolytes, bilirubin and infusion-site or systemic hypersensitivity reactions.
• Toxicity of amphotericin B deoxycholate, sirolimus, nifedipine or itraconazole when co-administered.

Clinical pharmacology

Micafungin non-competitively inhibits fungal 1,3-beta-D-glucan synthesis. It is highly protein-bound, has low CYP-mediated interaction potential and is eliminated predominantly by non-renal routes.

Formulation and product differences

• The selected product is a single-use powder for concentrate requiring aseptic reconstitution and dilution before intravenous infusion.
• It contains lactose monohydrate and is considered essentially sodium-free.
• The diluted solution must be protected from light and must not be used if cloudy or containing precipitate.

Solution for infusion

Route: Intravenous

Strengths: 50 mg, 100 mg