Names and pronunciation
(my-ca-fun′gin) Mycamine
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Drug reference
(my-ca-fun′gin) Mycamine
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Func. class.: Antifungal, systemic
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Chem. class.: Echinocandin
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ACTION: Inhibits an essential compo- nent of fungal cell walls; causes direct damage to fungal cell wall
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USES: Treatment of esophageal candidi- asis; prophylaxis for Candida infections in patients undergoing hematopoietic stem- cell transplantation (HSCT); susceptible Candida sp.: C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis
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CONTRAINDICATIONS: Hyper- sensitivity to this product or other echinocandins Precautions: Pregnancy, breastfeeding, children, geriatric patients, severe hepatic disease, renal impairment, hemolytic anemia
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SIDE EFFECTS GI: Abdominal pain, nausea, anorexia, vomiting, diarrhea, hyperbilirubine- mia, hepatitis GU: Renal failure HEMA: Hemolytic anemia INTEG: Rash, pruritus, inj-site pain MISC: Allergic reactions
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INTERACTIONS Increase: plasma concentrations— CYP3A4 substrates (aripiprazole, dofeti- lide, pimozide); itraconazole, sirolimus, NIFEdipine; may need dosage reduction Drug/Lab Test Increase: ALT/AST, alk phos, bilirubin, potassium, sodium, LDH, BUN, creatinine Decrease: blood glucose platelets, HB, WBCs
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DOSAGE AND ROUTES Esophageal candidiasis • Adult: IV INFUSION 150 mg/day given over 1 hr × 15 days • Child ≥4 mo, >30 kg: IV INFUSION 2.5 mg/kg/day, max 150 mg/day • Child ≥4 mo, ≤30 kg: IV INFUSION 3 mg/kg/day Candidemia/acute disseminated candidiasis, abscess/peritonitis • Adult: IV 100 mg/day over 1 hr × 15 days • Child ≥4 mo and >30 kg: IV 2 mg/kg/ day, max 100 mg/day; ≥4 mo and ≤30 kg: 2 mg/kg/day Prophylaxis for Candida infections in hemapoietic stem-cell transplant patients • Adult: IV INFUSION 50 mg/day given over 1 hr • Adolescent/child/infant ≥4 mo: IV INFUSION 1 mg/kg/day, max 50 mg/day
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Administer:
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Available forms: Powder for inj 50 mg, in single-dose vials 50-, 100-mg vial IV route Intermittent IV infusion • Visually inspect for particulate matter and discoloration prior to use • Reconstitution: Reconstitute each 50-mg vial or 100-mg vial with 5 mL of either 0.9% sodium chloride injection (without bacteriostatic agent) or 5% dextrose injection for a resultant concen- tration of 10 mg/mL or 20 mg/mL, re- spectively • Gently dissolve by swirling the vial. In order to minimize excessive foaming, do not vigorously shake the vial • Storage: Reconstituted product may be stored in the original vial protected from light for up to 24 hr at room tem- perature (77°F [25°C]) • Dilution • Adults: Transfer the needed amount of reconstituted micafungin to an IV bag containing 100 mL of 0.9% sodium M chloride injection or 5% dextrose in- jection • Pediatrics: Withdraw the calculated volume of reconstituted micafungin and add to an IV bag or syringe containing 0.9% sodium chloride injection or 5% dextrose injection (final concentration 0.5-4 mg/mL); label infusion bags or sy- ringes containing micafungin concentra- tions more than 1.5 mg/mL for adminis- tration through a central catheter only • Discard partially used vials; micafun- gin is preservative-free. • Storage: The final diluted solution may be stored protected from light for up to 24 hr at room temperature (77°F [25°C]) • To minimize the risk of infusion- related reactions, infuse solutions with concentrations more than 1.5 mg/mL via a central catheter • If an existing IV line will be used, flush the line with 0.9% sodium chloride injec- tion prior to and after infusion • Run as a slow IV infusion over 1 hr. If administered more rapidly, more fre- quent histamine-mediated reactions may occur. Do not give as a bolus • Do not mix or coinfuse micafungin with other medications. Micafungin has been shown to precipitate when mixed directly with several commonly used medications • Protect diluted micafungin from light; not necessary to cover the drip chamber or the tubing during use
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Assess: • Infection, clearing of cultures during treatment; obtain culture at baseline and during treatment; product may be started as soon as culture is taken (esophageal candidiasis); monitor cultures during HSCT for prevention of Candida infec- tions • CBC (RBC, Hct, HB), differential, platelet count baseline, periodically; no- tify prescriber of results • Renal studies: BUN, urine CCr, electro- lytes before and during therapy • Hepatic studies before and during treatment: bilirubin, AST, ALT, alk phos as needed • Bleeding: hematuria, heme-positive stools, bruising, petechiae, mucosa or orifices; blood dyscrasias can occur • For hypersensitivity: rash, pruritus, facial swelling, phlebitis • For hemolytic anemia • GI symptoms: frequency of stools, cramping; if severe diarrhea occurs, electrolytes may need to be given • Pregnancy/breastfeeding: use cau- tiously in breastfeeding; use in pregnancy if benefit outweighs risk to fetus, no ad- equate studies
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Evaluate: • Therapeutic response: prevention of Candida infection with HSCT or de- creased symptoms of Candida infection, negative culture
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid breastfeeding while taking this product, to notify prescriber if preg- nancy is planned or suspected • To report bleeding, facial swelling, wheezing, difficulty breathing, itching, rash, hives, increasing warmth, flushing • To report signs of infection: increased temperature, sore throat, flulike symptoms: nausea, vomiting, clay-colored stools, an- orexia, yellowing skin/eyes, dark urine, hepatotoxicity may occur
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PHARMACOKINETICS Metabolized in liver; excreted in feces, urine; terminal half-life 14-17.2 hr; pro- tein binding 99%
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• Child ≥4 mo, >30 kg: IV INFUSION 2.5 mg/kg/day, max 150 mg/day
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• Child ≥4 mo, ≤30 kg: IV INFUSION 3 mg/kg/day Candidemia/acute disseminated candidiasis, abscess/peritonitis
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• Child ≥4 mo and >30 kg: IV 2 mg/kg/ day, max 100 mg/day; ≥4 mo and ≤30 kg: 2 mg/kg/day Prophylaxis for Candida infections in hemapoietic stem-cell transplant patients
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• Adolescent/child/infant ≥4 mo: IV INFUSION 1 mg/kg/day, max 50 mg/day
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