Mycamine (micafungin)


Micafungin belongs to echinocandins. It is a semisynthetic lipopeptite and exerts its antifungal effects by inhibiting the synthesis of 1,3-β-D-glucan, an essential component of the cell walls of certain fungi, which is absent from mammalian cells. Its FDA indications include treatment of candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses while treatment has not been adequately studied in endocarditis, osteomyelitis and meningitis caused by Candida. Additionally, it is indicated for the treatment of esophageal candidiasis and prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation

Micafungin is fungicidal against most Candida spp., including azole-resistant Candida, and Aspergillus flavus. However, it is less active against C. parapsilosis, C. lusitaniae, and C. guilliermondii species. Although micafungin is active against the cyst form of Pneumocystis jiroveci, it has no direct effect on trophozoite proliferation. It has no activity against Cryptococcus neoformans, Trichosporon spp., Zygomycetes, and Fusarium spp..

In adult patients with invasive candidiasis, micafungin is noninferior to caspofungin or liposomal amphotericin B. Likewise, in adult patients with esophageal candidiasis, micafungin is noninferior to caspofungin or fluconazole. As for antifungal prophylaxis for heamopoietic stem cell transplant recipients, micafungin is superior to fluconazole. Micafungin is generally well tolerated as caspofungin and fluconazole, and is associated with less infusion-related reaction than liposomal amphotericin B. Nevertheless, micafungin is less expensive than caspofungin and liposomal amphotericin B.

No significant drug-drug interactions between micafungin and mycophenolate, cyclosporine, tacrolimus, prednisolone, fluconazole, voriconazole, amphotericin B, ritonavir, and rifampin. However, area under curve of sirolimus, nifedipine or itraconazole was increased in combination with micafungin. Close monitoring and dose adjustment if indicated are suggested.


Clinical Studies

Efficacy and safety of micafungin for treating febrile neutropenia in hematological malignancies.
Goto N, Hara T, Tsurumi H, Ogawa K, Kitagawa J, Kanemura N, Kasahara S, Yamada T, Shimizu M, Nakamura M, Matsuura K, Moriwaki H. Am J Hematol. 2010 Nov;85(11):872-6.

At the dose of 150 mg/day, micafungin demonstrated its safety and efficacy as the empirical antifungal therapy of febrile neutropenia in patients with hematological malignancies.

Micafungin alone or in combination with other systemic antifungal therapies in hematopoietic stem cell transplant recipients with invasive aspergillosis. Kontoyiannis DP, Ratanatharathorn V, Young JA, Raymond J, Laverdière M, Denning DW, Patterson TF, Facklam D, Kovanda L, Arnold L, Lau W, Buell D, Marr KA. Transpl Infect Dis. 2009 Feb;11(1):89-93.

Micafungin was well tolerated and is a reasonable option for treatment of invasive aspergillosis in this high-risk patient population

Micafungin versus liposomal amphotericin B for pediatric patients with invasive candidiasis: substudy of a randomized double-blind trial. Queiroz-Telles F, Berezin E, Leverger G, Freire A, van der Vyver A, Chotpitayasunondh T, Konja J, Diekmann-Berndt H, Koblinger S, Groll AH, Arrieta A; Micafungin Invasive Candidiasis Study Group. Pediatr Infect Dis J. 2008 Sep;27(9):820-6.

Micafungin appears to be as effective and as safe as liposomal amphotericin B for the treatment of invasive candidiasis in pediatric patients.

Review Articles

Micafungin: a brief review of pharmacology, safety, and antifungal efficacy in pediatric patients. Lehrnbecher T, Groll AH. Pediatr Blood Cancer. 2010 Aug;55(2):229-32.

Pediatric data regarding the employment of micafungin were reviewed with focus on pharmacokinetics, efficacy, and safety.

Immunocompromised hosts: immunopharmacology of modern antifungals. Ben-Ami R, Lewis RE, Kontoyiannis DP. Clin Infect Dis. 2008 Jul 15;47(2):226-35.

In this review, not only are the microbial effects of antifungal effects discussed but also its interaction with the immunity of the host.

Micafungin: a review of its use in adults for the treatment of invasive and oesophageal candidiasis, and as prophylaxis against Candida infections. Cross SA, Scott LJ. Drugs. 2008;68(15):2225-55.

This is an updated review of pharmacological profile and clinical efficacy of micafungin for the treatment of invasive and oesophageal candidiasis in adults, and as prophylaxis against Candida infections.

A comparative evaluation of properties and clinical efficacy of the echinocandins. Kim R, Khachikian D, Reboli AC. Expert Opin Pharmacother. 2007 Jul;8(10):1479-92.

The unique advantages of caspofungin, micafungin, and anidulafungin for clinician are highlighted.

Adverse Drug Reactions and Warnings

FDA Information

Manufacturer/Distributor Product Information