Micafungin (Intravenous)

Overview

Micafungin is an injected antifungal medication marketed under the brand name Mycamine that fights infections caused by fungus. Its most common use is to treat patients who have picked up an infection of the Candida fungus, but it is also used in a preventative role for patients who have had a stem cell transplant to reduce the possibility of such an infection. It is mostly prescribed to adults, although it can be prescribed to children who are older than four. Diseases caused by these fungal infections can include candidemia, acute disseminated candidiasis, candida peritonitis and abscess, and esophagal candidiasis. As with its recent applications to patients with stem cell therapy, micafungin is a versatile antifungal agent that may have applications for other fungal outbreaks.

Patients should not be prescribed micafungin if they have a history of allergies to similar antifungal medications. Those who have allergic reactions to caspofungin or anidulafungin are at a high risk of having a severe allergic reaction to this medication. There are also several health conditions, such as liver or kidney disease, that may make this an inappropriate treatment for some patients. As a powerful antifungal agent, this medicine should only be used under the close supervision of the physician treating the patient after a procedure or in the event of infection. It is not intended for self-injection or administration and in most situations will be injected through an IV by a medical professional.

Conditions Treated

  • Candidemia
  • Acute disseminated candidiasis
  • Candida peritonitis
  • Candida abscess
  • Esophageal candidiasis
  • Other fungal infections

Type Of Medicine

  • Antifungal

Side Effects

Micafungin may have a risk of side effects when used by some patients. Although these side effects may not occur in all patients they should be taken into consideration as of the more serious side effects may require medical attention. Immediate medical attention needs to be sought out if a patient has any of the following common symptoms when using micafungin:

  • Black, tarry, stools
  • Cough
  • Decreased frequency or amount of urine
  • Fast, pounding, or irregular heartbeat or pulse
  • Fever or chills
  • Increased thirst
  • Loss of appetite
  • Lower back or side pain
  • Nausea or vomiting
  • Painful or difficult urination
  • Pale skin
  • Pinpoint red spots on the skin
  • Shortness of breath
  • Swelling of the face, fingers, or lower legs
  • Trouble breathing
  • Ulcers, sores, or white spots in the mouth
  • Unusual bleeding or bruising
  • Unusual tiredness or weakness
  • Weight gain

Some of the less common serious side effects may include:

  • Bone pain
  • Changes in skin color, pain, tenderness, or swelling of the foot or leg
  • Chest pain
  • Convulsions
  • Drowsiness
  • Mood or mental changes
  • Muscle pain or cramps
  • Muscle spasms or twitching
  • Numbness or tingling in the hands, feet, or lips
  • Seizures
  • Swollen glands
  • Trembling

Although patients rarely have these following symptoms they may nonetheless be serious enough to merit medical attention:

  • Abdominal or stomach cramps
  • Blurred vision
  • Dizziness
  • Headache
  • Nervousness
  • Pounding in the ears
  • Slow or fast heartbeat
  • Weakness or heaviness of the legs

Some other serious side effects have been observed in patients using micafungin although their instance is not known:

  • Agitation
  • Back, leg, or stomach pain
  • Blistering, peeling, or loosening of the skin
  • Bruising
  • Diarrhea
  • Fast, weak pulse
  • General body swelling
  • Hives
  • Hostility or irritability
  • Itching
  • Joint pain
  • Lightheadedness
  • Light-colored stools
  • Nosebleeds
  • Persistent bleeding or oozing from puncture sites, mouth, or nose
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Red skin lesions, often with a purple center
  • Skin rash or redness
  • Vomiting of blood
  • Yellow eyes or skin

Some side effects are considered temporary and may subside as the body gets used to the injections. These include the following routine symptoms that will probably not be cause for concern:

  • Belching
  • Bluish color
  • Cold sweats
  • Change in taste
  • Confusion as to time, place, or person
  • Cool, pale skin
  • Depression
  • Difficulty having a bowel movement
  • Feeling unusually cold or shivering
  • Flushing
  • Hallucinations
  • Heartburn
  • Hiccups
  • Increased hunger
  • Injection site pain
  • Nightmares
  • Sleepiness or unusual drowsiness
  • Stomach discomfort or upset
  • Slurred speech
  • Welts
  • Unusual excitement, nervousness, or restlessness

If any other symptoms than these occur when using micafungin inform a medical care provider as these may be indicative of a more serious condition.

Dosage

Micafungin is given as a once-daily dose over the course of several weeks. Exact doses will be determined by the condition that it is treating, whether it is being used as a preventative or treatment, and the weight of the patient. It is injected intravenously, usually through an iv drip by a medical professional. The medication needs to be handled very carefully and not shaken during preparation or before injection. Before use, it needs to be carefully inspected to ensure that it has not changed colors. It should also not be used if it has particles floating in the liquid. Injections should be prepared only when they are about to be used as environmental conditions or improper handling can make the medication ineffective. If the medication is administered via IV in the home the person administering the medication needs to be trained in its use. After the mixture of the medication is cannot be exposed to light, so the IV bag needs to be covered when the dose is being administered. The micafungin drip will take a full hour to complete and should not be interrupted. It is very important that it not be administered with other intravenous medications in the same drip or through the same IV line. When administered to children, the dose will be very precise based on the weigh of the child. Any changes in weight may need to be reported in order to change the dose. Each needle used for injecting micafungin is only to be used once and disposed of appropriately after use in a puncture-proof container. Vials of this medication are single use and need to be thrown away after every use even if there is still medication left after injecting the dose.

Interactions

Micafungin can have interactions with certain other medications that can produce undesirable results. For this reason, some of these medications should not be used at all during the course of treatment with micafungin. If there is a reason why they must be used at the same time certain precautions will be in order and may include changes in doses or times that the drugs are taken. For this reason, it is very important that the prescribing physician be aware of all prescription drugs and over the counter medications are being taken during the course of an antifungal treatment. When used together with micafungin, the following medications may increase the risk of side-effects of one or both medications.

  • Itraconazole
  • Nifedipine
  • Sirolimus

Although these are not all of the medications that may react with micafungin they are the most notable examples. There may be a risk of interaction with certain foods, drink, alcohol, tobacco, vitamins, supplements, and herbal remedies as well. This possibility needs to be discussed between provider and patient before prescribing the medication.

There are some medical problems that may influence the decision regarding whether or not to use micafungin. Some of these conditions will interfere with how the medicine works or the dose may make the conditions worse. The prescribing physician will need to know if there is a history of any of the following medical problems or if a patient is currently demonstrating symptoms that may indicate that these conditions are present.

  • Bleeding problems
  • Kidney problems
  • Liver disease

Warnings

Micafungin should only be administered under the close supervision of a doctor and regular examinations will be necessary in order to ensure that the medication is working properly. Regular blood tests will determine if there is progress and if there are any side effects that are a consequence of taking this medication. The largest concern when using micafungin is the risk of a serious allergic reaction that can result in anaphylaxis. This life-threatening condition requires immediate emergency medical treatment. If a patient shows any of the following symptoms immediate medical attention is called for:

  • Rash
  • Itching
  • Swelling of the face, tongue, and throat,
  • Trouble breathing
  • Chest pain after injection

There is also a risk of serious liver problems while using this medication. Symptoms that indicate this may be happening include pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. If any or all of these symptoms occur the health care provider needs to be informed.

Storage

Micafungin will not normally be maintained in the home but rather be kept at the hospital or medical facility where it is administered. In its powder form, it needs to be stored at room temperature away from sources of moisture, heat, and light. When mixed, micafungin may be stored at room temperature but must be used the same day that it was mixed. In general, it needs to be kept under very controlled conditions including temperature and environmental exposures. If used at home, any unused portion must be disposed of in accordance with local requirements regarding the disposal of medical waste. Both medication and sharps need to be stored securely and kept out of the reach of children or house pets.

Summary

For patients who are at risk from fungal infections that can cause serious illnesses, micafungin can be both an effective treatment for an acute condition and a useful preventative measure to stave off possible infections. Although these diseases can be minor, such routine yeast infections or thrush, the more invasive form of these infections can get into the bloodstream and become life-threatening. Micafungin injections may represent the best possible treatment for a patient with an invasive infection, and even though there are serious warnings associated with the medication in regards to allergic reactions and interactions with other health problems, it is considered a generally safe treatment. If used properly under the supervision of a medical professional, micafungin may save a patient's life.