Micafungin (micafungin sodium)

Dosage of micafungin sodium is expressed in terms of micafungin.

A loading dose of micafungin is not required.

Micafungin sodium is administered by slow IV infusion. The drug should not be given by rapid IV injection.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

Myelosuppressives; Immunomodulators/Sodium Iodide I 131

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Sodium iodide I 131 can cause depression of the hematopoetic system. Myelosuppressives and immunomodulators also suppress the immune system.(1)

CLINICAL EFFECTS: Concurrent use of sodium iodide I 131 with agents that cause bone marrow depression, including myelosuppressives or immunomodulators, may result in an enhanced risk of hematologic disorders, including anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia. Bone marrow depression may increase the risk of serious infections and bleeding.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The US manufacturer of sodium iodide I 131 states that concurrent use with bone marrow depressants may enhance the depression of the hematopoetic system caused by large doses of sodium iodide I 131.(1) Sodium iodide I 131 causes a dose-dependent bone marrow suppression, including neutropenia or thrombocytopenia, in the 3 to 5 weeks following administration. Patients may be at increased risk of infections or bleeding during this time. Monitor complete blood counts within one month of therapy. If results indicate leukopenia or thrombocytopenia, dosimetry should be used to determine a safe sodium iodide I 131 activity.(1)

DISCUSSION: Hematologic disorders including death have been reported with sodium iodide I 131. The most common hematologic disorders reported include anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia.(1)

There are no moderate interactions for this drug.

Micafungin is contraindicated in patients with known hypersensitivity to the drug, other echinocandin antifungals (e.g., anidulafungin, caspofungin), or any ingredient in the formulation.

There are no contraindication contraindications for this drug.

• Intravascular hemolysis

• Kidney disease with reduction in glomerular filtration rate (GFr)

Adverse effects reported in 5% or more of patients receiving micafungin include GI effects (diarrhea, nausea, vomiting, abdominal pain, abdominal distention ), pyrexia, infusion-related reactions, hypoglycemia, hypomagnesemia, hypernatremia, hyperkalemia, epistaxis, hematologic effects (thrombocytopenia, neutropenia, anemia), febrile neutropenia, increased AST, increased ALT, increased alkaline phosphatase, rash, pruritus, urticaria, headache, insomnia, anxiety, decreased urine output, hematuria, atrial fibrillation, and tachycardia. Injection site reactions (inflammation, phlebitis, thrombophlebitis) have been reported.

More Frequent

• Hypertension
• Hypocalcemia
• Hypokalemia
• Neutropenic disorder
• Thrombocytopenic disorder

Less Frequent

• Atrial fibrillation
• Hyperbilirubinemia
• Hyperkalemia
• Hypermagnesemia
• Increased aspartate transaminase

Rare or Very Rare

• Abnormal hepatic function tests
• Acute myocardial infarction
• Anaphylaxis
• Anemia
• Delirium
• Disseminated intravascular coagulation
• Hemolytic anemia
• Hepatic failure
• Hepatitis
• Hepatocellular damage
• Hepatomegaly
• Injection site sequelae
• Intravascular hemolysis
• Jaundice
• Kidney disease with reduction in glomerular filtration rate (GFr)
• Pancytopenia
• Pericardial effusion
• Renal failure
• Shock
• Stevens-johnson syndrome
• Thrombotic thrombocytopenic purpura
• Toxic epidermal necrolysis

More Frequent

• Acute abdominal pain
• Body fluid retention
• Diarrhea
• Dyspepsia
• Fever
• Flushing
• Headache disorder
• Hypotension
• Nausea
• Phlebitis after infusion
• Vomiting

Less Frequent

• Chills
• Hypoglycemic disorder
• Insomnia
• Symptoms of anxiety
• Tachycardia

Rare or Very Rare

• Facial edema
• Pruritus of skin
• Skin rash
• Vasodilation of blood vessels

No enhanced messaging available.

Safety and efficacy of micafungin have not been established in pediatric patients younger than 4 months of age.

Safety and efficacy of micafungin in pediatric patients 4 months of age and older have been demonstrated based on evidence from adequate and well-controlled studies in adults and pediatric patients and additional pediatric pharmacokinetic and safety data.

Although data are limited, some experts state that micafungin can be considered for first-line treatment of invasive candidiasis or for alternative treatment of esophageal candidiasis in children with human immunodeficiency virus (HIV) infection.

Category C. (See Users Guide.)

There are no adequate and well-controlled studies of micafungin in pregnant women, and the manufacturer states that the drug should be used during pregnancy only if potential benefits outweigh potential risks to the fetus.

In rabbits, administration of micafungin in a dosage about 4 times the recommended human dosage (based on body surface area comparisons) resulted in increased abortions and visceral abnormalities (abnormal lobation of the lung, levocardia, retrocaval ureter, anomalous right subclavian artery, dilatation of the ureter).

Micafungin is distributed into milk in rats; it is not known whether the drug is distributed into milk in humans.

Micafungin should be used with caution in nursing women.

Dosage adjustments are not necessary in patients 65 years of age or older.

Although no overall differences in safety and efficacy were observed between geriatric adults 65 years of age or older and younger adults in clinical trials and other clinical experience has not revealed any evidence of age-related differences, the possibility that some older patients may have increased sensitivity to the drug cannot be ruled out.

There are no clinically important differences in the pharmacokinetics of micafungin in healthy adults 66-78 years of age compared with those 20-24 years of age. Dosage adjustments are not necessary when micafungin is used in geriatric patients.