Micafungin

INTRODUCTION

Indications

Esophageal candidiasis. Candidemia/acute disseminated candidiasis/Candidal peritonitis and abscesses. Prophylaxis of Candida infections during hematopoietic stem cell transplantation.

Action

Inhibits synthesis of glucan required for the formation of fungal cell wall. Therapeutic Effects: Death of susceptible fungi. Spectrum: Active against the following Candida spp.: C. albicans, C. glabrata, C. krusei, C. parapsilosis, C. tropicalis.

Adverse Reactions/Side Effects

GI: worsening hepatic function/hepatitis. GU: renal impairment. Hemat: hemolysis/hemolytic anemia. Local: injection-site reactions. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS (RARE).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Be alert for signs of liver dysfunction and hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

• Monitor and report signs of hemolytic anemia, including unusual weakness and fatigue, dizziness, jaundice, and abdominal pain.

• Monitor IV injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct patient to report signs of renal impairment, including decreased urine output, cloudy urine, and sudden weight gain due to fluid retention.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Protein Binding: >99 %.

Metabolism and Excretion: Mostly metabolized; 71% fecal elimination.

Half-life: 15 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity.

Use Cautiously in: Severe hepatic impairment; OB/Lactation/Pedi: Lactation or children (safety not established), pregnancy (use only if clearly needed).

Interactions

Drug-Drug: ↑ blood levels and risk of toxicity with sirolimus and nifedipine (dose adjustments may be necessary).

Route/Dosage

IV (Adults): Esophageal candidiasis—150 mg/day for 15 days (range 10–30 days); Candidemia/acute disseminated candidiasis/Candida peritonitis and abscesses—100 mg/day for 15 days (range 10–47 days); Prevention of Candida infections in stem cell transplantation—50 mg/day.