Echinocandin Antifungal — Invasive Candidiasis / Prophylaxis in HSCT Pregnancy: No data from use in pregnant women; micafungin crossed the placental barrier and reproductive toxicity was seen in animal studies. Should not be used during pregnancy unless clearly necessary. Excretion in human breast milk unknown (excreted in animal milk) - weigh benefit of breast-feeding against benefit of therapy. Testicular toxicity was seen in animals; may have potential to affect male fertility.

Micafungin

Brand names: Mycamine

Micafungin is an intravenous echinocandin antifungal used for invasive and oesophageal candidiasis and for prophylaxis of Candida infection in certain at-risk patients such as stem cell transplant recipients.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Treatment of invasive candidiasis: 100 mg/day (body weight over 40 kg) or 2 mg/kg/day (body weight 40 kg or less)

Route: intravenous infusion over approximately 1 hour after reconstitution and dilution

Frequency: once daily

Max: If response is inadequate (e.g. persistence of cultures, no clinical improvement), the dose may be increased to 200 mg/day in patients weighing over 40 kg, or 4 mg/kg/day in patients weighing 40 kg or less

Infectious-diseases context entry - same active ingredient and same UK SPC source as the micafungin entry. Dose regimen depends on body weight. Applies to adults, adolescents 16 years of age and over, and the elderly. Other indications in this group: oesophageal candidiasis 150 mg/day (over 40 kg) or 3 mg/kg/day (40 kg or less); prophylaxis of Candida infection 50 mg/day (over 40 kg) or 1 mg/kg/day (40 kg or less). Treatment duration - invasive candidiasis: minimum 14 days, continuing for at least one week after two sequential negative blood cultures and after resolution of clinical signs and symptoms; oesophageal candidiasis: at least one week after resolution of clinical signs and symptoms; prophylaxis: at least one week after neutrophil recovery. Treatment should be initiated by a physician experienced in the management of fungal infections. Obtain specimens for fungal culture and other relevant laboratory studies (including histopathology) before therapy; therapy may be started before results are known but should be adjusted once available. More rapid infusion may result in more frequent histamine-mediated reactions. Hepatic impairment: no dose adjustment in mild or moderate impairment; insufficient data in severe hepatic impairment and use is not recommended. EXTRACTION CAVEAT: the SPC posology tables use greater-than/less-than-or-equal comparators and the 'greater than' symbol was lost in text extraction (source reads 'Body weight 40 kg' alongside 'Body weight <=40 kg'). The weight thresholds above are rendered as 'over 40 kg' / '40 kg or less' - clinician to confirm against the full SPC table.

Paediatric dose

Dose: 2 mg/kg

Route: intravenous infusion over approximately 1 hour

Frequency: once daily (2 mg/kg/day)

Max: May be increased to 4 mg/kg/day if response is inadequate (or to 200 mg/day in children weighing over 40 kg)

Structured value is for treatment of invasive candidiasis in children 4 months of age and over up to adolescents under 16 years, body weight 40 kg or less. Children in that band weighing over 40 kg: 100 mg/day (may increase to 200 mg/day). Prophylaxis of Candida infection in that band: 1 mg/kg/day (40 kg or less) or 50 mg/day (over 40 kg). Children (including neonates) under 4 months of age: treatment of invasive candidiasis 4-10 mg/kg/day; prophylaxis of Candida infection 2 mg/kg/day. Micafungin dosed at 4 mg/kg in children under 4 months approximates drug exposures achieved in adults receiving 100 mg/day for invasive candidiasis; if CNS infection is suspected a higher dosage (e.g. 10 mg/kg) should be used due to dose-dependent CNS penetration. Safety and efficacy of the 4 and 10 mg/kg doses for invasive candidiasis with CNS involvement in children (including neonates) under 4 months has not been adequately established. Experience in patients under 2 years of age is limited. Paediatric patients under 1 year of age may be more prone to liver injury. Treatment duration as for adults. Oesophageal candidiasis dosing is not stated for the paediatric population in this SPC. Verify all paediatric doses against a children's formulary before prescribing.

Dose adjustments

Renal

No dose adjustment is necessary in patients with renal impairment. However, micafungin may cause kidney problems, renal failure and abnormal renal function tests - monitor closely for worsening renal function.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to the active substance, to other echinocandins, or to any of the excipients

Side effects

Nausea (2.8%), vomiting (2.5%), diarrhoea, abdominal pain (common)
Blood alkaline phosphatase increased (2.7%), aspartate aminotransferase increased (2.3%), alanine aminotransferase increased, blood bilirubin increased, abnormal liver function test (common)
Phlebitis (2.5%, primarily in HIV-infected patients with peripheral lines) (common)
Leukopenia, neutropenia, anaemia (common); haemolytic anaemia and haemolysis (rare)
Hypokalaemia, hypomagnesaemia, hypocalcaemia (common); headache, pyrexia, rigors, rash (common)
Anaphylactic/anaphylactoid reaction including shock, and exfoliative cutaneous reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis) (uncommon to rare)

Interactions

Amphotericin B desoxycholate - co-administration only when benefits clearly outweigh risks, with close monitoring for amphotericin B desoxycholate toxicity
Sirolimus - monitor for sirolimus toxicity; reduce sirolimus dose if necessary
Nifedipine - monitor for nifedipine toxicity; reduce nifedipine dose if necessary
Itraconazole - monitor for itraconazole toxicity; reduce itraconazole dose if necessary
Concomitant hepatotoxic and/or genotoxic medicines - conduct micafungin treatment on a careful risk/benefit basis

Clinical monograph

How it works

It non-competitively inhibits beta-(1,3)-D-glucan synthase, an enzyme essential for synthesis of a key fungal cell-wall component absent from mammalian cells, leading to fungal cell death.

Prescribing in practice

Liver function should be monitored as hepatic effects can occur, and regulatory advice notes liver tumours were seen in long-term animal studies, so prolonged use is weighed against benefit.
Infusion-related reactions, including histamine-mediated symptoms, can occur and are reduced by appropriate infusion rates.
It is given intravenously only and, unlike azoles, has comparatively few cytochrome P450-mediated interactions, though the SPC should still be checked.

Monitoring

Monitor liver function and review for infusion reactions, haemolysis and renal effects during therapy.

Counselling the patient

Report any rash, flushing or breathlessness during the infusion.
This treatment is given by a drip and your blood tests will be checked during the course.
Mention any history of liver problems to your team.

Evidence & guidelines

Efficacy in invasive and oesophageal candidiasis is established in randomised trials and reflected in the SPC.

Reference: ESCMID Candida Guidelines; EMA Micafungin Hepatotoxicity Review 2012; PEDIATRIC Micafungin Studies; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways