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Echinocandin Antifungal — Invasive Candidiasis / Prophylaxis in HSCT Pregnancy: Avoid — animal teratogenicity data; limited human data

Micafungin

Brand names: Mycamine

Adult dose

Dose: Invasive candidiasis: 100 mg IV once daily (150 mg if C. parapsilosis suspected); Prophylaxis in HSCT: 50 mg IV once daily; Oesophageal candidiasis: 150 mg IV once daily
Route: Intravenous infusion over 1 hour
Frequency: Once daily
Max: 150 mg/day
Echinocandin with same mechanism as anidulafungin and caspofungin. Preferred echinocandin for prophylaxis in haematopoietic stem cell transplant (HSCT) — licensed specifically for this. Like anidulafungin: no significant CYP450 interactions; no dose adjustment for renal/hepatic impairment.

Paediatric dose

Dose: 2 mg/kg (max 100 mg/day) for candidiasis; 1 mg/kg (max 50 mg/day) for prophylaxis mg/kg
Route: IV
Frequency: Once daily
Max: 100 mg/day
BNFc: licensed in children including neonates — only echinocandin with neonatal licence data; used for neonatal candidiasis

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment for mild-moderate impairment; severe hepatic impairment — limited data but no known dose change needed

Paediatric weight-based calculator

BNFc: licensed in children including neonates — only echinocandin with neonatal licence data; used for neonatal candidiasis

Clinical pearls

  • Micafungin is the only echinocandin licensed for neonatal candidiasis in UK — important for neonatal ICU use where invasive candidiasis carries high mortality
  • Animal hepatotoxicity data: rat studies showed hepatic tumours with micafungin — EMA reviewed in 2012 and concluded benefit-risk remains positive for short courses; recommended duration monitoring of LFTs
  • Licensed for HSCT antifungal prophylaxis — specifically studied and approved for this indication unlike other echinocandins
  • C. parapsilosis: echinocandins have higher MICs against this species — some guidelines recommend higher doses (150 mg) or switching to fluconazole if sensitive

Contraindications

  • Hypersensitivity to micafungin or other echinocandins

Side effects

  • Elevated LFTs (hepatocellular damage — more common than other echinocandins)
  • Hepatic tumours in animals (regulatory concern — no human evidence)
  • Nausea
  • Headache
  • Hypokalaemia
  • Haematological changes (leucopenia, anaemia)

Interactions

  • Sirolimus — increases sirolimus AUC (~21%) — monitor levels
  • Nifedipine — increases nifedipine AUC — monitor BP
  • Itraconazole — increases itraconazole AUC

Monitoring

  • LFTs (more frequent monitoring than other echinocandins due to hepatotoxicity concern)
  • Renal function and electrolytes
  • Clinical response and serial cultures
  • Sirolimus levels if co-prescribed

Reference: BNFc; BNF 90; ESCMID Candida Guidelines; EMA Micafungin Hepatotoxicity Review 2012; PEDIATRIC Micafungin Studies. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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