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Echinocandin Antifungal — Invasive Candidiasis / Prophylaxis in HSCT

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.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

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. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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