MYCAMINE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MYCAMINE (MYCAMINE).

How it works

Micafungin is an echinocandin antifungal that inhibits the synthesis of 1,3-β-D-glucan, an essential component of the fungal cell wall, leading to osmotic instability and cell death.

What the body does with it

Metabolism	Micafungin undergoes hepatic metabolism via arylsulfatase and catechol-O-methyltransferase pathways, with minor involvement of CYP450 enzymes. It is a substrate of CYP3A4 but not a major pathway.
Excretion	Primarily excreted unchanged via feces (approximately 28%) and to a lesser extent via urine (approximately 15%). Overall, elimination is primarily non-renal with biliary/fecal excretion as the major route. Less than 1% is excreted as metabolites.
Half-life	Terminal elimination half-life is approximately 14.3 hours (range 11–17 hours) in healthy adults. In pediatric patients, half-life is shorter (approximately 10–12 hours). Clinically, steady state is achieved by day 3 with daily dosing.
Protein binding	Highly protein bound (≥99%) primarily to albumin. Also binds to alpha-1-acid glycoprotein. Binding is linear over the therapeutic concentration range.
Volume of Distribution	Volume of distribution at steady state (Vdss) is approximately 0.39 L/kg (range 0.28–0.55 L/kg) in adults. This low Vd indicates limited extravascular distribution, consistent with high protein binding and primarily intravascular localization.
Bioavailability	Not applicable; mycamine (micafungin) is only available as an intravenous formulation. Oral bioavailability is negligible and not used clinically.
Onset of Action	Intravenous administration: Antifungal effects begin within hours following infusion; however, clinically significant antifungal activity is observed within 24–48 hours after the first dose.
Duration of Action	Duration of antifungal activity extends beyond the dosing interval due to prolonged half-life. With once-daily dosing, therapeutic concentrations are maintained throughout the 24-hour interval. Post-antifungal effect may persist for several hours after concentrations fall below MIC.

Classification & Brands

Action Class	Fungal cell wall synthesis inhibitor (Echiocandins)
Brand Substitutes	Ibimica 50mg Injection, Micalan Injection, Micanfa 50mg Injection, Fungofine 50mg Injection, Micazar 50mg Injection, Micaggin 100mg Injection, Brumica 100mg Injection, Micafung Plus 100mg Injection

Dosing & administration

100 mg IV once daily for invasive candidiasis; 150 mg IV once daily for esophageal candidiasis.

Dosage form	INJECTABLE
Renal impairment	No dose adjustment required for any degree of renal impairment.
Liver impairment	No dose adjustment for mild-to-moderate hepatic impairment (Child-Pugh class A and B). Insufficient data for severe hepatic impairment (Child-Pugh class C); use with caution.
Pediatric use	For neonates and infants <4 months: weight <40 kg: 10 mg/kg IV once daily. For children ≥4 months and adolescents: weight <40 kg: 2 mg/kg IV once daily; weight ≥40 kg: 100 mg IV once daily.
Geriatric use	No specific dose adjustment required; consider age-related renal function decline, but no renal adjustment needed based on GFR.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for MYCAMINE (MYCAMINE).

Breastfeeding	Excreted in rat milk at concentrations 6-fold higher than maternal plasma. No human data; M/P ratio unknown. Caution advised; consider alternative antifungal during breastfeeding.
Teratogenic Risk	Pregnancy Category C. Animal studies (rats at 0.5 mg/kg, rabbits at 1.25 mg/kg) showed fetal toxicity (reduced ossification, increased resorptions) at maternally toxic doses. No adequate human studies. Avoid in first trimester unless benefit outweighs risk; use only if clearly needed in second/third trimester.

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to micafungin or other echinocandins"]

Clinical Precautions

Precautions

["Hepatic effects: elevations in AST, ALT, and bilirubin; monitor liver function","Rare cases of hepatic necrosis and hepatic failure","Renal effects: elevations in BUN and creatinine","Hypersensitivity reactions including anaphylaxis and exfoliative dermatitis","Risk of hemolytic anemia mediated by immune mechanisms"]

Clinical Tips & Counseling

Drug interactions

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MYCAMINE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MYCAMINE (MYCAMINE).

How it works

Micafungin is an echinocandin antifungal that inhibits the synthesis of 1,3-β-D-glucan, an essential component of the fungal cell wall, leading to osmotic instability and cell death.

What the body does with it

Metabolism	Micafungin undergoes hepatic metabolism via arylsulfatase and catechol-O-methyltransferase pathways, with minor involvement of CYP450 enzymes. It is a substrate of CYP3A4 but not a major pathway.
Excretion	Primarily excreted unchanged via feces (approximately 28%) and to a lesser extent via urine (approximately 15%). Overall, elimination is primarily non-renal with biliary/fecal excretion as the major route. Less than 1% is excreted as metabolites.
Half-life	Terminal elimination half-life is approximately 14.3 hours (range 11–17 hours) in healthy adults. In pediatric patients, half-life is shorter (approximately 10–12 hours). Clinically, steady state is achieved by day 3 with daily dosing.
Protein binding	Highly protein bound (≥99%) primarily to albumin. Also binds to alpha-1-acid glycoprotein. Binding is linear over the therapeutic concentration range.
Volume of Distribution	Volume of distribution at steady state (Vdss) is approximately 0.39 L/kg (range 0.28–0.55 L/kg) in adults. This low Vd indicates limited extravascular distribution, consistent with high protein binding and primarily intravascular localization.
Bioavailability	Not applicable; mycamine (micafungin) is only available as an intravenous formulation. Oral bioavailability is negligible and not used clinically.
Onset of Action	Intravenous administration: Antifungal effects begin within hours following infusion; however, clinically significant antifungal activity is observed within 24–48 hours after the first dose.
Duration of Action	Duration of antifungal activity extends beyond the dosing interval due to prolonged half-life. With once-daily dosing, therapeutic concentrations are maintained throughout the 24-hour interval. Post-antifungal effect may persist for several hours after concentrations fall below MIC.

Classification & Brands

Action Class	Fungal cell wall synthesis inhibitor (Echiocandins)
Brand Substitutes	Ibimica 50mg Injection, Micalan Injection, Micanfa 50mg Injection, Fungofine 50mg Injection, Micazar 50mg Injection, Micaggin 100mg Injection, Brumica 100mg Injection, Micafung Plus 100mg Injection

Dosing & administration

100 mg IV once daily for invasive candidiasis; 150 mg IV once daily for esophageal candidiasis.

Dosage form	INJECTABLE
Renal impairment	No dose adjustment required for any degree of renal impairment.
Liver impairment	No dose adjustment for mild-to-moderate hepatic impairment (Child-Pugh class A and B). Insufficient data for severe hepatic impairment (Child-Pugh class C); use with caution.
Pediatric use	For neonates and infants <4 months: weight <40 kg: 10 mg/kg IV once daily. For children ≥4 months and adolescents: weight <40 kg: 2 mg/kg IV once daily; weight ≥40 kg: 100 mg IV once daily.
Geriatric use	No specific dose adjustment required; consider age-related renal function decline, but no renal adjustment needed based on GFR.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for MYCAMINE (MYCAMINE).

Breastfeeding	Excreted in rat milk at concentrations 6-fold higher than maternal plasma. No human data; M/P ratio unknown. Caution advised; consider alternative antifungal during breastfeeding.
Teratogenic Risk	Pregnancy Category C. Animal studies (rats at 0.5 mg/kg, rabbits at 1.25 mg/kg) showed fetal toxicity (reduced ossification, increased resorptions) at maternally toxic doses. No adequate human studies. Avoid in first trimester unless benefit outweighs risk; use only if clearly needed in second/third trimester.

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to micafungin or other echinocandins"]

Clinical Precautions

Precautions

Clinical Tips & Counseling

Drug interactions

Loading safety data…