Candidiasis, systemic, treatment: IV: 10 mg/kg/dose once daily (Benjamin 2018; Bradley 2019; ESCMID [Hope 2012]; HHS [OI pediatric 2019]; Kovanda 2018; Leroux 2018; Red Book [AAP 2018]; Rivera-Chaparro 2019); doses as high as 15 mg/kg/dose have been reported (Auriti 2016; Smith 2009). Duration of therapy should be individualized based on clinical response and presence of deep foci; treat for a minimum of 14 days from the first negative blood culture for candidemia (ESCMID [Hope 2012]; IDSA [Pappas 2016]). Note: Manufacturer labeling recommends 4 mg/kg/dose once daily in patients without CNS or ocular involvement; however, a pharmacokinetic model in patients 1 to 7 kg suggested that doses of 3 to 4 mg/kg/day in neonates and young infants would result in only 40.5% to 43.3% of patients achieving exposure similar to adults receiving 100 mg/day (Auriti 2016).
Aspergillosis, treatment, invasive (salvage therapy): Infants, Children, and Adolescents: Limited data available:
Note: In infants, initial doses at the higher end of the dosage range may be necessary due to pharmacokinetic differences (IDSA [Patterson 2016]). Treatment duration should be individualized based on patient-specific factors including site of infection, immunosuppression, and response to therapy; minimum duration is 6 to 12 weeks (AST [Husain 2019]; IDSA [Patterson 2016]).
≤40 kg: IV: 2 to 3 mg/kg/dose once daily (AST [Husain 2019]; IDSA [Patterson 2016]); higher doses of 4 to 6 mg/kg/dose once daily have also been described (Hashii 2014; Kobayashi 2007; Kobayashi 2015; Singer 2003).
>40 kg: IV: 100 mg/dose once daily; may increase to 150 mg/dose if clinically indicated; maximum daily dose: 150 mg/day (AST [Husain 2019]; Emiroglu 2011; IDSA [Patterson 2016]; Tetsuka 2017).
Candidiasis, esophageal (alternative agent in patients who cannot tolerate oral therapy):
Non-HIV-exposed/-infected: Infants ≥4 months, Children, and Adolescents: Note: IDSA guidelines recommend 14 to 21 days of treatment for esophageal candidiasis (IDSA [Pappas 2016]).
≤30 kg: IV: 3 mg/kg/dose once daily.
>30 kg: IV: 2.5 mg/kg/dose once daily; maximum dose: 150 mg/dose.
HIV-exposed/-infected (HHS [OI adult 2019]; HHS [OI pediatric 2019]): Note: Treatment is recommended for 14 to 21 days for esophageal candidiasis (HHS [OI adult 2019]; HHS [OI pediatric 2019]):
Infants <15 kg: IV: 5 to 7 mg/kg/dose once daily.
Children 2 to 8 years and ≤40 kg: IV: 3 to 4 mg/kg/dose once daily.
Children ≥9 years:
≤40 kg: IV: 2 to 3 mg/kg/dose once daily.
>40 kg: IV: 100 mg/dose once daily.
Adolescents: IV: 150 mg/dose once daily.
Candidiasis, systemic (including candidemia and invasive candidiasis):
Note: Duration of therapy should be individualized (based on deep-tissue foci, clinical response, etc); candidemia should be treated for a minimum of 14 days from the first negative blood culture and resolution of symptoms (ESCMID [Hope 2012]; IDSA [Pappas 2016]).
Infants <4 months: IV: 10 mg/kg/dose once daily (Benjamin 2018; ESCMID [Hope 2012]; Kovanda 2018; Leroux 2018; Rivera-Chaparro 2019); doses as high as 15 mg/kg/dose have been reported (Auriti 2016). Note: Manufacturer labeling recommends 4 mg/kg/dose once daily in patients without CNS or ocular involvement; however, a pharmacokinetic model in patients weighing 1 to 7 kg suggested that doses of 3 to 4 mg/kg/day in neonates and young infants would only result in 40.5% to 43.3% of patients achieving exposure similar to adults receiving 100 mg/day (Auriti 2016).
Infants ≥4 months, Children, and Adolescents: IV: Initial: 2 mg/kg/dose once daily; usual maximum dose: 100 mg/dose (Bradley 2019; Mycamine prescribing information [European Medicines Agency] 2018; Queiroz-Telles 2008; manufacturer's labeling); may increase to 4 mg/kg/dose if clinical condition does not improve or mycologic persistence occurs at lower doses; maximum dose: 200 mg/dose (Mycamine prescribing information [European Medicines Agency] 2018; Queiroz-Telles 2008). Manufacturer labeling recommends 2 mg/kg/dose once daily in patients without CNS or ocular involvement; however, a pharmacokinetic model indicates that doses of 3 to 4 mg/kg/day may be necessary to achieve AUC:MIC targets against Candida albicans in pediatric patients (Xu 2015).
Empiric antifungal therapy (neutropenic fever): Infants ≥4 months, Children, and Adolescents: IV: 2 to 3 mg/kg/dose once daily; maximum dose: 200 mg/dose (IDSA [Patterson 2016]; Kobayashi 2013; Styczynski 2016).
Fungal infection, prophylaxis in hematopoietic stem cell transplant (HSCT) recipients:
Infants <4 months: Limited data available: IV: 2 mg/kg/dose once daily (Mycamine prescribing information [European Medicines Agency] 2018); dose based on pharmacokinetic exposure similar to adults receiving 50 mg.
Infants ≥4 months, Children, and Adolescents: IV: 1 mg/kg/dose once daily; maximum dose: 50 mg/dose; doses as high as 3 mg/kg/day have been used in trials (Kusuki 2009; van Burik 2004; Yoshikawa 2014).
Alternate day dosing: Very limited data available: Infants ≥7 months and Children ≤10 years: IV: 3 mg/kg/dose every 48 hours; dosing based on a small pharmacokinetic modeling study in which a total of 15 patients (age: 0.6 months to 10 years) undergoing HSCT received a single dose of 3 mg/kg of micafungin; modeled exposures with 3 mg/kg/dose every 48 hours were similar to those achieved in previous studies evaluating 1 mg/kg/dose once daily (Mehta 2010).
No dosage adjustment necessary; not dialyzable, supplemental dosing is not required following hemodialysis.
No dosage adjustment necessary.
(For additional information see "Micafungin: Drug information")
Aspergillosis, invasive (including disseminated and extrapulmonary) (alternative agent) (off-label use):
Note: Reserve for salvage therapy, typically as part of an appropriate combination regimen. Monotherapy is further reserved for patients who are intolerant of or refractory to azoles and polyenes (IDSA [Patterson 2016]; Patterson 2022); for patients with severe or progressive infection, some experts use as initial therapy in combination with voriconazole (Denning 2006; Patterson 2022).
IV: 100 to 150 mg once daily (IDSA [Patterson 2016]; Kontoyiannis 2009).
Duration: When given as monotherapy, the minimum duration is 6 to 12 weeks depending on degree/duration of immunosuppression, disease site, and response to therapy (IDSA [Patterson 2016]); immunosuppressed patients may require more prolonged treatment (AST-IDCOP [Husain 2019]; Patterson 2022). When given as part of a combination regimen, the optimal duration is uncertain. Some experts have given an echinocandin for ~2 weeks in combination with voriconazole before step-down to voriconazole monotherapy (Marr 2015).
Candidiasis:
Candidemia (neutropenic and nonneutropenic patients), including disseminated candidiasis: IV: 100 mg once daily. Total duration (including oral step-down therapy) is ≥14 days after first negative blood culture and continues until signs/symptoms of candidemia and neutropenia, if present, have resolved; metastatic complications warrant a longer duration (AST-IDCOP [Aslam 2019]; IDSA [Pappas 2016]; Pappas 2007).
Cardiac device infection (including implantable cardiac defibrillator, pacemaker, ventricular assist device) (off-label use) : IV: 150 mg once daily; step down to azole therapy in clinically stable patients with susceptible isolates and negative repeat cultures; total antifungal duration is ≥4 weeks after device removal for isolated generator pocket infection and ≥6 weeks after device removal for wire infection (IDSA [Pappas 2016]).
Chronic disseminated (hepatosplenic) (off-label use): IV: 100 mg once daily for several weeks, followed by oral azole step-down therapy until lesion resolution and through periods of immunosuppression (IDSA [Pappas 2016]).
Empiric therapy, suspected invasive candidiasis (nonneutropenic ICU patients) (off-label use):
Note: Antifungal therapy is not routinely warranted for initial management of nonneutropenic patients with sepsis. Consider use for critically ill patients with unexplained fever or unexplained hypotension despite broad-spectrum antimicrobial therapy and risk factors for invasive candidiasis (eg, indwelling venous catheter, hemodialysis, trauma or burns, recent surgery, parenteral nutrition) (IDSA [Pappas 2016]; Kauffman 2021a; SCCM [Rhodes 2017]).
IV: 100 mg once daily. For those who improve, continue empiric antifungal therapy for 2 weeks; consider discontinuing after 4 to 5 days in patients with no evidence of invasive candidiasis and no clinical response (AST-IDCOP [Aslam 2019]; IDSA [Pappas 2016]).
Endocarditis, native or prosthetic valve (off-label use): IV: 150 mg once daily; step down to azole therapy in clinically stable patients with susceptible isolates and negative repeat cultures; total antifungal duration is ≥6 weeks after valve replacement surgery, with longer duration for perivalvular abscesses, other complications, or a nonsurgical approach (IDSA [Pappas 2016]).
Esophageal, refractory disease (alternative agent):
Note: Reserve for fluconazole-refractory disease in patients who require IV therapy (eg, severe disease) (Kauffman 2021c).
IV: 150 mg once daily (AST-IDCOP [Aslam 2019]; de Wet 2005; HHS [OI adult 2021]; IDSA [Pappas 2016]; Kauffman 2021c). Transition to an oral antifungal once patient tolerates oral intake if susceptibility allows; total antifungal duration is 14 to 28 days (HHS [OI adult 2021]; IDSA [Pappas 2016]; Kauffman 2021c).
Intra-abdominal infection (eg, peritonitis, abdominal abscess): IV: 100 mg once daily. Total duration (including oral step-down therapy) is ≥14 days and continues until source control and clinical resolution (AST-IDCOP [Aslam 2019]; IDSA [Pappas 2016]; Pappas 2007; SIS [Mazuski 2017]).
Oropharyngeal, refractory disease (alternative agent) (off-label use):
Note: Reserve for fluconazole-refractory disease in patients who require IV therapy (eg, severe disease) (Kauffman 2021d).
IV: 100 mg once daily. Transition to an oral antifungal once patient tolerates oral intake if susceptibility allows; total antifungal duration is 14 to 28 days (IDSA [Pappas 2016]; Kauffman 2021d).
Osteoarticular infection (osteomyelitis or septic arthritis) (off-label use): IV: 100 mg once daily for ≥2 weeks; total duration of therapy (including oral step-down therapy) is 6 to 12 months for osteomyelitis and ≥6 weeks for septic arthritis (IDSA [Pappas 2016]; Kauffman 2022b).
Thrombophlebitis, suppurative (off-label use): IV: 150 mg once daily; continue antifungal therapy until catheter removed and thrombus resolved, and for ≥2 weeks after candidemia (if present) has cleared (IDSA [Pappas 2016]).
Neutropenic fever, empiric antifungal therapy (alternative agent) (off-label use):
Note: Recommended for patients with persistent or recurrent fever after ≥4 days of antimicrobial therapy when the duration of neutropenia is expected to exceed 7 days (IDSA [Freifeld 2011]; IDSA [Patterson 2016]). Some experts reserve for patients without suspicion of mold infection (eg, pulmonary nodules) (Wingard 2021).
IV: 100 mg once daily (IDSA [Patterson 2016]; Toubai 2007; Yanada 2006).
Prophylaxis against invasive fungal infections:
Hematologic malignancy or hematopoietic cell transplant (alternative agent):
Note: Some experts reserve for patients at low risk for mold infection (ASCO/IDSA [Taplitz 2018]; Wingard 2021).
IV: 50 to 100 mg once daily. Duration is at least until resolution of neutropenia and varies based on degree and duration of immunosuppression (ASBMT [Tomblyn 2009]; ASCO/IDSA [Taplitz 2018]; Epstein 2018; Huang 2012; IDSA [Freifeld 2011]; IDSA [Patterson 2016]; van Burik 2004).
Solid organ transplant (alternative agent) (off-label use): IV: 100 mg once daily; duration varies based on patient risk factors and transplant center protocol (AST-IDCOP [Aslam 2019]; AST-IDCOP [Husain 2019]; Fishman 2021; IDSA [Patterson 2016]; Saliba 2015; Sun 2013).
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (Hebert 2005; manufacturer's labeling).
Hemodialysis, intermittent (thrice weekly): Poorly dialyzed: No supplemental dose or dosage adjustment necessary (manufacturer’s labeling).
Peritoneal dialysis: Unlikely to be significantly dialyzed (highly protein bound): No dosage adjustment necessary (expert opinion).
CRRT: Poorly dialyzed: No dosage adjustment necessary (Hirata 2007; Maseda 2014; Maseda 2015; Tenorio-Cañamás 2019; Vossen 2017).
PIRRT (eg, sustained, low-efficiency diafiltration): Unlikely to be significantly dialyzed (highly protein bound): No dosage adjustment necessary (expert opinion).
No dosage adjustment necessary.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Reconstituted, Intravenous, as sodium:
Generic: 50 mg (1 ea); 100 mg (1 ea)
Solution Reconstituted, Intravenous, as sodium [preservative free]:
Mycamine: 50 mg (1 ea [DSC])
Mycamine: 50 mg (1 ea [DSC]) [contains lactose]
Mycamine: 100 mg (1 ea [DSC])
Mycamine: 100 mg (1 ea [DSC]) [contains lactose]
Generic: 50 mg (1 ea); 100 mg (1 ea)
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous, as sodium:
Mycamine: 50 mg (1 ea); 100 mg (1 ea) [contains lactose]
Parenteral: IV: In pediatric patients, final concentrations >1.5 mg/mL should be administered via a central line to minimize risk of infusion reactions. Prior to administration, flush line with NS. Infuse over 1 hour; more rapid infusions may result in a higher incidence of histamine-mediated reactions. Do not coinfuse with other medications since precipitation may occur.
IV: For IV use only; infuse over 1 hour; may reduce infusion rate for infusion reaction (eg, rash, pruritus, facial swelling, vasodilatation). Flush line with NS prior to administration.
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Reconstituted and diluted solutions in D5W or NS are stable for 24 hours at room temperature. Protect infusion solution from light (it is not necessary to protect the drip chamber or tubing from light).
Treatment of candidemia, acute disseminated candidiasis, Candida peritonitis and abscess without meningoencephalitis and/or ocular dissemination (FDA approved in ages <4 months); treatment of candidemia, acute disseminated candidiasis, Candida peritonitis and abscess (FDA approved in ages ≥4 months and adults); treatment of esophageal candidiasis (FDA approved in ages ≥4 months and adults); prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplant (FDA approved in ages ≥4 months and adults); has also been used for treatment of invasive Aspergillosis.
Note: Micafungin is ineffective against cryptococcosis, fusariosis, and zygomycosis.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Candidiasis treatment:
>10%:
Cardiovascular: Phlebitis (19%)
Gastrointestinal: Diarrhea (7% to 11%), vomiting (7% to 18%)
Hematologic & oncologic: Anemia (infants, children, and adolescents: 18%)
Hepatic: Abnormal hepatic function tests (4%; infants, children, and adolescents: <15%), hyperbilirubinemia (infants, children, and adolescents: <15%)
Renal: Renal failure syndrome (infants, children, and adolescents: <15%)
Miscellaneous: Fever (9% to 13%)
1% to 10%:
Cardiovascular: Atrial fibrillation (adults: 3%), tachycardia (infants, children, and adolescents: 4%)
Dermatologic: Skin rash (2% to 5%)
Endocrine & metabolic: Abnormal aspartate transaminase (3%), hyperkalemia (adults: 5%), hypoglycemia (adults: 6%)
Gastrointestinal: Abdominal distention (infants, children, and adolescents: 2%), abdominal pain (infants, children, and adolescents: 4%), nausea (7% to 10%)
Hematologic & oncologic: Neutropenia (infants, children, and adolescents: 5%), thrombocytopenia (infants, children, and adolescents: 9%)
Hepatic: Increased serum alkaline phosphatase (3% to 6%)
Nervous system: Headache (adults: 9%)
Candidiasis prophylaxis in hematopoietic stem cell transplantation :
>10%:
Cardiovascular: Tachycardia (16% to 26%)
Dermatologic: Pruritus (infants, children, and adolescents: 33%), skin rash (25% to 30%), urticaria (<5%; infants, children, and adolescents: 19%)
Gastrointestinal: Abdominal distention (infants, children, and adolescents: 19%), abdominal pain (26% to 35%), diarrhea (77%; infants, children, and adolescents: 51%), nausea (70% to 71%), vomiting (65% to 66%)
Genitourinary: Decreased urine output (infants, children, and adolescents: 23%), hematuria (infants, children, and adolescents: 23%)
Hematologic & oncologic: Anemia (infants, children, and adolescents: 51%), febrile neutropenia (infants, children, and adolescents: 16%), neutropenia (75% to 77%), thrombocytopenia (72% to 75%)
Hepatic: Abnormal hepatic function tests (infants, children, and adolescents: <15%), hyperbilirubinemia (infants, children, and adolescents: <15%), increased serum alanine aminotransferase (16%)
Nervous system: Anxiety (22% to 23%), headache (adults: 44%), insomnia (adults: 37%)
Renal: Renal failure syndrome (infants, children, and adolescents: <15%)
Miscellaneous: Fever (infants, children, and adolescents: 61%), infusion-related reaction (infants, children, and adolescents: 16%)
1% to 10%:
Cardiovascular: Acute myocardial infarction (adults: <5%), pericardial effusion (adults: <5%)
Endocrine & metabolic: Hypernatremia (<5%), hypokalemia (<5%)
Hematologic & oncologic: Disorder of hemostatic components of blood (adults: <5%), pancytopenia (adults: <5%), thrombotic thrombocytopenic purpura (adults: <5%)
Hepatic: Hepatic failure (adults: <5%), hepatic injury (adults: <5%), hepatomegaly (adults: <5%), jaundice (adults: <5%)
Hypersensitivity: Anaphylaxis (adults: <5%), hypersensitivity reaction (adults: <5%)
Local: Infusion site reaction (adults: <5%), venous thrombosis at injection site (adults: <5%)
Nervous system: Encephalopathy (adults: <5%), delirium (adults: <5%), intracranial hemorrhage (adults: <5%), seizure (adults: <5%)
Respiratory: Epistaxis (infants, children, and adolescents: 9%)
Postmarketing (any indication):
Cardiovascular: Shock, vasodilation
Dermatologic: Facial swelling, Stevens-Johnson syndrome, toxic epidermal necrolysis
Hematologic & oncologic: Disseminated intravascular coagulation, hemolysis, hemolytic anemia
Hepatic: Hepatic disease
Hypersensitivity: Anaphylactic shock, anaphylaxis, nonimmune anaphylaxis, severe hypersensitivity reaction
Local: Injection site phlebitis, thrombophlebitis at injection site
Renal: Increased blood urea nitrogen, increased serum creatinine, renal insufficiency
Hypersensitivity to micafungin, other echinocandins, or any component of the formulation
Concerns related to adverse effects:
• Hemolytic anemia/hemoglobinuria: Hemolytic anemia and hemoglobinuria have been reported.
• Hepatic impairment: New-onset or worsening hepatic impairment, including hepatitis and hepatic failure, has been reported. Monitor closely and evaluate appropriateness of continued use in patients who develop abnormal liver function tests during treatment.
• Hypersensitivity reactions: Severe anaphylactic reactions, including shock, have been reported. Infusion reactions (eg, rash, pruritus, facial swelling, vasodilatation) have also been reported. Infusion should be discontinued for serious hypersensitivity reactions (eg, anaphylaxis). The infusion rate may be slowed for possible histamine-mediated infusion reactions.
• Injection-site reactions: Injection-site reactions (eg, phlebitis, thrombophlebitis) have been reported; more frequent with peripheral administration.
• Renal impairment: Increased BUN, serum creatinine, renal dysfunction, and/or acute renal failure has been reported; use with caution in patients that develop worsening renal function during treatment; monitor closely.
Special populations:
• Obesity: Data suggest that micafungin clearance increases as a function of weight; higher doses may be necessary in patients with obesity (Hall 2011). There are limited data to define the optimal dose in this population (Maseda 2018; Pasipanodya 2015; Wasmann 2019).
Substrate of CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Saccharomyces boulardii: Antifungal Agents (Systemic, Oral) may diminish the therapeutic effect of Saccharomyces boulardii. Risk X: Avoid combination
Sirolimus Products: Micafungin may increase the serum concentration of Sirolimus Products. Risk C: Monitor therapy
Adverse events have been observed in animal reproduction studies.
Agents other than micafungin are preferred for the treatment of candidiasis in pregnancy (IDSA [Pappas 2016]).
Signs and symptoms of infusion reaction (histamine-mediated symptoms) including rash, pruritus, facial swelling, and vasodilation. AST, ALT, bilirubin, SCr, BUN, serum potassium, and CBC (baseline and periodically during therapy; increase monitoring in patients who develop abnormalities) (Arrieta 2011).
Concentration-dependent inhibition of 1,3-beta-D-glucan synthase resulting in reduced formation of 1,3-beta-D-glucan, an essential polysaccharide comprising 30% to 60% of Candida cell walls (absent in mammalian cells); decreased glucan content leads to osmotic instability and cellular lysis
Absorption: Oral: Poor.
Distribution: Distributes into lung, liver, and spleen; minimally to CNS and eyes (Caudle 2012).
Preterm infants: Reported data highly variable; possibly dependent on GA/weight and PNA: Vdss:
PNA 0 to 1 day, weight <1,500 g: 0.76 ± 0.28 L/kg (Kawada 2009).
PNA >4 days, weight <2,500 g: 1.515 ± 0.516 L/kg (Smith 2009).
PNA >3 weeks, weight ≥1,000 g: 0.43 ± 0.11 L/kg (range: 0.28 to 0.66 L/kg) (Heresi 2006).
Neonates and infants <4 months: Median 0.35 L/kg (range: 0.225 to 0.482 L/kg) (Leroux 2018).
Infants ≥4 months and Children <2 years: 0.319 ± 0.0615 L/kg (range: 0.24 to 0.45 L/kg) (Albano 2015).
Children 2 to 8 years: Vdss: 0.35 ± 0.18 L/kg (Seibel 2005).
Children ≥9 years and Adolescents ≤17 years: Vdss: 0.28 ± 0.09 L/kg (Seibel 2005).
Adults: Vd: 0.39 ± 0.11 L/kg.
Protein binding: Neonates: 96.7% (Yanni 2011); Adults: >99% to albumin.
Metabolism: Hepatic to M-1, catechol form by arylsulfatase; further metabolized to M-2, methoxy form by catechol-O-methyltransferase; hydroxylation to M-5 by CYP3A.
Half-life elimination:
Preterm infants:
PNA <1 week: 6.7 ± 2.2 hours (Kawada 2009).
PNA >3 weeks: Mean 8.3 hours (range: 5.6 to 11 hours) (Heresi 2006).
Term and preterm infants <4 months: Mean range: 11 to 13.6 hours (Benjamin 2010; Leroux 2018).
Infants ≥4 months and Children <2 years: 11.5 ± 2.17 hours (range: 7.9 to 16 hours) (Albano 2015).
Children 2 to 5 years: 11.1 ± 1.32 hours (range: 8.9 to 13.8 hours) (Albano 2015).
Children 6 to 11 years: 14.7 ± 6.98 hours (range: 9.8 to 28.4 hours) (Albano 2015).
Children ≥12 years and Adolescents ≤16 years: 13.1 ± 1.68 hours (range: 10.5 to 16.2 hours) (Albano 2015).
Healthy Adults: 11 to 21 hours.
Adults receiving bone marrow or peripheral stem-cell transplantation: 10.7 to 13.5 hours (Carver 2004).
Time to peak, serum:
Infants ≥4 months, Children, and Adolescents ≤16 years: 0.9 to 2 hours (Albano 2015; Benjamin 2013).
Excretion: Primarily feces (71%); urine (<1%, unchanged [Hebert 2005]).
Clearance:
Preterm infants:
PNA 0 to 1 day, weight <1,500 g: 1.48 ± 0.78 mL/minute/kg (Kawada 2009).
PNA >4 days, weight <2,500 g: 0.575 ± 0.196 mL/minute/kg (Smith 2009).
PNA >3 weeks, weight ≥1,000 g: 0.648 ± 0.2 mL/minute (Heresi 2006).
Term and preterm infants <4 months: 0.5 ± 0.2 mL/minute/kg (range: 0.2 to 0.8 mL/minute/kg) (Benjamin 2010).
Infants ≥4 months and Children <2 years: 0.328 ± 0.046 mL/minute/kg (range: 0.243 to 0.402 mL/minute/kg) (Albano 2015).
Children 2 to 5 years: 0.34 ± 0.058 mL/minute/kg (range: 0.237 to 0.4 mL/minute/kg) (Albano 2015).
Children 6 to 11 years: 0.22 ± 0.039 mL/minute/kg (range: 0.155 to 0.267 mL/minute/kg) (Albano 2015).
Children ≥12 years and Adolescents ≤16 years: 0.217 ± 0.037 mL/minute/kg (range: 0.17 to 0.278 mL/minute/kg) (Albano 2015).
Adults: ~0.3 mL/minute/kg.
Hepatic function impairment: Moderate impairment (Child-Pugh class B): AUC and Cmax reduced ~22% compared to normal hepatic function. Severe impairment (Child-Pugh class C): AUC and Cmax of parent drug reduced ~30% compared to normal hepatic function (no dose adjustment required).
Obesity: Data suggest that micafungin clearance increases as a function of weight (Hall 2011).
Solution (reconstituted) (Micafungin Sodium Intravenous)
50 mg (per each): $89.76 - $112.20
100 mg (per each): $57.60 - $224.40
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.