Criteria & Principles
Spectrum of in vitro activity:
Candida albicans, Candida glabrata, Candida guilliermondii, Candida parapsilosis, Candida tropicalis, Candida krusei, Candida lusitaniae, Aspergillus spp.
Place in therapy:
- Initial therapy for candidemia
- Treatment of species that are known to have a decreased susceptibility or inherent resistance to azole agents (i.e. Candida krusei, Candida glabrata) or amphotericin B products (ie. Candida lusitaniae)
- Cases of aspergillosis refractory to standard therapies (amphotericin B and/or voriconazole) or patients unable to tolerate alternate therapies
Usual Dose & Administration
Usual adult dose, including candidemia and febrile neutropenia
100 mg IV q24h
Antifungal prophylaxis
100 mg IV q24h
ECMO
Consider higher loading doses (i.e. 200 mg x1) in patients on ECMO with active infection
Adjustment of Dose & Administration
Indication-Specific Adjustment
Micafungin 150 mg dose is favored in obesity, endocarditis, esophageal candidiasis, and patients on ECMO
Renal Adjustment
No recommended dose adjustments in patients with renal insufficiency
Hepatic Adjustment
No recommended dose adjustments in patients with liver disease. However, micafungin has NOT been studied in patients with severe impairment
Cost Index
$$$$$$ (51+)
General Notes
- Up-to-date cost information, click here
- IV antimicrobials outpatient (OPAT) dosing, click here
- Obesity dosing weight recommendations here
- Helpful drug-drug interaction check website here
- When dosing guidance is provided it is important to note the following:
Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.