Micafungin

Antifungal

Also known as: Mycamine, Micafungin Sodium, FK463

EchinocandinsResearch phase: FDA-approvedRegulatory: FDA-approved (2005) for invasive candidiasis, esophageal candidiasis, and antifungal prophylaxis in HSCT recipients (Mycamine).

Mechanism

Micafungin is an IV echinocandin antifungal that works the same way as caspofungin — by blocking fungal cell wall synthesis. It is approved for treating invasive candidiasis, esophageal candidiasis, and for preventing fungal infections in stem cell transplant patients. It has the advantage of no dose adjustment needed for liver or kidney impairment.

Technical detail

Micafungin is a semisynthetic lipopeptide echinocandin derived from FR901379 (a metabolite of Coleophoma empetri). It inhibits 1,3-beta-D-glucan synthase (FKS1/FKS2 subunit), disrupting fungal cell wall integrity. Concentration-dependent fungicidal activity against Candida spp. and fungistatic against Aspergillus spp. Micafungin has the narrowest spectrum of drug interactions among echinocandins. Highly protein-bound (>99%) with hepatic metabolism primarily via arylsulfatase and catechol-O-methyltransferase, not CYP450.

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