|Drug class||Antifungal (echinochandin)|
|Main uses||Treat or prevent severe candidiasis|
|Side effects||Low white blood cells, low red blood cells, low potassium, low calcium, nausea, liver problems, fever|
|Metabolism||Via catechol-O-methyltransferase pathway|
|Elimination half-life||11–17 hours|
|Excretion||40% feces, <15% urine|
|Chemical and physical data|
|Molar mass||1270.28 g·mol−1|
Micafungin, sold under the brand name Mycamine, is an antifungal medication used to treat or prevent severe candidiasis. It may also be used for aspergillosis. It is given by gradual injection into a vein.
Common side effects include low white blood cells, low red blood cells, low potassium, low calcium, nausea, liver problems, and fever. Other side effects may include anaphylaxis and kidney problems. Safety in pregnancy is unclear. It is an echinochandin which stops the production of beta-1,3-glucan, an essential component of fungal cell walls.
Micafungin was approved for medical use in the United States in 2005 and Europe in 2008. It is available as a generic medication. In the United States 7 doses of 100 mg costs about 370 USD. This amount in the United Kingdom costs about £2,000. It is on the World Health Organization's List of Essential Medicines.
Micafungin is indicated for the treatment of candidemia, acute disseminated candidiasis, Candida peritonitis, abscesses and esophageal candidiasis. Since January 23, 2008, micafungin has been approved for the prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation (HSCT).
Mechanism of action
Micafungin works by way of concentration-dependent inhibition of 1,3-beta-D-glucan synthase resulting in reduced formation of 1,3-beta-D-glucan, which is an essential polysaccharide comprising one-third of the majority of Candida spp. cell walls. This decreased glucan production leads to osmotic instability and thus cellular lysis.  
The metabolism of micafungin occurs hepatically via acryp sulfatase followed by secondary metabolism by a transferase. Precautions should be taken with regards to dosing, as micafungin weakly inhibits CYP3A4.
Society and culture
Micafungin is a natural antifungal product derived from other fungi as a defense mechanism for competition of nutrients, etc. To be specific, micafungin is derived from FR901379, and is produced by Coleophoma empetri.
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