Micafungin !

Intravenous echinocandin for candidaemia, oesophageal candidiasis and prevention of Candida infection in stem cell transplant.

Updated 2026-11-01

Class: Echinocandins
Enzyme: β-1,3-D-glucan synthase (Fks1 catalytic subunit)
ATC code: J02AX05
WHO Model List of Essential Medicines

β-1,3-D-glucan synthase (Fks1 catalytic subunit)Micafungin

The figure shows caspofungin, another echinocandin, bound to the yeast glucan synthase Fks1; micafungin acts on the same enzyme.

Target in 3D: β-1,3-D-glucan synthase (Fks1 catalytic subunit). PDB structure 9PE1 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Micafungin inhibits the synthesis of 1,3-β-D-glucan, an essential part of the fungal cell wall that is absent from mammalian cells. Without it the wall cannot withstand the cell's internal pressure.

Micafungin blocks fungal glucan synthase
The wall loses its 1,3-β-D-glucan scaffold
Candida cells lyse

Pharmacokinetics

Absorption: Intravenous only.
Distribution: Highly protein-bound; it does not reach the CSF.
Metabolism: Its kinetics are not changed by cyclosporine, itraconazole, voriconazole or fluconazole.

Indications

Candidaemia, acute disseminated candidiasis, Candida peritonitis and abscesses. Candidiasis: oral, oesophageal and invasive →
Oesophageal candidiasis. Infectious and pill-induced oesophagitis (Candida, HSV, CMV) →
Prevention of Candida infections in haematopoietic stem cell transplant recipients.

Adverse effects

Common

Diarrhoea, nausea, vomiting and abdominal pain
Fever and headache
Low platelet and neutrophil counts
Histamine-type reactions if infused too fast (rash, itching, facial swelling)

Contraindications

Hypersensitivity to micafungin, any component or other echinocandins

Key interactions

Sirolimus, nifedipine and itraconazole: Micafungin raises their levels; watch for toxicity and reduce their dose if needed.

What is monitored

Liver tests
Haemoglobin and signs of haemolysis
Kidney function

Administration and safety

Intravenous infusion only, over about an hour; faster infusions cause more histamine-type reactions.
Dilute in saline or dextrose as the label directs.
Do not mix or co-infuse with other drugs: it precipitates with several common medicines.

Nursing care

Observe for flushing, rash, itching or swelling during the infusion.
Watch for dark urine, pallor or jaundice (haemolysis or liver injury).
Follow liver and kidney tests during treatment.

Pregnancy and breastfeeding

May harm the fetus based on animal studies; pregnant women are informed of the risk.

Test yourself

Think of the answer, then tap the question to see it.

Has micafungin been shown to work against fungi other than Candida?

Its label says efficacy against fungi other than Candida has not been established.

Why is micafungin infused over about an hour?

Faster infusions cause more histamine-mediated reactions.

Which blood complication is specific to micafungin's warnings?

Haemolysis and haemolytic anaemia.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - MICAFUNGIN- micafungin sodium injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2025); Micafungin Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2024); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 61 (McGraw Hill, 2023).

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Representative model, for educational purposes only.