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# Micafungin

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

Updated 2026-11-01

- Class: [Echinocandins](https://durgical.com/en/pharmacology/classes/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](https://www.rcsb.org/structure/9PE1) · Drag to rotate · pinch to zoom

## 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 →](https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/)
- Oesophageal candidiasis. [Infectious and pill-induced oesophagitis (Candida, HSV, CMV) →](https://durgical.com/en/conditions/infectious-and-pill-induced-oesophagitis/)
- 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)

### Serious (rare, important)

- Anaphylaxis
- Haemolysis and haemolytic anaemia
- Hepatic dysfunction, hepatitis or liver failure; liver tumours were seen in long rat studies
- Rises in urea and creatinine; acute kidney failure (isolated cases)

## 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.

## Memory aid

«MICA for Candida»: micafungin is the echinocandin labelled for Candida, from candidaemia to transplant prophylaxis.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/micafungin/)

## Related drugs

- [Caspofungin](https://durgical.com/en/pharmacology/caspofungin/)
- [Fluconazole](https://durgical.com/en/pharmacology/fluconazole/)

## Related conditions

- [Candidiasis: oral, oesophageal and invasive](https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/)
- [Infectious and pill-induced oesophagitis (Candida, HSV, CMV)](https://durgical.com/en/conditions/infectious-and-pill-induced-oesophagitis/)

[← Back to the class: Echinocandins](https://durgical.com/en/pharmacology/classes/echinocandins/)

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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=33e579c1-b315-44cb-a690-e2dd2cdf44ee) (DailyMed (U.S. National Library of Medicine), 2025); [Micafungin Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a624050.html) (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.

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