Micafungin Sodium
Name: Micafungin Sodium
Interactions for Micafungin Sodium
Substrate for and weak inhibitor of CYP3A in vitro; CYP3A plays minor role in metabolism in vivo.1 4 8
Drugs Metabolized by Hepatic Microsomal Enzymes
Pharmacokinetic interactions unlikely with drugs metabolized by CYP isoenzymes 1A2, 2C9, 2C19, 2D6, 2E1, and 3A4.1 4 5 18 19
Drugs Affecting or Affected by P-glycoprotein Transport
Not an inhibitor or substrate of the P-glycoprotein transport system; pharmacokinetic interactions unlikely.1 4
Specific Drugs
| Drug | Interaction | Comments |
|---|---|---|
| Amphotericin B | No effect on micafungin pharmacokinetics1 In vitro evidence of additive or synergistic antifungal effects against Aspergillus; no in vitro evidence of antagonism2 | Micafungin dosage adjustment not needed1 |
| Corticosteroids (prednisolone) | No evidence of pharmacokinetic interactions 1 | Micafungin dosage adjustment not needed1 |
| Fluconazole | No evidence of pharmacokinetic interactions with oral or IV fluconazole1 2 | Micafungin dosage adjustment not needed1 |
| Immunosuppressive agents (cyclosporine, mycophenolate, sirolimus, tacrolimus) | Cyclosporine: Decreased oral clearance and increased half-life of cyclosporine; no effect on micafungin pharmacokinetics17 Mycophenolate: No evidence of pharmacokinetic interactions1 Sirolimus: Increased sirolimus AUC; no effect on peak sirolimus plasma concentrations; no effect on micafungin pharmacokinetics1 Tacrolimus: No evidence of pharmacokinetic interactions 1 16 | Cyclosporine: Monitor cyclosporine concentrations when micafungin initiated or discontinued; adjust cyclosporine dosage as needed;17 20 40 micafungin dosage adjustment not necessary1 Mycophenolate: Micafungin dosage adjustment not needed1 Sirolimus: Monitor for sirolimus toxicity and reduce sirolimus dosage if necessary;1 micafungin dosage adjustment not needed1 Tacrolimus: Micafungin dosage adjustment not needed1 |
| Itraconazole | Increased itraconazole peak plasma concentration and AUC;1 no effect on micafungin pharmacokinetics1 | Monitor for itraconazole toxicity and reduce itraconazole dosage if necessary;1 micafungin dosage adjustment not needed1 |
| Nifedipine | Increased nifedipine peak plasma concentration and AUC; no effect on micafungin pharmacokinetics1 | Monitor for nifedipine toxicity and reduce nifedipine dosage if necessary; micafungin dosage adjustment not needed1 |
| Rifampin | No effect on micafungin pharmacokinetics1 | Micafungin dosage adjustment not needed1 |
| Ritonavir | No effect on micafungin pharmacokinetics1 | Micafungin dosage adjustment not needed1 |
| Voriconazole | No effect on pharmacokinetics of voriconazole or micafungin1 In vitro evidence of additive antifungal effects against Aspergillus;2 indifferent antifungal effects reported against Candida46 | Micafungin dosage adjustment not needed1 |