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Micafungin

Medically reviewed by Drugs.com. Last updated on May 18, 2020.

Pronunciation

(mi ka FUN gin)

Index Terms

  • Micafungin Sodium

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous, as sodium [preservative free]:

Mycamine: 50 mg (1 ea)

Mycamine: 50 mg (1 ea) [contains lactose]

Mycamine: 100 mg (1 ea)

Mycamine: 100 mg (1 ea) [contains lactose]

Generic: 50 mg (1 ea); 100 mg (1 ea)

Brand Names: U.S.

  • Mycamine

Pharmacologic Category

  • Antifungal Agent, Parenteral
  • Echinocandin

Pharmacology

Concentration-dependent inhibition of 1,3-beta-D-glucan synthase resulting in reduced formation of 1,3-beta-D-glucan, an essential polysaccharide comprising 30% to 60% of Candida cell walls (absent in mammalian cells); decreased glucan content leads to osmotic instability and cellular lysis

Absorption

Oral: Poor

Distribution

Distributes into lung, liver, and spleen; minimally to CNS and eyes (Caudle 2012).

Preterm infants: Reported data highly variable; possibly dependent on GA/weight and PNA: Vdss:

PNA 0 to 1 day, weight <1,500 g: 0.76 ± 0.28 L/kg (Kawada 2009).

PNA >4 days, weight <2,500 g: 1.515 ± 0.516 L/kg (Smith 2009).

PNA >3 weeks, weight ≥1,000 g: 0.43 ± 0.11 L/kg (range: 0.28 to 0.66 L/kg) (Heresi 2006).

Neonates and infants <4 months: Median 0.35 L/kg (range: 0.225 to 0.482 L/kg) (Leroux 2018).

Infants ≥4 months and Children <2 years: 0.319 ± 0.0615 L/kg (range: 0.24 to 0.45 L/kg) (Albano 2015).

Children 2 to 8 years: Vdss: 0.35 ± 0.18 L/kg (Seibel 2005).

Children ≥9 years and Adolescents ≤17 years: Vdss: 0.28 ± 0.09 L/kg (Seibel 2005).

Adults: Vd: 0.39 ± 0.11 L/kg.

Metabolism

Hepatic to M-1, catechol form by arylsulfatase; further metabolized to M-2, methoxy form by catechol-O-methyltransferase; hydroxylation to M-5 by CYP3A

Excretion

Primarily feces (71%); urine (<1%, unchanged [Herbert 2005]).

Clearance:

Preterm infants:

PNA 0 to 1 day, weight <1,500 g: 1.48 ± 0.78 mL/minute/kg (Kawada 2009).

PNA >4 days, weight <2,500 g: 0.575 ± 0.196 mL/minute/kg (Smith 2009).

PNA >3 weeks, weight ≥1,000 g: 0.648 ± 0.2 mL/minute (Heresi 2006).

Term and preterm infants <4 months: 0.5 ± 0.2 mL/minute/kg (range: 0.2 to 0.8 mL/minute/kg) (Benjamin 2010).

Infants ≥4 months and Children <2 years: 0.328 ± 0.046 mL/minute/kg (range: 0.243 to 0.402 mL/minute/kg) (Albano 2015).

Children 2 to 5 years: 0.34 ± 0.058 mL/minute/kg (range: 0.237 to 0.4 mL/minute/kg) (Albano 2015).

Children 6 to 11 years: 0.22 ± 0.039 mL/minute/kg (range: 0.155 to 0.267 mL/minute/kg) (Albano 2015).

Children ≥12 years and Adolescents ≤16 years: 0.217 ± 0.037 mL/minute/kg (range: 0.17 to 0.278 mL/minute/kg) (Albano 2015).

Adults: ~0.3 mL/minute/kg.

Time to Peak

Serum:

Infants ≥4 months, Children, and Adolescents ≤16 years: 0.9 to 2 hours (Albano 2015; Benjamin 2013).

Half-Life Elimination

Preterm infants:

PNA <1 week: 6.7 ± 2.2 hours (Kawada 2009).

PNA >3 weeks: Mean 8.3 hours (range: 5.6 to 11 hours) (Heresi 2006).

Term and preterm infants <4 months: Mean range: 11 to 13.6 hours (Benjamin 2010; Leroux 2018).

Infants ≥4 months and Children <2 years: 11.5 ± 2.17 hours (range: 7.9 to 16 hours) (Albano 2015).

Children 2 to 5 years: 11.1 ± 1.32 hours (range: 8.9 to 13.8 hours) (Albano 2015).

Children 6 to 11 years: 14.7 ± 6.98 hours (range: 9.8 to 28.4 hours) (Albano 2015).

Children ≥12 years and Adolescents ≤16 years: 13.1 ± 1.68 hours (range: 10.5 to 16.2 hours) (Albano 2015).

Healthy Adults: 11 to 21 hours.

Adults receiving bone marrow or peripheral stem-cell transplantation: 10.7 to 13.5 hours (Carver 2004).

Protein Binding

Neonates: 96.7% (Yanni 2011); Adults: >99% to albumin

Special Populations: Hepatic Function Impairment

Moderate impairment (Child-Pugh class B): AUC and Cmax reduced ~22% compared to normal hepatic function. Severe impairment (Child-Pugh class C): AUC and Cmax of parent drug reduced ~30% compared to normal hepatic function (no dose adjustment required).

Use: Labeled Indications

Candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses: Treatment of candidemia, acute disseminated candidiasis, Candida peritonitis and abscesses in adults and pediatric patients ≥4 months of age or in pediatric patients ≤4 months of age without meningoencephalitis and/or ocular dissemination.

Esophageal candidiasis: Treatment of esophageal candidiasis in adults and pediatric patients ≥4 months of age.

Prophylaxis of Candida infections: Prophylaxis of Candida infections in adults and pediatric patients ≥4 months of age undergoing hematopoietic stem cell transplantation.

Off Label Uses

Aspergillosis, invasive (salvage therapy)

Based on the Infectious Diseases Society of America (IDSA) Practice Guidelines for the Diagnosis and Management of Aspergillosis, micafungin is an effective and recommended therapeutic option for salvage therapy (either alone or in combination with another antifungal) for the treatment of invasive aspergillosis.

Candidiasis, intravascular infections

Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis, micafungin is an effective and recommended treatment for patients with candida intravascular infections, including patients with endocarditis (native or prosthetic valve), infections of implantable cardiac devices (pacemaker, implantable cardiac defibrillator), and Candida suppurative thrombophlebitis.

Candidiasis, osteoarticular infections

Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis, micafungin is an effective and recommended treatment for patients with Candida osteoarticular infections, including Candida osteomyelitis and Candida septic arthritis.

Candidiasis, chronic disseminated (hepatosplenic)

Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis, micafungin is an effective and recommended treatment for patients with chronic disseminated (hepatosplenic) candidiasis.

Candidiasis empiric therapy (non-neutropenic ICU patients)

Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis, micafungin is an effective and recommended agent for empiric therapy of suspected invasive candidiasis in non-neutropenic patients in the ICU.

Candidiasis, oropharyngeal (refractory disease)

Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis, micafungin may be considered as an alternative for patients with oropharyngeal candidiasis refractory to other antifungals.

Candidiasis, prophylaxis against invasive candidiasis (high-risk ICU patients)

Based on the Infectious Diseases Society of America (IDSA) clinical practice guidelines for the management of candidiasis, micafungin may be considered as an alternative agent for prophylaxis against invasive candidiasis in high-risk patients in adult ICUs with a high rate of invasive candidiasis (>5%).

Empiric antifungal therapy (neutropenic fever)

Based on the Infectious Diseases Society of America (IDSA) Practice Guidelines for the Diagnosis and Management of Aspergillosis, micafungin is effective and recommended for empiric antifungal therapy in high-risk neutropenic patients who remain febrile despite broad-spectrum antibiotic therapy. According to the guidelines, empiric therapy is not recommended for patients with an anticipated duration of neutropenia <10 days, unless other findings indicate a suspected invasive fungal infection.

Contraindications

Hypersensitivity to micafungin, other echinocandins, or any component of the formulation

Dosing: Adult

Aspergillosis, invasive (salvage therapy) (off-label use): IV: 100 to 150 mg once daily. Minimum duration of therapy is 6 to 12 weeks, although duration is highly dependent on degree/duration of immunosuppression, disease site, and evidence of disease improvement (IDSA [Patterson 2016])

Candidemia, acute disseminated candidiasis, and Candida peritonitis and abscesses: IV: 100 mg once daily; mean duration of therapy (from clinical trials) was 15 days (range: 10 to 47 days). Note: For treatment of candidemia, IDSA Candidiasis guidelines recommend a total duration of antifungal therapy of at least 2 weeks after the documented clearance of Candida from the bloodstream and resolution of candidemia-associated symptoms in patients without metastatic complications; may transition to fluconazole (eg, after 5 to 7 days in non-neutropenic patients) in clinically stable patients, with fluconazole-susceptible isolates and negative repeat cultures (IDSA [Pappas 2016]).

Candidiasis, chronic disseminated (hepatosplenic) (off-label use): IV: 100 mg daily for several weeks, followed by oral fluconazole therapy (IDSA [Pappas 2016])

Candidiasis, empiric therapy (suspected invasive candidiasis in non-neutropenic ICU patients) (off-label use): IV: 100 mg daily; treatment should continue for 14 days in patients showing clinical improvement. Consider discontinuing after 4 to 5 days in patients with no clinical response (IDSA [Pappas 2016]).

Candidiasis, intravascular infections (native or prosthetic valve endocarditis, infection of implantable cardiac devices, suppurative thrombophlebitis) (off-label use): IV: 150 mg daily. For native or prosthetic valve endocarditis, therapy should continue for at least 6 weeks after valve replacement surgery (longer durations in patients with abscesses or other complications); for patients with implantable cardiac devices, therapy should continue for 4 to 6 weeks after surgery (4 weeks for infections limited to generator pockets and at least 6 weeks for infections involving the wires); for suppurative thrombophlebitis, after catheter removal, continue for at least 2 weeks after candidemia has cleared. Note: Step-down to fluconazole therapy is recommended in clinically stable patients and fluconazole-susceptible isolates with negative repeat cultures (IDSA [Pappas 2016]).

Candidiasis, osteoarticular infections (osteomyelitis or septic arthritis) (alternative therapy) (off-label use): IV: 100 mg daily for at least 14 days, followed by fluconazole therapy (IDSA [Pappas 2016])

Candidiasis, oropharyngeal (refractory disease) (alternative therapy) (off-label use): IV: 100 mg once daily (IDSA [Pappas 2016])

Empiric antifungal therapy (neutropenic fever) (off-label use): IV: 100 mg once daily (IDSA [Patterson 2016])

Esophageal candidiasis: IV: 150 mg once daily; mean duration of therapy (from clinical trials) was 15 days (range: 10 to 30 days). Note: IDSA Candidiasis guidelines suggest considering a transition to oral fluconazole therapy once oral intake tolerable. In patients with fluconazole-refractory disease, continue micafungin for 14 to 21 days (IDSA [Pappas 2016]).

Prophylaxis of Candida infections: IV:

In hematopoietic stem cell transplantation: 50 mg once daily; mean duration of therapy (from clinical trials) was 19 days (range: 6 to 51 days)

In high-risk ICU patients in units with high incidence of invasive candidiasis (alternative therapy; off-label use): 100 mg daily (Pappas [IDSA 2016])

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Aspergillosis, treatment, invasive (salvage therapy): Infants, Children, and Adolescents: Limited data available:

Note: In infants, initial doses at the higher end of the dosage range may be necessary due to pharmacokinetic differences (IDSA [Patterson 2016]). Treatment duration should be individualized based on patient-specific factors including site of infection, immunosuppression, and response to therapy; minimum duration is 6 to 12 weeks (AST [Husain 2019]; IDSA [Patterson 2016]).

≤40 kg: IV: 2 to 3 mg/kg/dose once daily (AST [Husain 2019]; IDSA [Patterson 2016]); higher doses of 4 to 6 mg/kg/dose once daily have also been described (Hashii 2014; Kobayashi 2007; Kobayashi 2015; Singer 2003).

>40 kg: IV: 100 mg/dose once daily; may increase to 150 mg/dose if clinically indicated; maximum daily dose: 150 mg/day (AST [Husain 2019]; Emiroglu 2011; IDSA [Patterson 2016]; Tetsuka 2017).

Candidiasis, esophageal (alternative agent in patients who cannot tolerate oral therapy):

Non-HIV-exposed/-infected: Infants ≥4 months, Children, and Adolescents: Note: IDSA guidelines recommend 14 to 21 days of treatment for esophageal candidiasis (IDSA [Pappas 2016]).

≤30 kg: IV: 3 mg/kg/dose once daily.

>30 kg: IV: 2.5 mg/kg/dose once daily; maximum dose: 150 mg/dose.

HIV-exposed/-infected (HHS [OI adult 2019]; HHS [OI pediatric 2019]): Note: Treatment is recommended for 14 to 21 days for esophageal candidiasis (HHS [OI adult 2019]; HHS [OI pediatric 2019]):

Infants <15 kg: IV: 5 to 7 mg/kg/dose once daily.

Children 2 to 8 years and ≤40 kg: IV: 3 to 4 mg/kg/dose once daily.

Children ≥9 years:

≤40 kg: IV: 2 to 3 mg/kg/dose once daily.

>40 kg: IV: 100 mg/dose once daily.

Adolescents: IV: 150 mg/dose once daily.

Candidiasis, systemic (including candidemia and invasive candidiasis):

Note: Duration of therapy should be individualized (based on deep-tissue foci, clinical response, etc); candidemia should be treated for a minimum of 14 days from the first negative blood culture and resolution of symptoms (ESCMID [Hope 2012]; IDSA [Pappas 2016]).

Infants <4 months: IV: 10 mg/kg/dose once daily (Benjamin 2018; ESCMID [Hope 2012]; Kovanda 2018; Leroux 2018; Rivera-Chaparro 2019); doses as high as 15 mg/kg/dose have been reported (Auriti 2016). Note: Manufacturer labeling recommends 4 mg/kg/dose once daily in patients without CNS or ocular involvement; however, a pharmacokinetic model in patients weighing 1 to 7 kg suggested that doses of 3 to 4 mg/kg/day in neonates and young infants would only result in 40.5% to 43.3% of patients achieving exposure similar to adults receiving 100 mg/day (Auriti 2016).

Infants ≥4 months, Children, and Adolescents: IV: Initial: 2 mg/kg/dose once daily; usual maximum dose: 100 mg/dose (Bradley 2019; Mycamine prescribing information [European Medicines Agency] 2018; Queiroz-Telles 2008; manufacturer's labeling); may increase to 4 mg/kg/dose if clinical condition does not improve or mycologic persistence occurs at lower doses; maximum dose: 200 mg/dose (Mycamine prescribing information [European Medicines Agency] 2018; Queiroz-Telles 2008). Manufacturer labeling recommends 2 mg/kg/dose once daily in patients without CNS or ocular involvement; however, a pharmacokinetic model indicates that doses of 3 to 4 mg/kg/day may be necessary to achieve AUC:MIC targets against Candida albicans in pediatric patients (Xu 2015).

Empiric antifungal therapy (neutropenic fever): Infants ≥4 months, Children, and Adolescents: IV: 2 to 3 mg/kg/dose once daily; maximum dose: 200 mg/dose (IDSA [Patterson 2016]; Kobayashi 2013; Styczynski 2016).

Fungal infection, prophylaxis in hematopoietic stem cell transplant (HSCT) recipients:

Infants <4 months: Limited data available: IV: 2 mg/kg/dose once daily (Mycamine prescribing information [European Medicines Agency] 2018); dose based on pharmacokinetic exposure similar to adults receiving 50 mg.

Infants ≥4 months, Children, and Adolescents: IV: 1 mg/kg/dose once daily; maximum dose: 50 mg/dose; doses as high as 3 mg/kg/day have been used in trials (Kusuki 2009; van Burik 2004; Yoshikawa 2014).

Alternate day dosing: Very limited data available: Infants ≥7 months and Children ≤10 years: IV: 3 mg/kg/dose every 48 hours; dosing based on a small pharmacokinetic modeling study in which a total of 15 patients (age: 0.6 months to 10 years) undergoing HSCT received a single dose of 3 mg/kg of micafungin; modeled exposures with 3 mg/kg/dose every 48 hours were similar to those achieved in previous studies evaluating 1 mg/kg/dose once daily (Mehta 2010).

Reconstitution

Aseptically add 5 mL of NS (preservative free) or D5W to each 50 or 100 mg vial. To minimize foaming, gently swirl to dissolve; do not shake. Further dilute 50 to 150 mg in 100 mL NS or D5W. Protect infusion solution from light (it is not necessary to protect the drip chamber or tubing from light).

Administration

IV: For IV use only; infuse over 1 hour; may reduce infusion rate for infusion reaction (eg, rash, pruritus, facial swelling, vasodilatation). Flush line with NS prior to administration.

Storage

Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Reconstituted and diluted solutions in D5W or NS are stable for 24 hours at room temperature. Protect infusion solution from light (it is not necessary to protect the drip chamber or tubing from light).

Drug Interactions

Saccharomyces boulardii: Antifungal Agents (Systemic, Oral) may diminish the therapeutic effect of Saccharomyces boulardii. Avoid combination

Sirolimus: Micafungin may increase the serum concentration of Sirolimus. Monitor therapy

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Candidiasis treatment:

>10%:

Cardiovascular: Phlebitis (19%)

Gastrointestinal: Diarrhea (7% to 11%), vomiting (7% to 18%)

Hematologic & oncologic: Anemia (infants, children, and adolescents: 18%)

Hepatic: Abnormal hepatic function tests (4%; infants, children, and adolescents: <15%), hyperbilirubinemia (infants, children, and adolescents: <15%)

Renal: Renal failure syndrome (infants, children, and adolescents: <15%)

Miscellaneous: Fever (9% to 13%)

1% to 10%:

Cardiovascular: Atrial fibrillation (adults: 3%), tachycardia (infants, children, and adolescents: 4%)

Dermatologic: Skin rash (2% to 5%)

Endocrine & metabolic: Abnormal aspartate transaminase (3%), hyperkalemia (adults: 5%), hypoglycemia (adults: 6%)

Gastrointestinal: Abdominal distention (infants, children, and adolescents: 2%), abdominal pain (infants, children, and adolescents: 4%), nausea (7% to 10%)

Hematologic & oncologic: Neutropenia (infants, children, and adolescents: 5%), thrombocytopenia (infants, children, and adolescents: 9%)

Hepatic: Increased serum alkaline phosphatase (3% to 6%)

Nervous system: Headache (adults: 9%)

Candidiasis prophylaxis in hematopoietic stem cell transplantation:

>10%:

Cardiovascular: Tachycardia (16% to 26%)

Dermatologic: Pruritus (infants, children, and adolescents: 33%), skin rash (25% to 30%), urticaria (<5%; infants, children, and adolescents: 19%)

Gastrointestinal: Abdominal distention (infants, children, and adolescents: 19%), abdominal pain (26% to 35%), diarrhea (77%; infants, children, and adolescents: 51%), nausea (70% to 71%), vomiting (65% to 66%)

Genitourinary: Decreased urine output (infants, children, and adolescents: 23%), hematuria (infants, children, and adolescents: 23%)

Hematologic & oncologic: Anemia (infants, children, and adolescents: 51%), febrile neutropenia (infants, children, and adolescents: 16%), neutropenia (75% to 77%), thrombocytopenia (72% to 75%)

Hepatic: Abnormal hepatic function tests (infants, children, and adolescents: <15%), hyperbilirubinemia (infants, children, and adolescents: <15%), increased serum alanine aminotransferase (16%)

Nervous system: Anxiety (22% to 23%), headache (adults: 44%), insomnia (adults: 37%)

Renal: Renal failure syndrome (infants, children, and adolescents: <15%)

Miscellaneous: Fever (infants, children, and adolescents: 61%), infusion-related reaction (infants, children, and adolescents: 16%)

1% to 10%:

Cardiovascular: Acute myocardial infarction (adults: <5%), pericardial effusion (adults: <5%)

Endocrine & metabolic: Hypernatremia (<5%), hypokalemia (<5%)

Hematologic & oncologic: Disorder of hemostatic components of blood (adults: <5%), pancytopenia (adults: <5%), thrombotic thrombocytopenic purpura (adults: <5%)

Hepatic: Hepatic failure (adults: <5%), hepatic injury (adults: <5%), hepatomegaly (adults: <5%), jaundice (adults: <5%)

Hypersensitivity: Anaphylaxis (adults: <5%), hypersensitivity reaction (adults: <5%)

Local: Infusion site reaction (adults: <5%), venous thrombosis at injection site (adults: <5%)

Nervous system: Encephalopathy (adults: <5%), delirium (adults: <5%), intracranial hemorrhage (adults: <5%), seizure (adults: <5%)

Respiratory: Epistaxis (infants, children, and adolescents: 9%)

Postmarketing (any indication):

Cardiovascular: Shock, vasodilation

Dermatologic: Facial swelling, Stevens-Johnson syndrome, toxic epidermal necrolysis

Hematologic & oncologic: Disseminated intravascular coagulation, hemolysis, hemolytic anemia

Hepatic: Hepatic disease

Hypersensitivity: Anaphylactic shock, anaphylaxis, nonimmune anaphylaxis, severe hypersensitivity reaction

Local: Injection site phlebitis, thrombophlebitis at injection site

Renal: Increased blood urea nitrogen, increased serum creatinine, renal insufficiency

Warnings/Precautions

Concerns related to adverse effects:

• Hemolytic anemia/hemoglobinuria: Hemolytic anemia and hemoglobinuria have been reported.

• Hepatic impairment: New-onset or worsening hepatic impairment, including hepatitis and hepatic failure, has been reported. Monitor closely and evaluate appropriateness of continued use in patients who develop abnormal liver function tests during treatment.

• Hypersensitivity reactions: Severe anaphylactic reactions, including shock, have been reported. Infusion reactions (eg, rash, pruritus, facial swelling, vasodilatation) have also been reported. Infusion should be discontinued for serious hypersensitivity reactions (eg, anaphylaxis). The infusion rate may be slowed for possible histamine-mediated infusion reactions.

• Injection-site reactions: Injection-site reactions (eg, phlebitis, thrombophlebitis) have been reported; more frequent with peripheral administration.

• Renal impairment: Increased BUN, serum creatinine, renal dysfunction, and/or acute renal failure has been reported; use with caution in patients that develop worsening renal function during treatment; monitor closely.

Monitoring Parameters

Periodic liver function tests, serum creatinine, BUN and CBC (increase monitoring in patients who develop abnormalities); infusion reactions (possible histamine-mediated symptoms) including rash, pruritus, facial swelling, and vasodilatation

Pregnancy Considerations

Adverse events have been observed in animal reproduction studies.

Agents other than micafungin are preferred for the treatment of candidiasis in pregnancy (IDSA [Pappas 2016]).

Patient Education

What is this drug used for?

• It is used to treat fungal infections.

• It is used to prevent fungal infections.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Nausea

• Vomiting

• Injection site irritation

• Diarrhea

• Headache

• Abdominal pain

• Trouble sleeping

• Anxiety

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Kidney problems like unable to pass urine, blood in the urine, change in amount of urine passed, or weight gain

• Liver problems like dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin

• Low blood sugar like dizziness, headache, fatigue, feeling weak, shaking, fast heartbeat, confusion, increased hunger, or sweating

• Electrolyte problems like mood changes, confusion, muscle pain or weakness, abnormal heartbeat, seizures, lack of appetite, or severe nausea or vomiting

• Fast heartbeat

• Abnormal heartbeat

• Infection

• Bruising

• Bleeding

• Severe loss of strength and energy

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.