Описание
Микафунгин натрия — полусинтетический липопептид, ранее известный как FK-463 — противогрибковый препарат группы эхинокандинов, под торговой маркой Микамин (Mycamine). Микафунгин препарат внутривенного использования. Препарат используется с 2005 года, для терапии кандидоза пищевода у пациентов взрослого возраста. С 2008 году микафунгин стали успешно применять для лечения взрослых лиц с острым рассеянным кандидозом, кандидемией, интраабдоминальными кандидозными абсцессами и кандидозным перитонитом. С 2013 года препарат стал использоваться для лечения детей в возрасте старше 4 месяцев по тем же показаниям. И с 2020 года препарат разрешено применять для лечения кандидоза инвазивного у детей в возрасте младше 4 месяцев. Принимая решение об использовании Микамина, следует учитывать потенциальный риск развития опухолей печени. Поэтому Микамин следует применять, только если не могут быть использованы другие противогрибковые лекарственные средства.
Состав препарата Микамин
Один флакон содержит:
- действующее веществo — микафунгин (в виде микафунгина натрия) 50 мг или 100 мг,
- дополнительные вещества: лактозы моногидрат, натрия гидроксид, лимонная кислота безводная.
Показания к применению
Микафунгин показан для лечения
взрослых:
- кандидемии, острого диссеминированного кандидоза, кандидозных перитонита, абсцессов и эзофагита;
- лечение инвазивного кандидоза;
- лечение эзофагеального кандидоза;
- профилактика кандидозных инфекций у пациентов, перенесших аллогенную трансплантацию гемопоэтических стволовых клеток или больных;
детей (в т.ч. новорожденные) и подростки <16 лет:
- лечение инвазивного кандидоза;
- профилактика кандидоза у пациентов после пересадки гемопоэтических стволовых клеток.
Фармакодинамика
Противогрибковое средство, производное эхинокандина. Механизм действия связан с неконкурентным ингибированием синтеза 1,3-β-D-глюкана, являющегося важным компонентом клеточной стенки грибов. 1,3-β-D-глюкан не содержится в клетках млекопитающих.
Микафунгин обладает противогрибковой активностью в отношении грибов рода Candida spp. и значительно ингибирует активный рост Aspergillus spp. In vivo на мышах была показана активность микафунгина. Он снижал тяжесть грибкового поражения и повышал выживаемость мышей в состоянии иммуносупрессии на модели диссеминированного кандидоза и кандидоза слизистых оболочек.
В клинических исследованиях показана эффективность микафунгина в профилактике кандидоза после пересадки гемопоэтических стволовых клеток, а также при лечении эзофагеального кандидоза.
Вероятность развития вторичной резистентности к микафунгину является очень низкой.
Фармакокинетика
Абсорбция
Лекарственное средство вводится внутривенно. В диапазоне суточных доз 50-150 мг микафунгин характеризуется линейной зависимостью между величиной AUC и введеной дозой. данных о системной кумуляции лекарственного средства при повторном введении не имеется, равновесная концентрация наступаев в течение 4-5 дней от начала применения.
Распределение
После внутривенного введения концентрация микафунгина биэкспоненциально снижается. Микафунгин быстро распределяется в тканях. Связывание микафунгина с белками плазмы высокое — более 99% in vitro. Главным образом, микафунгин связывается с альбумином. В меньшей степени микафунгин связывается с альфа1-кислым гликопротеином. Объем распределения при равновесной концентрации равен 18-19 литров.
Метаболизм
Микафунгин циркулирует в системном кровотоке преимущественно в неизмененном виде. Известно, что микафунгин метаболизируется с формированием нескольких соединений; из них М-1 (катехоловая форма), М-2 (метоксипроизводное M1) и М-5 (образуется в результате гидроксилирования боковой цепи) определяются в небольших количествах в системном кровотоке как производные микафунгина. Метаболиты не оказывают существенного влияния на эффективность микафунгина. In vitro микафунгин может метаболизироваться изоферментами CYP3A, однако процесс гидроксилирования вещества при участии изоферментов CYP3A не является основным путем метаболизма in vivo.
Элиминация и экскреция
Период полувыведения микафунгина составляет 10 — 17 часов и не изменяется в диапазоне до 8 мг/кг после однократного и повторных введений. Общий клиренс у здоровых лиц и взрослых пациентов как при однократном, так и при повторных введениях равен 0,15-0,3 мл/мин/кг и не зависел от дозы. Спустя 28 дней после однократного введения 25 мг микамина здоровым добровольцам только 11,6% радиоактивной метки обнаруживали в моче, а 71,0% — в фекалиях, что свидетельствует о преимущественно непочечной элиминации микафунгина. Метаболиты М-1 и М-2 обнаруживали в плазме в следовых концентрациях, а метаболит М-5 составил 6,5% от исходного соединения.
Фармакокинетика у различных групп пациентов
Пожилые пациенты
Фармакокинетические параметры у лиц пожилого возраста (66-78 лет) при инфузионном введении 50 мг микафунгина в течение 1 часа существенно не отличались от таковых у молодых лиц (20-24 года).
Пациенты с нарушенной функцией печени
Использование микамина может привести к значительным ухудшениям функции печени (увеличение активности АЛТ, АСТ или общего билирубина, более чем в 3 раза превышающее ВНГ) как у здоровых лиц, так и у пациентов. В некоторых случаях отмечали более тяжелую дисфункцию печени (гепатит или печеночная недостаточность).
Чтобы свести к минимуму риск адаптивной регенерации и возможного последующего формирования опухолей печени, при повышении активности АСТ, АЛТ рекомендуется прекращение препарата. Лечение микамином следует вести, тщательно рассчитывая соотношение риска и пользы, особенно у пациентов с тяжелым нарушением функции печени либо хроническими болезнями печени, представляющих собой предопухолевые состояния, такие как вирусный гепатит, выраженный фиброз печени, цирроз, врожденные ферментопатии или болезни печени у новорожденных, а также в случае одновременного применения препаратов, оказывающих гепатотоксическое и/или генотоксическое действие.
Пациенты с почечной дисфункцией
Тяжелая почечная недостаточность (клубочковая фильтрация < 30 мл/мин) существенно не влияла на фармакокинетику микафунгина.
Пол/раса
Пол и раса существенно не влияли на фармакокинетические параметры микафунгина.
Педиатрические пациенты
У пациентов в возрасте до 2 лет увеличен риск гепатотоксичности. У крыс при применении препарата в течение >3 мес наблюдалось формирование печеночно-клеточных опухолей и появление локальных очагов измененных гепатоцитов. Значение этого факта для клинического применения препарата у пациентов не определена. В процессе применения микафунгином необходимо проводить тщательный мониторинг функции печени.
Периодичность появления некоторых побочных реакций у детей была выше, чем у взрослых. У детей до 1 года примерно в два раза чаще отмечалось увеличение активности АСТ, АЛТ и ЩФ, чем у детей старше 1 года. Вероятной причиной таких различий было разное исходное состояние детей до 1 года в исследованиях по сравнению с детьми более старшего возраста и взрослыми пациентами.
Механизм (-ы) развития резистентности
Как и к другим противогрибковым средствам возможно снижения чувствительности и резистентности микроорганизмов к микафунгину. Также нельзя исключить перекрестную резистентность с другими эхинокандинами. Снижение чувствительности к эхинокандинам связывают с мутациями в генах Fks1 и Fks2, кодирующих главную субъединицу глюкансинтетазы.
Профилактика
В предотвращении инвазивных грибковых инфекций микафунгин был более эффективен, чем флуконазол у пациентов из группы высокого риска развития грибковой инфекции (например, пациенты, проходящие трансплантацию гемопоэтических стволовых клеток). Успешность лечения определялась как отсутствие доказанной, вероятной или подозреваемой системной грибковой инфекции к моменту окончания лечения или исследования.
Показатель успешности лечения был статистически значительно выше для микафунгина, чем для флуконазола (1,6 % против 2,4 % новых инфекций). Новые инфекции, вызванные Aspergillus, наблюдались у 1 против 7 пациентов, и/или возможные новые инфекции, вызванные Candida, встречались у 4 против 2 пациентов в группах приема микафунгина и флуконазола соответственно. Прочие новые инфекции вызывались Fusarium (1 и 2 пациента соответственно) и Zygomycetes (1 и 0 пациентов соответственно). Характер и частота развития неблагоприятных явлений были схожи между терапевтическими группами.
Фармацевтические характеристики
Лиофилизат для приготовления раствора для инфузий в виде массы белого цвета, 50 мг и 100 мг.
Упаковка, срок годности, условия хранения
По 52,5 или 106 мг микафунгина (в виде микафунгина натрия) во флаконе из бесцветного стекла (тип I), закупоренном изобутилен-изопреновой пробкой, колпачком из алюминия/полипропилена и упаковочной термоусадочнорй пленкой. По одному флакону с инструкцией в картонной пачке.
храненить в защищенном от света месте, при температуре не выше 25°С.
Хранить в недоступном для детей месте
Срок хранения 3 года
Наша компания работает как на территории Казахстана, так и осуществляет доставку в страны ближнего зарубежья. Обращайтесь к нам за консультациями по контактным телефонам.
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