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miconazole

A01AB09

Forms & Strengths

Oral gel: 20 mg/mL
Topical cream: 2%a
Topical ointment: 2%
Vaginal suppository: 100 mg, 200 mg, 1200 mg
Vaginal cream: 2%, 4%

Adult Dosing

Oral candidiasis: 2.5 mL oral gel applied qid after food, retained near lesions
Vulvovaginal candidiasis: 1200 mg vaginal suppository x 1, or 200 mg qd x 3 days, or 100 mg qd x 7 days
Tinea corporis/cruris/pedis: Topical 2% cream applied bid for 2-4 weeks

Pediatric Dosing

Infants >= 6 months and children (oral candidiasis): 1.25 mL oral gel qid after food
Neonates < 6 months (oral candidiasis): Safety and efficacy not established; use with caution due to choking risk
Adolescents (vulvovaginal/topical): Same as adult dosing

Indications

Oral candidiasis (oral gel)
Vulvovaginal candidiasis (vaginal creams and suppositories)
Topical fungal infections including tinea cruris, tinea corporis, and tinea pedis

Mechanism of Action

Inhibits fungal cytochrome P450 14 alpha-demethylase
Decreases ergosterol synthesis in the fungal cell membrane
Increases fungal cell membrane permeability and causes leakage of cellular contents

Contraindications

Hypersensitivity to miconazole or any component of the formulation
Co-administration with CYP3A4 substrates that prolong QT interval (e.g., cisapride, pimozide, quinidine)
Hepatic impairment when administered orally

Adverse Reactions

Taste perversion (oral gel)
Nausea and vomiting (oral gel)
Local burning, irritation, and pruritus (topical/vaginal)
Pelvic cramps (vaginal suppositories)
Elevated liver enzymes (rare, systemic exposure)

Drug Interactions

Significant inhibition of CYP3A4 and CYP2C9 enzymes
Increases plasma concentrations of oral anticoagulants (e.g., warfarin), leading to increased bleeding risk
Increases levels of oral hypoglycemics (e.g., sulfonylureas), increasing hypoglycemia risk
Increases systemic exposure of phenytoin and statins

Curated Content: Needs Vetting Before Put to Clinical Use