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DERMATOLOGICALS › ANTIFUNGALS FOR DERMATOLOGICAL USE › ANTIFUNGALS FOR TOPICAL USE › Imidazole and triazole derivatives
miconazole, combinations
D01AC52
Forms & Strengths
- Topical cream: Miconazole nitrate 2% / Hydrocortisone 1%
- Topical ointment: Miconazole nitrate 2% / Zinc oxide 15%
- Vaginal suppositories/cream with combination adjuncts
Adult Dosing
- Topical fungal infections with inflammation: Apply thin layer to affected area twice daily for up to 7 days
- Diaper dermatitis with secondary candidiasis: Apply thin layer with each diaper change for up to 7 days
- Vulvovaginal candidiasis: Insert one applicatorful or suppository intravaginally once daily at bedtime for 3 to 7 days
Pediatric Dosing
- Topical infections (pediatric > 2 years): Apply twice daily for up to 7 days
- Diaper dermatitis (infants > 1 month): Apply with each diaper change for maximum 7 days
- Safety and efficacy in neonates not established
Indications
- Treatment of superficial dermatophyte infections complicated by inflammation or pruritus
- Cutaneous candidiasis with inflammatory symptoms
- Diaper dermatitis complicated by secondary Candida infection
- Vulvovaginal candidiasis
Mechanism of Action
- Miconazole inhibits fungal ergosterol synthesis, increasing cellular membrane permeability and causing fungal cell lysis
- Hydrocortisone provides localized anti-inflammatory, antipruritic, and vasoconstrictive effects
- Zinc oxide acts as a skin protectant and mild astringent
Contraindications
- Hypersensitivity to miconazole, imidazole antifungals, corticosteroids, or any component
- Untreated primary fungal, bacterial, or viral skin infections (for combination products containing corticosteroids)
- Tuberculous or syphilitic skin lesions
- Varicella and vaccinia viral skin lesions
Adverse Reactions
- Local skin irritation, burning, stinging, or redness
- Pruritus and dry skin
- Secondary cutaneous infection
- Long-term or occlusive topical corticosteroid use: striae, skin atrophy, telangiectasia, hypopigmentation, and systemic corticosteroid absorption
Drug Interactions
- Systemic absorption of topical corticosteroids may interact with antidiabetic agents, decreasing glycemic control
- Potential enhancement of oral anticoagulant (e.g., warfarin) effects with systemic absorption of miconazole, though minimal with topical formulations
- Concomitant use of other local dermatological agents may increase skin irritation
Curated Content: Needs Vetting Before Put to Clinical Use