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GENITO URINARY SYSTEM AND SEX HORMONES › GYNECOLOGICAL ANTIINFECTIVES AND ANTISEPTICS › ANTIINFECTIVES AND ANTISEPTICS, EXCL. COMBINATIONS WITH CORTICOSTEROIDS › Imidazole derivatives
miconazole
G01AF04
Forms & Strengths
- Vaginal Suppositories: 100 mg, 200 mg, 1200 mg
- Vaginal Cream: 2%, 4%
- Topical Cream: 2%
- Topical Ointment: 2%
- Topical Powder: 2%
- Oral Mucoadhesive Buccal Tablet: 50 mg
Adult Dosing
- Vulvovaginal Candidiasis (Cream 2%): One applicatorful intravaginally daily for 7 days
- Vulvovaginal Candidiasis (Cream 4%): One applicatorful intravaginally daily for 3 days
- Vulvovaginal Candidiasis (Suppository 100 mg): One intravaginally daily at bedtime for 7 days
- Vulvovaginal Candidiasis (Suppository 200 mg): One intravaginally daily at bedtime for 3 days
- Vulvovaginal Candidiasis (Suppository 1200 mg): One intravaginally as a single dose
- Tinea corporis/cruris/pedis: Apply to affected area twice daily for 2 to 4 weeks
- Oropharyngeal Candidiasis (Buccal Tablet): 50 mg applied to the upper gum region once daily for 14 days
Pediatric Dosing
- Vulvovaginal Candidiasis (Postmenarcheal adolescents): Same as adult dosing
- Topical Tinea infections (Children >= 2 years): Apply to affected area twice daily for 2 to 4 weeks
- Oropharyngeal candidiasis (Children >= 16 years): 50 mg buccal tablet once daily for 14 days
Indications
- Treatment of vulvovaginal candidiasis
- Topical treatment of tinea pedis, tinea cruris, and tinea corporis caused by Trichophyton rubrum, T. mentagrophytes, and Epidermophyton floccosum
- Topical treatment of cutaneous candidiasis
- Treatment of oropharyngeal candidiasis in adults
Mechanism of Action
- Inhibits fungal cytochrome P450-dependent enzyme lanosterol 14-alpha-demethylase
- Blocks conversion of lanosterol to ergosterol, disrupting fungal cell membrane synthesis
- Increases fungal cell membrane permeability and leakage of intracellular components
Contraindications
- Hypersensitivity to miconazole or any component of the formulation
- Systemic fungal infections
- Co-administration with warfarin (for oral buccal formulations due to increased risk of bleeding)
Adverse Reactions
- Vulvovaginal burning, itching, or irritation
- Pelvic cramps
- Headache
- Application site skin reactions (erythema, stinging, blistering)
- Taste disturbance (with buccal tablet)
Drug Interactions
- Warfarin: Increased bleeding risk and elevated INR when combined with systemic or oral gel formulations
- HMG-CoA Reductase Inhibitors (Statins): Increased risk of myopathy and rhabdomyolysis via CYP3A4 inhibition
- Hypoglycemic agents (sulfonylureas): Enhanced hypoglycemic effect
- Phenytoin: Increased phenytoin toxicity due to CYP2C9 and CYP3A4 inhibition
Curated Content: Needs Vetting Before Put to Clinical Use