Miconazole
Mechanism :
Miconazole nitrate is a synthetic antifungal agent which inhibits the growth of the common dermatophytes, Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum, the yeast like fungus, Candida albicans, and the organism responsible for tinea versicolor (Malassezia furfur).
Indication :
- Tinea cruris
- Tinea corporis
- Tinea pedis
- Tinea capitis
- Candidiasis of skin and nail
- Oral candidiasis
Contraindications :
Contraindicated in individuals who have shown hypersensitivity to any of its ingredients. Avoid contact with eyes.
Dosing :
Topical:
>2 years: Apply on affected area 2 times daily for upto 1 month.
Oral thrush:
>16 years: 50 mg buccal tab applied to gum region every day for 2 weeks.
Vaginal: >12 years
2% cream: 1 applicatorful every night for 7 days or 4% cream; 1 applicatorful every night for 3 days.
100 mg vaginal suppository: Insert one suppository every night for 7 days or 200 mg. vaginal suppository: Insert one suppository every night for 3 days or 1200 mg vaginal suppository, insert one suppository once.
Adverse Effect :
Burning, irritation, abdominal cramps, allergic contact dermatitis, itching, stinging, maceration, erythema. With oral dose- diarrhoea, nausea, headache, dysgeusia, upper abdominal pain, vomiting.
Interaction :
Acenocoumarol: Miconazole may increase the serum concentration of acenocoumarol by decreasing its metabolism.
Anisindione: Miconazole may increase the serum concentration of anisindione by decreasing its metabolism.
Dicoumarol: Miconazole may increase the serum concentration of dicumarol by decreasing its metabolism.
Eltrombopag: Affects hepatic CYP2C9/10 metabolism, will increase effect/level of eltrombopag.
Tacrine: The metabolism of Tacrine, a CYP1A2 substrate, may be reduced by Miconazole, a CYP1A2 inhibitors.
Tacrolimus: The strong CYP3A4 inhibitor, Miconazole, may decrease the metabolism and clearance of Tacrolimus, a CYP3A4 substrate.
Tadalafil: Miconazole may reduce the metabolism of Tadalafil.
Tamoxifen: Miconazole may decrease the therapeutic effect of Tamoxifen by decreasing the production of active metabolites.
Tamsulosin: Miconazole, a CYP3A4/2D6 inhibitor, may decrease the metabolism and clearance of Tamsulosin, a CYP3A4/2D6 substrate.
Telithromycin: Miconazole may increase the plasma concentration of Telithromycin.
Temsirolimus: Miconazole may inhibit the metabolism and clearance of Temsirolimus.
Teniposide: The strong CYP3A4 inhibitor, Miconazole, may decrease the metabolism and clearance of Teniposide, a CYP3A4 substrate.
Tiagabine: The strong CYP3A4 inhibitor, Miconazole, may decrease the metabolism and clearance of Tiagabine, a CYP3A4 substrate.
Tizanidine: Miconazole may decrease the metabolism and clearance of Tizanidine. Consider alternate therapy or use caution during co-administration.
Tolbutamide: Miconazole, a strong CYP2C9 inhibitor, may decrease the metabolism and clearance of Tolbutamide, a CYP2C9 substrate.
Tolterodine: Miconazole may decrease the metabolism and clearance of Tolterodine.
Torasemide: Miconazole, a strong CYP2C9 inhibitor, may increase the serum concentration of Torasemide, a CYP2C9 substrate, by decreasing Torasemide metabolism and clearance.
Tramadol: Miconazole may increase Tramadol toxicity by decreasing Tramadol metabolism and clearance. Miconazole may decrease the effect of Tramadol by decreasing active metabolite production.
Trazodone: The CYP3A4 inhibitor, Miconazole, may increase Trazodone efficacy/toxicity by decreasing Trazodone metabolism and clearance.
Trimethoprim: The strong CYP2C9 inhibitor, Miconazole, may decrease the metabolism and clearance of Trimethoprim, a CYP2C9 substrate.
Trimipramine: The strong CYP3A4/2D6/2C19 inhibitor, Miconazole, may decrease the metabolism and clearance of Trimipramine, a CYP3A4/2D6/2C19 substrate.
Vardenafil: Miconazole, a strong CYP3A4 inhibitor, may reduce the metabolism and clearance of Vardenafil.
Venlafaxine: Miconazole, a CYP2D6 and CYP3A4 inhibitor, may decrease the metabolism and clearance of Venlafaxine, a CYP2D6 and CYP3A4 substrate.
Verapamil: Miconazole, a strong CYP3A4 inhibitor, may increase the serum concentration of Verapamil, a CYP3A4 substrate, by decreasing its metabolism and clearance.
Vinblastine: Miconazole, a strong CYP3A4 inhibitor, may decrease the metabolism of Vinblastine.
Vincristine: Miconazole, a strong CYP3A4 inhibitor, may increase the serum concentration of Vincristine by decreasing its metabolism.
Vinorelbine: Miconazole, a strong CYP3A4 inhibitor, may increase the serum concentration of Vinorelbine by decreasing its metabolism.
Voriconazole: Miconazole, a strong CYP2C9 inhibitor, may increase the serum concentration of voriconazole by decreasing its metabolism.
Warfarin: Miconazole, a strong CYP2C9 inhibitor, may decrease the metabolism of warfarin.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Unlikely to be significantly dialysed. Dose as in normal renal function |
Hepatic Dose :
No dose adjustments are recommended.
Adhesive buccal tablets: Should be administered with caution in patients with hepatic impairment.