Miconazole is an antifungal medication used to treat ring worm, pityriasis versicolor, and yeast infections of the skin or vagina. It is applied to the skin or vagina as a cream or ointment.

Molecular Structure


Class of Drug

Antibiotic, penicillin family, aminopenicillin.

Mechanism of Action

Thickens cell wall, thereby altering permeability of fungal cell membrane.

Susceptible organisms in vivo: Coccidioides immitis, Candida albicans, Cryptococcus neoformans, Histoplasma, Paracoccidioides, Brasiliensis.

Indications / Dosage / Route

Routes of Administration: IV and Topical.

Condition: Severe systemic fungal infections caused by susceptible organisms resistant to other azoles

Dose: Adults: IV 300-600 mg daily.

         Children: >1 year: IV 20-40 mg/kg daily. Maximum dose per infusion: 15 mg/kg.

Children: <1 year: 15-30 mg/kg daily in 3 or 4 divided doses.

Condition: Cutaneous or mucocutaneous fungal infections caused by susceptible organisms

Dose: Adults: Topical: Cover affected areas b.i.d., 2-4 weeks

         Adults: Vaginal use: 200-mg suppository, h.s., 3 days.

Adjustment of Dosage

Kidney disease: None

Liver disease: None.

Elderly: None

Pediatric: Safely and efficacy in children <1 year have not been established.

Food and Drug Interactions

Food: No restrictions.

Pregnancy: Category C (IV form).

Lactation: No data available. Potentially toxic to infant. Avoid breastfeeding.

Contraindications: Hypersensitivity to miconazole.

Warnings / Precautions

> Use with caution in patients with hepatic insufficiency.

> Inject IV form very slowly (over 30-60 minutes) to avoid arrhythmias. IV administration is carried out in hospital under strictly monitored conditions.

> Use only to treat severe systemic fungal disease.

> Before IV administration, ascertain whether patient is hyper sensitive to the drug.

> Premedicate with an antiemetic to lessen or avoid nausea and vomiting.

> Advise patient about the symptoms of fungal infections.

> If a pruritic rash develops, it may persist long after drug is stopped. Diphenhydramine may be useful in counteracting this condition.

Clinically Important Drug Interactions

> Miconazole increases effects/toxicity of oral anticoagulants, sulfonylureas, phenytoin.

> Drugs that increase effects/toxicity of miconazole: ketocona zole, cyclosporine.

> Drugs that decrease effects/toxicity of ketoconazole: rifampin.

Adverse Reactions

> Common: Nausea, vomiting, diarrhea, rash

> Serious: Anaphylactoid reaction, phlebitis at injection site, arrhythmias, cardiorespiratory arrest.

Parameters to Monitor

> Cardiorespiratory arrest and anaphylaxis.

Advice to Patient

> Continue topical application for at least 1 month. If no improvement, consult treating physician.

Further Useful Info

> Used mainly as topical drug for yeast infections.

> IV (for infectious disease specialist only) for unusual mold infections such as Pseudallescheria boydii and highly resistant strains of fungi.

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