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.
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.
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.
> 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.