Home Drug Guide Miconazole

Drug Guide

Generic Name

Miconazole

Brand Names Monistat, Oravig

Classification

Therapeutic: Antifungal

Pharmacological: Imidazole antifungal

FDA Approved Indications

Vaginal yeast infections (Monistat)
Oral candidiasis (Oravig)

Mechanism of Action

Miconazole inhibits the synthesis of ergosterol, an essential component of fungal cell membranes, leading to increased membrane permeability and cell death.

Dosage and Administration

Adult: Vaginal dosage: 100 mg once at bedtime for 3, 6, or 7 days as prescribed. Oravig (oral): 50 mg once daily for 14 days.

Pediatric: Use approved age-specific formulations and dosing guidance.

Geriatric: No specific dosage adjustments required; monitor renal and hepatic function.

Renal Impairment: Use with caution; no specific dosage adjustment available.

Hepatic Impairment: Use with caution; no specific dosage adjustment available.

Pharmacokinetics

Absorption: Minimal systemic absorption when applied topically; well absorbed after oral administration.

Distribution: Widely distributed; crosses the blood-brain barrier to some extent.

Metabolism: Metabolized in the liver via the cytochrome P450 enzyme system.

Excretion: Primarily excreted in urine and feces.

Half Life: Approx. 2-8 hours, varies by formulation and route.

Contraindications

Hypersensitivity to miconazole or other azole antifungals.

Precautions

Use cautiously in hepatic impairment, as it is metabolized by the liver.
Avoid in patients with known hypersensitivity to imidazoles.

Adverse Reactions - Common

Local skin irritation, burning, or itching (Common)
Vaginal discomfort or irritation (Common)

Adverse Reactions - Serious

Allergic reactions including swelling, rash, difficulty breathing (Rare)
Hepatotoxicity (very rare) (Rare)

Drug-Drug Interactions

Warfarin: Increased bleeding risk.
QT prolonging agents: Risk of cardiac arrhythmias.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess for signs of fungal infection, allergic reactions, hepatic function.

Diagnoses:

Infection control
Risk of allergic reaction

Implementation: Administer as prescribed; counsel on application techniques; monitor hepatic function during systemic use.

Evaluation: Monitor for resolution of infection and adverse effects.

Patient/Family Teaching

Use medication as directed, completing the full course.
Report any signs of allergic reactions or adverse effects.
Avoid applying topical medication in eyes, nose, or mouth unless directed.

Special Considerations

Black Box Warnings:

None currently.

Genetic Factors: Consider genetic variations affecting metabolism if systemic use prolonged.

Lab Test Interference: May affect liver function tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, headache, allergic reactions.

Treatment: Supportive care; no specific antidote. Seek medical attention.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable for the duration of the labeled expiration date.