Drug Guide
Terconazole
Classification
Therapeutic: Antifungal
Pharmacological: Azole antifungal
FDA Approved Indications
- Treatment of vulvovaginal candidiasis (yeast infection) caused by susceptible Candida species
Mechanism of Action
Terconazole inhibits the fungal cytochrome P450 enzyme 14α-sterol demethylase, leading to decreased synthesis of ergosterol, an essential component of fungal cell membranes. This results in increased membrane permeability and cell death.
Dosage and Administration
Adult: Typically, 0.4% vaginal cream or suppository once daily at bedtime for 3 to 7 days.
Pediatric: Use is not well established; consult pediatric guidelines or specialist.
Geriatric: No specific adjustments proposed; use with caution, monitor for adverse effects.
Renal Impairment: No specific dosage adjustments recommended; use with caution.
Hepatic Impairment: No specific adjustments; caution advised. Use only if the benefits outweigh potential risks.
Pharmacokinetics
Absorption: Minimal systemic absorption when used vaginally.
Distribution: Limited data; presumed to stay localized in vaginal tissues.
Metabolism: Metabolized minimally systemically; mostly remains in vaginal tissues.
Excretion: Limited systemic absorption; excretion details mostly unknown.
Half Life: Data not available; primarily localized action.
Contraindications
- Hypersensitivity to terconazole or other azole antifungals.
Precautions
- Use with caution in patients with a history of sensitivity to azole antifungals; caution in pregnancy, particularly in the first trimester; monitor for hypersensitivity reactions.
Adverse Reactions - Common
- Vaginal burning or stinging (Common)
- Vaginal irritation or itching (Common)
- Vaginal discomfort or dryness (Common)
Adverse Reactions - Serious
- Hypersensitivity reactions (Rare)
- Contact dermatitis (Rare)
Drug-Drug Interactions
- Caution with concomitant use of drugs that are metabolized by CYP450 enzymes; systemic absorption is minimal, so interactions are unlikely.
Drug-Food Interactions
- No significant food interactions noted.
Drug-Herb Interactions
- Limited data; exercise caution with herbal products affecting CYP enzymes or causing allergic reactions.
Nursing Implications
Assessment: Monitor for signs of fungal infection resolution and adverse reactions.
Diagnoses:
- Impaired skin integrity r/t fungal infection.
- Risk of allergic reaction.
Implementation: Administer as prescribed, typically at bedtime for 3-7 days. Educate about ointment/application techniques.
Evaluation: Assess for relief of symptoms and absence of adverse effects.
Patient/Family Teaching
- Complete full course of therapy even if symptoms resolve early.
- Report any signs of hypersensitivity, increased irritation, or allergic reactions.
- Maintain proper vulvovaginal hygiene.
- Warn about possible local irritation but emphasize the importance of completing therapy.
Special Considerations
Black Box Warnings:
- None for vaginal terconazole.
Genetic Factors: Limited data; no known genetic contraindications.
Lab Test Interference: Unlikely to interfere with laboratory tests.
Overdose Management
Signs/Symptoms: Overdose is unlikely due to localized application and minimal systemic absorption.
Treatment: Supportive care if accidental ingestion or unusual exposure occurs.
Storage and Handling
Storage: Store at room temperature away from moisture and heat.
Stability: Stable until expiration date on packaging.