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# Miconazole vaginal pessary
## Overview
Miconazole vaginal pessaries are antifungal agents used to treat vulvovaginal candidiasis (yeast infections).
## Primary Indications
Treatment of vulvovaginal candidiasis.
## Adult Dosing
* **100 mg pessary:** Insert one pessary vaginally at bedtime for 7 consecutive days.
* **200 mg pessary:** Insert one pessary vaginally at bedtime for 3 consecutive days.
* **Suppository (100 mg):** Insert one suppository vaginally at bedtime for 7 consecutive days.
* **Cream (2%):** One applicatorful (approximately 5g) inserted vaginally at bedtime for 7 consecutive days.
## Pediatric Dosing
* Data on the safety and efficacy of miconazole vaginal pessaries in pediatric patients (under 18 years) is limited. Use should be based on clinical judgment and may require consultation with a specialist.
## Dose Adjustments
No dose adjustments are typically required for renal or hepatic impairment.
## Contraindications
* Hypersensitivity to miconazole or any component of the formulation.
* Caution with concurrent use of warfarin; monitor INR closely.
## Adverse Effects
* **Common:** Vaginal burning, itching, irritation, lower abdominal cramping.
* **Less Common:** Rash, urticaria.
## Key Drug Interactions
* **Warfarin:** Miconazole can inhibit CYP2C9, increasing warfarin levels and the risk of bleeding. Coadministration is generally not recommended. If coadministration is necessary, monitor INR frequently and adjust warfarin dose as needed.
* **CYP3A4 substrates:** Miconazole can inhibit CYP3A4, potentially increasing the serum concentration of drugs metabolized by this enzyme.
## Monitoring
* Monitor for signs and symptoms of recurrent or persistent infection.
* Monitor INR if coadministered with warfarin.
## Clinical Pearls
* Complete the full course of treatment even if symptoms improve before completion.
* Avoid intercourse during treatment.
* Partners may require treatment if symptomatic.
* Latex condoms and diaphragms may be damaged by miconazole, leading to reduced effectiveness and increased risk of pregnancy or STI transmission.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before making clinical decisions. Dosing and recommendations may vary based on local protocols and individual patient factors.
