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# Miconazole vaginal pessary
## Overview
Miconazole is an imidazole antifungal agent used to treat vaginal yeast infections.
## Primary Indications
Vulvovaginal candidiasis (yeast infection).
## Adult Dosing
* **100 mg vaginal pessary:** Insert one pessary vaginally at bedtime for 7 days.
* **200 mg vaginal pessary:** Insert one pessary vaginally at bedtime for 3 days.
* **Single-dose 1200 mg vaginal suppository:** Insert one suppository vaginally at bedtime.
Specific duration of therapy may depend on product labeling or local protocol.
## Pediatric Dosing
Safety and efficacy in pediatric patients have not been established for the vaginal pessary formulations.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment.
## Contraindications
* Hypersensitivity to miconazole or any component of the formulation.
## Adverse Effects
* **Common:** Vaginal burning, itching, irritation, abdominal cramps.
* **Less Common:** Headache, rash.
## Key Drug Interactions
* **Warfarin:** Miconazole (especially oral or IV, but caution with topical) can inhibit CYP2C9, leading to increased INR and bleeding risk. Monitor INR closely if co-administered.
## Monitoring
* Symptom resolution.
* For patients on warfarin, monitor INR.
## Clinical Pearls
* Complete the full course of treatment even if symptoms improve earlier.
* Avoid intercourse during treatment.
* Patient counseling regarding potential for burning or irritation is recommended.
* Consider an alternative agent if symptoms do not improve after completing therapy.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace the need for individual clinical judgment or consultation of the most current prescribing information and relevant literature. Always verify current dosing, indications, and contraindications with the official product labeling and institutional protocols.
