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# Miconazole Vaginal Pessary ## Overview Miconazole is a synthetic imidazole antifungal agent that inhibits the synthesis of ergosterol, a vital component of fungal cell membranes. This disruption leads to increased cell membrane permeability and eventual cell death. ## 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. * **100 mg/6.5 g vaginal cream:** Insert one applicatorful (approximately 100 mg) vaginally at bedtime for 7 days. * **4% vaginal cream (100 mg/applicatorful):** Insert one applicatorful vaginally at bedtime for 3 days. ## Pediatric Dosing * **Children 12 years and older:** Use adult dosing. * **Children younger than 12 years:** Safety and efficacy not established. Consult with a pediatrician for appropriate management. ## Dose Adjustments * No dose adjustments are typically required for hepatic or renal impairment due to minimal systemic absorption. ## 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 can inhibit CYP2C9, potentially increasing the anticoagulant effect of warfarin. Monitor INR closely if coadministered. * **CYP3A4 substrates:** Miconazole can inhibit CYP3A4, potentially increasing plasma concentrations of drugs metabolized by this enzyme (e.g., certain calcium channel blockers, immunosuppressants). ## Monitoring * Clinical response (resolution of symptoms). * Monitor for signs of local irritation or allergic reaction. * If coadministered with warfarin, monitor INR. ## Clinical Pearls * Complete the full course of therapy even if symptoms improve earlier. * Avoid sexual intercourse during treatment. * Pessaries may weaken latex condoms and diaphragms; consider alternative contraception during treatment. * Pregnancy: While systemic absorption is low, use during the first trimester should be avoided unless clearly needed and benefits outweigh risks. Consult with an obstetrician. *** **Disclaimer:** This information is intended for healthcare professionals and should not replace clinical judgment. Always refer to the most current prescribing information and institutional guidelines for definitive patient care decisions.