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# Miconazole Vaginal Pessary ## Overview Miconazole is a synthetic imidazole antifungal agent effective against a wide range of yeasts and fungi. The vaginal pessary is designed for local vaginal administration. ## Primary Indications Treatment of vulvovaginal candidiasis (yeast infection). ## Adult Dosing * **100 mg vaginal pessary:** Insert one pessary vaginally at bedtime for 7 consecutive days. * **200 mg vaginal pessary:** Insert one pessary vaginally at bedtime for 3 consecutive days. * **400 mg vaginal pessary:** Insert one pessary vaginally at bedtime for 1 consecutive day. ## Pediatric Dosing Dosing for pediatric patients is not well-established for the vaginal pessary formulation. Use in this population should be based on clinical judgment and consultation with a pediatrician. ## Dose Adjustments No dose adjustments are typically required for renal or hepatic impairment due to minimal systemic absorption. ## Contraindications * Hypersensitivity to miconazole or any component of the formulation. * Use with oral anticoagulants (e.g., warfarin) due to potential for increased INR. ## Adverse Effects Common adverse effects include vaginal irritation, burning, itching, and redness. Less common effects may include pelvic cramps and vulvar swelling. ## Key Drug Interactions * **Warfarin:** Miconazole can inhibit CYP2C9 and CYP3A4, leading to increased warfarin levels and risk of bleeding. Monitor INR closely and consider alternative antifungal agents if possible. * **Other CYP3A4 substrates:** Potential for increased concentrations of other drugs metabolized by CYP3A4 (e.g., certain statins, calcium channel blockers, benzodiazepines). ## Monitoring * Monitor for resolution of symptoms. * If symptoms persist after completing therapy, re-evaluate for alternative diagnoses or resistant organisms. * Monitor INR closely if co-administered with warfarin. ## Clinical Pearls * Pessaries should be inserted as deeply as possible into the vagina, preferably at bedtime to minimize leakage. * Treatment should be completed even if symptoms improve earlier. * Avoid intercourse during treatment. * Use of tampons and douches should be avoided. * If pregnancy is suspected, consult a healthcare provider. *** *This information is intended for healthcare professionals. Please verify current prescribing information and local protocols before administering this medication.*