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# Miconazole vaginal pessary ## Overview Miconazole is a synthetic imidazole antifungal agent. Vaginal pessaries are formulated for intravaginal administration to treat vulvovaginal candidiasis. ## Primary Indications Treatment of vulvovaginal candidiasis (yeast infections). ## Adult Dosing * **100 mg pessary:** Insert one pessary vaginally at bedtime for 7 consecutive nights. * **200 mg pessary:** Insert one pessary vaginally at bedtime for 3 consecutive nights. * **100 mg/g vaginal cream:** Used in conjunction with a 100 mg pessary, apply approximately 5g intravaginally at bedtime for 7 nights. Alternatively, a single 200 mg pessary can be used with 5g of 2% cream for 7 nights. ## Pediatric Dosing Dosing for pediatric patients is not well-established for vaginal formulations. Consult specific pediatric guidelines or product labeling. ## Dose Adjustments No dose adjustments are typically required for renal or hepatic impairment for vaginal administration due to minimal systemic absorption. ## Contraindications Hypersensitivity to miconazole or any component of the formulation. ## Adverse Effects Commonly reported: Vaginal burning, itching, irritation, or rash. Less common: Abdominal pain, headache. ## Key Drug Interactions Miconazole is a potent inhibitor of CYP3A4 and CYP2C9. Systemic absorption from vaginal administration is generally low, but potential for drug interactions exists, especially with prolonged or widespread use or in patients with impaired absorption. Caution is advised with oral anticoagulants (e.g., warfarin) and other CYP3A4 substrates (e.g., certain statins, calcium channel blockers, immunosuppressants). ## Monitoring * Monitor for relief of symptoms (itching, burning, discharge). * Assess for adverse effects. * Evaluate for recurrence of infection. ## Clinical Pearls * Complete the full course of treatment, even if symptoms improve earlier. * Avoid intercourse during treatment to prevent reinfection or transmission. * The pessary and cream may weaken latex condoms and diaphragms. * If symptoms do not improve after the full course, consider alternative diagnoses or antifungal agents. *** *This information is intended for healthcare professionals. Always verify current prescribing information and local protocols before use.*