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# Miconazole Vaginal Pessary ## Overview Miconazole is a synthetic imidazole antifungal agent. ## Primary Indications Treatment of vulvovaginal candidiasis (yeast infection). ## Adult Dosing * **100 mg vaginal suppository:** Insert one suppository vaginally at bedtime for 7 consecutive nights. * **200 mg vaginal suppository:** Insert one suppository vaginally at bedtime for 3 consecutive nights. * **100 mg vaginal cream:** Insert one applicatorful (approximately 5 grams) vaginally at bedtime for 7 consecutive nights. * **4% vaginal cream:** Insert one applicatorful (approximately 5 grams) vaginally at bedtime for 3 consecutive nights. *Note: The 100mg and 200mg suppositories are sometimes referred to as "pessaries."* ## Pediatric Dosing Dosing for children under 12 years of age has not been established by the FDA for these specific vaginal formulations. Consult with a pediatrician for appropriate management. ## Dose Adjustments No dose adjustments are typically required for hepatic or renal impairment. ## Contraindications Hypersensitivity to miconazole or any component of the formulation. ## Adverse Effects Common adverse effects include vaginal itching, burning, irritation, and lower abdominal cramping. ## Key Drug Interactions * **Warfarin:** Miconazole can inhibit the metabolism of warfarin, increasing the risk of bleeding. Monitor INR closely and consider alternative antifungal therapy if possible. * **CYP3A4 Substrates:** Miconazole can inhibit CYP3A4, potentially increasing the plasma concentrations of other drugs metabolized by this enzyme. ## Monitoring Monitor for symptom relief and signs of local irritation or allergic reaction. ## Clinical Pearls * Avoid concurrent use of spermicides as miconazole may inactivate them. * Symptomatic relief may occur within a few days, but complete the full course of therapy. * If symptoms persist after the full course, re-evaluate diagnosis and consider alternative treatment. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*