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# Miconazole Vaginal Suppository
## Overview
Miconazole is an imidazole antifungal agent. The vaginal suppository formulation is used to treat vulvovaginal candidiasis (yeast infections).
## Primary Indications
Treatment of vulvovaginal candidiasis (VVC) caused by susceptible Candida species.
## Adult Dosing
* **100 mg vaginal suppository:** Insert 1 suppository vaginally at bedtime for 7 days.
* **200 mg vaginal suppository:** Insert 1 suppository vaginally at bedtime for 3 days.
* **Higher strength suppositories (e.g., 1200 mg single-dose):** Insert 1 suppository vaginally as a single dose.
## Pediatric Dosing
Data for use in pediatric patients is limited. Consult specific pediatric guidelines or an infectious disease specialist for age-appropriate dosing.
## Dose Adjustments
No dose adjustments are typically needed for renal or hepatic impairment with vaginal administration.
## Contraindications
* Hypersensitivity to miconazole or any component of the formulation.
* Use with oral or transdermal **CYP3A4 inhibitors** (e.g., cisapride, dofetilide, quinidine, pimozide, simvastatin, lovastatin). Miconazole can significantly increase plasma concentrations of these drugs, potentially leading to serious adverse events.
## Adverse Effects
Common:
* Vaginal burning, itching, irritation
* Pelvic cramps
Uncommon:
* Headache
* Rash
## Key Drug Interactions
* **CYP3A4 Inhibitors:** Miconazole is a potent inhibitor of CYP3A4. Concomitant use with drugs metabolized by CYP3A4 (e.g., warfarin, some calcium channel blockers, certain immunosuppressants) may increase their plasma concentrations and associated toxicities. Avoid coadministration with known potent CYP3A4 substrates where levels can be dangerous (see Contraindications).
* **Warfarin:** Increased INR and bleeding risk. Monitor INR closely if used concurrently.
## Monitoring
* Monitor for signs and symptoms of VVC resolution.
* Monitor for adverse effects.
* If using concurrently with warfarin, monitor INR.
## Clinical Pearls
* Complete the full course of therapy even if symptoms improve earlier.
* Avoid sexual intercourse during treatment to prevent potential reinfection and to avoid irritating the sensitive vaginal mucosa.
* Miconazole suppositories can weaken latex condoms and diaphragms. Advise patients to use alternative birth control methods during treatment and for at least 3 days after completion.
* Vaginal products can increase the risk of systemic absorption of other medications.
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*Disclaimer: This information is intended for healthcare professionals and does not replace a thorough review of the most current prescribing information, product monographs, or clinical guidelines. Always verify current dosing, indications, contraindications, and safety warnings before administering any medication.*
