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# Miconazole Vaginal Pessary
## Overview
Miconazole is an imidazole antifungal agent used to treat vaginal yeast infections (vulvovaginal candidiasis).
## Primary Indications
Treatment of vulvovaginal candidiasis caused by *Candida* species.
## 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 (applicator):** Insert one applicatorful vaginally at bedtime for 7 consecutive nights.
* **2% vaginal cream (applicator):** Insert one applicatorful vaginally at bedtime for 3 consecutive nights.
## Pediatric Dosing
Dosing in pediatric patients is not well established and should be based on clinical judgment and available product information. Safety and efficacy have not been confirmed in children under 12 years of age.
## Dose Adjustments
No dose adjustments are typically necessary for renal or hepatic impairment for topical vaginal administration.
## Contraindications
* Hypersensitivity to miconazole or any component of the formulation.
## Adverse Effects
* **Common:** Vaginal burning, itching, irritation, vulvar edema, pain.
* **Less Common:** Allergic reactions, abdominal cramps.
## Key Drug Interactions
Miconazole is a moderate inhibitor of CYP3A4 and CYP2C9. Although systemic absorption from vaginal administration is minimal, caution is advised with coadministration of drugs primarily metabolized by these enzymes, especially those with a narrow therapeutic index (e.g., warfarin, some statins, some anticonvulsants).
## Monitoring
* Monitor for signs and symptoms of vaginal yeast infection, including itching, burning, and discharge.
* Assess for local irritation or allergic reaction.
## Clinical Pearls
* Complete the full course of therapy as prescribed, even if symptoms improve.
* Avoid sexual intercourse during treatment.
* Consider alternative therapy if symptoms do not improve after completing treatment or if recurrence is frequent.
* Pessaries and vaginal creams may weaken latex condoms and diaphragms.
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**Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult with a qualified healthcare provider for patient-specific recommendations.
