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# Miconazole Vaginal Pessary ## Overview Miconazole is an imidazole antifungal agent that inhibits the synthesis of ergosterol, a vital component of fungal cell membranes. The vaginal pessary formulation is intended for topical intravaginal treatment. ## Primary Indications * Treatment of vulvovaginal candidiasis (yeast infection). ## Adult Dosing * **100 mg vaginal pessary:** Insert 1 pessary intravaginally at bedtime for 7 consecutive days. * **200 mg vaginal pessary:** Insert 1 pessary intravaginally at bedtime for 3 consecutive days. * **100 mg/g vaginal cream (often packaged with applicators and sometimes used in conjunction with or instead of pessaries):** Typically 5g (one full applicator) inserted intravaginally at bedtime for 7 days. ## Pediatric Dosing * Safety and efficacy in pediatric patients have not been established for the vaginal pessary formulation. ## Dose Adjustments * No dose adjustment is necessary for hepatic or renal impairment. ## Contraindications * Hypersensitivity to miconazole or any component of the formulation. ## Adverse Effects * **Common:** Vaginal burning, itching, irritation, pelvic cramps. * **Less Common:** Headache, rash. ## Key Drug Interactions * **Warfarin:** Miconazole (especially oral forms but caution with topical) can inhibit CYP2C9, leading to increased warfarin levels and risk of bleeding. Monitor INR closely if coadministered. * **CYP3A4 Substrates:** Miconazole can inhibit CYP3A4. Although systemic absorption from vaginal pessaries is low, theoretical potential for interactions with other CYP3A4 substrates exists. ## Monitoring * Monitor for symptom resolution. * Monitor for signs of local irritation or allergic reaction. * If coadministered with warfarin, monitor INR. ## Clinical Pearls * Treatment duration depends on the strength of the pessary used. Ensure patient understands the full course of therapy. * Avoid intercourse during treatment as the pessary may affect latex condoms and diaphragms. * Vaginal itching or burning may be exacerbated initially but should improve with continued therapy. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.*