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# Miconazole Vaginal Pessary ## Overview Miconazole is an imidazole antifungal agent. ## Primary Indications Treatment of vulvovaginal candidiasis (yeast infection). ## Adult Dosing * **100 mg vaginal pessary:** Insert 1 pessary vaginally at bedtime for 7 days. * **200 mg vaginal pessary:** Insert 1 pessary vaginally at bedtime for 3 days. * **High potency (e.g., 1200 mg):** Insert 1 pessary vaginally as a single dose. Dosing frequency and duration may vary based on the specific product and severity of infection. ## Pediatric Dosing * **100 mg vaginal pessary:** For adolescent females (age 12 years and older) with uncomplicated vulvovaginal candidiasis, the adult dosing regimens (7-day, 3-day, or single-dose) are generally applicable. Safety and efficacy in prepubescent children have not been established for vaginal formulations. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment due to minimal systemic absorption from vaginal administration. ## Contraindications * Hypersensitivity to miconazole or any component of the formulation. ## Adverse Effects Common: Vaginal burning, itching, irritation, or discomfort. Lower abdominal cramping may occur. ## Key Drug Interactions * **Warfarin:** Miconazole, particularly when used orally or in high concentrations, can inhibit CYP3A4 and CYP2C9, potentially increasing warfarin levels and the risk of bleeding. While systemic absorption is limited with vaginal products, caution and monitoring of INR are advised, especially with prolonged use or in patients with risk factors. * **Other CYP3A4 substrates:** Increased plasma concentrations of other drugs metabolized by CYP3A4 may occur, although this is less likely with vaginal administration due to limited systemic absorption. ## Monitoring * Clinical signs and symptoms of vulvovaginal candidiasis. * If used concurrently with warfarin, monitor INR. ## Clinical Pearls * Avoid intercourse during treatment. * The pessary may damage latex condoms and diaphragms, reducing their effectiveness. * For recurrent or persistent infections, a healthcare provider should be consulted. *** *This information is intended for clinical decision-making and does not replace the need to consult the official prescribing information and current clinical guidelines.*