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# Miconazole Vaginal Pessary ## Overview Miconazole is an imidazole antifungal agent. The vaginal pessary formulation is used for the treatment of vulvovaginal candidiasis (yeast infection). ## Primary Indications * Treatment of vulvovaginal candidiasis (yeast infection). ## Adult Dosing * Insert one 100 mg vaginal pessary intravaginally at bedtime for 7 consecutive nights. * Alternatively, insert one 200 mg vaginal pessary intravaginally at bedtime for 3 consecutive nights. * Some products may also contain a 1200 mg single-dose vaginal suppository. ## Pediatric Dosing * Dosing in pediatric patients has not been established for the vaginal pessary formulation. Consult with a pediatrician or infectious disease specialist for guidance. ## Dose Adjustments * No dose adjustment is typically necessary for renal or hepatic impairment when used as a vaginal pessary due to minimal systemic absorption. ## Contraindications * Hypersensitivity to miconazole or any component of the formulation. ## Adverse Effects * Common: Vaginal burning, itching, irritation, pelvic cramps. * Less Common: Rash, hives. ## Key Drug Interactions * **Warfarin:** Miconazole can inhibit CYP2C9, potentially increasing warfarin levels and INR. Monitor INR closely if co-administered. Avoid concurrent use of oral miconazole with warfarin; topical vaginal miconazole has a lower risk but caution is still advised. ## Monitoring * Monitor for signs and symptoms of recurrent or persistent infection. * Monitor INR if the patient is also on warfarin. ## Clinical Pearls * Complete the full course of treatment even if symptoms improve. * Avoid sexual intercourse during treatment. * If symptoms do not improve after completing treatment, or if they worsen, the patient should consult a healthcare provider. * Some formulations may weaken latex or rubber products (e.g., condoms, diaphragms). --- ***Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and guidelines before use. Dosing and recommendations may vary based on patient-specific factors and local protocols.*