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## Miconazole Vaginal Pessary ### Overview Miconazole is an imidazole antifungal agent. ### Primary Indications Treatment of vulvovaginal candidiasis (yeast infection). ### Adult Dosing * **Formulation:** Pessary (suppository). * **Dose:** Typically 100 mg or 200 mg pessary. * **Frequency and Duration:** * 100 mg pessary: Insert one pessary vaginally at bedtime for 7 consecutive nights. * 200 mg pessary: Insert one pessary vaginally at bedtime for 3 consecutive nights. * A single-dose 1200 mg pessary is also available. ### Pediatric Dosing * Safety and efficacy in pediatric patients have not been established for the vaginal pessary formulation. ### Dose Adjustments No specific dose adjustments are required for renal or hepatic impairment with vaginal administration. ### Contraindications * Known 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 (especially oral formulations, but caution with vaginal) can inhibit CYP2C9, increasing warfarin levels and bleeding risk. Monitor INR closely if used concurrently. * **CYP3A4 Substrates:** Vaginal miconazole may have some systemic absorption, potentially interacting with drugs metabolized by CYP3A4. ### Monitoring * Monitor for signs and symptoms of vaginal candidiasis. * Assess for local irritation or allergic reactions. * If concurrent use with warfarin, monitor INR. ### Clinical Pearls * Pessaries are inserted high into the vagina. * Treatment should be completed even if symptoms improve before the course is finished. * Avoid sexual intercourse during treatment. * Partner may require treatment if symptomatic. * Some formulations may weaken latex condoms and diaphragms. *** *Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols before making any clinical decisions.*