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# Miconazole Vaginal Pessary ## Overview Miconazole is an imidazole antifungal agent used to treat vaginal yeast infections (vulvovaginal candidiasis). It is available as a vaginal pessary (suppository) for local application. ## Primary Indications Treatment of vulvovaginal candidiasis. ## Adult Dosing * **100 mg vaginal pessary:** Insert 1 pessary vaginally at bedtime for 7 consecutive days. * **200 mg vaginal pessary:** Insert 1 pessary vaginally at bedtime for 3 consecutive days. * **Single-dose 1200 mg vaginal pessary:** Insert 1 pessary vaginally as a single dose. ## Pediatric Dosing Dosing in pediatric patients is not well-established. Use with caution and consider consultation with a pediatric specialist. ## Dose Adjustments No dose adjustments are typically required for renal or hepatic impairment due to minimal systemic absorption. ## Contraindications Hypersensitivity to miconazole or any component of the formulation. ## Adverse Effects Common adverse effects include vulvovaginal burning, itching, irritation, and abdominal cramping. ## Key Drug Interactions * **Warfarin:** Miconazole (particularly oral formulations, but topical has some systemic absorption potential) can inhibit CYP2C9, increasing warfarin levels and the risk of bleeding. Monitor INR closely if co-administered. * **CYP3A4 Substrates:** Miconazole can inhibit CYP3A4. While systemic absorption is limited with vaginal products, caution is advised with co-administration of drugs that are sensitive CYP3A4 substrates (e.g., certain statins, calcium channel blockers). ## Monitoring * Monitor for symptom relief. * Monitor for signs of local irritation or allergic reaction. * If co-administered with warfarin, monitor INR. ## Clinical Pearls * Ensure complete insertion of the pessary. * Complete the full course of treatment even if symptoms improve earlier. * Avoid intercourse during treatment. * Partners may require treatment if they have symptoms of balanitis. * The pessary may weaken latex condoms and diaphragms, reducing their effectiveness. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and local guidelines before making clinical decisions.*