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## Miconazole Vaginal
**Overview**
Miconazole is a synthetic imidazole antifungal agent.
**Primary Indications**
Treatment of vulvovaginal candidiasis (yeast infection).
**Adult Dosing**
* **1-day treatment:**
* 1200 mg vaginal suppository inserted intravaginally at bedtime.
* **3-day treatment:**
* 200 mg vaginal suppository inserted intravaginally at bedtime for 3 consecutive nights.
* **7-day treatment:**
* 100 mg vaginal suppository inserted intravaginally at bedtime for 7 consecutive nights.
* 2% vaginal cream: 1 applicatorful (approximately 5 grams) inserted intravaginally at bedtime for 7 nights.
**Pediatric Dosing**
* Data for pediatric use is limited. Dosing and safety have not been established in children.
**Dose Adjustments**
No specific dose adjustments are recommended for renal or hepatic impairment for vaginal formulations.
**Contraindications**
Hypersensitivity to miconazole or any component of the formulation.
**Adverse Effects**
Common: Vaginal burning, itching, irritation.
Less common: Pelvic cramps, headache.
**Key Drug Interactions**
* **CYP3A4 Inhibitor:** Miconazole is a potent inhibitor of CYP3A4. Coadministration with drugs metabolized by CYP3A4 (e.g., warfarin, certain statins, immunosuppressants) may increase plasma concentrations of these drugs, potentially leading to serious adverse effects. Systemic absorption of miconazole via vaginal administration is generally low, but caution is still advised, especially with prolonged use or in patients with compromised mucosal integrity.
**Monitoring**
* Monitor for signs and symptoms of vaginal candidiasis.
* Assess for and manage adverse effects, particularly local irritation and potential drug interactions if systemic absorption is suspected.
**Clinical Pearls**
* Complete the full course of treatment as prescribed, even if symptoms improve sooner.
* Avoid intercourse during treatment.
* Partners may need treatment if they have symptoms of balanitis or vulvitis.
* May weaken latex condoms and diaphragms.
***
*Disclaimer: This information is intended for clinical use and does not replace professional judgment. Always consult the most current prescribing information and institutional protocols before administering any medication.*
