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# Miconazole Vaginal Pessary ## Overview Miconazole is an imidazole antifungal agent. It is available in vaginal pessary (suppository) formulations for the treatment of vulvovaginal candidiasis (yeast infection). ## Primary Indications * Treatment of vulvovaginal candidiasis. ## Adult Dosing * **100 mg pessary:** Insert one pessary vaginally at bedtime for 7 days. * **200 mg pessary:** Insert one pessary vaginally at bedtime for 3 days. * **100 mg/g cream (if using cream applicator instead of pessary):** Insert one applicatorful (approximately 5 g) vaginally at bedtime for 7 days. * **Maximum dose:** Not applicable for standard vaginal therapy; follow package instructions for the specific formulation. ## Pediatric Dosing * **100 mg pessary:** Use as directed for adults. Safety and efficacy in children younger than 12 years have not been established. * **200 mg pessary:** Use as directed for adults. Safety and efficacy in children younger than 12 years have not been established. ## Dose Adjustments * No specific dose adjustments are typically required based on renal or hepatic impairment for vaginal formulations, as systemic absorption is minimal. ## Contraindications * Hypersensitivity to miconazole or any component of the formulation. ## Adverse Effects * **Common:** Vaginal burning, itching, irritation, pelvic cramps. * **Less Common:** Rash, urticaria. ## Key Drug Interactions * **Warfarin:** Miconazole, particularly when used systemically or in high vaginal doses, may inhibit CYP3A4 and CYP2C9, leading to increased warfarin levels and potential for bleeding. Monitor INR closely if concomitant use is necessary. * **CYP3A4 Substrates:** Concomitant use with other CYP3A4 substrates may increase the risk of adverse effects associated with those substrates. ## Monitoring * Clinical signs and symptoms of vulvovaginal candidiasis. * Monitor for signs of local irritation or allergic reaction. * If concomitant warfarin therapy, monitor INR. ## Clinical Pearls * Complete the full course of therapy even if symptoms improve. * Avoid sexual intercourse during treatment to prevent potential transmission to partner or reduced efficacy. * Pessaries may weaken latex condoms and diaphragms. Advise patients to use alternative birth control methods. * Itching and burning may occur initially but usually subside. If severe, discontinue use. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on local protocols and individual patient factors.