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# Miconazole Vaginal
## Overview
Miconazole is an imidazole antifungal agent used to treat vaginal yeast infections.
## Primary Indications
Vulvovaginal candidiasis.
## Adult Dosing
* **1-day treatment:** 1200 mg vaginal suppository inserted once at bedtime.
* **3-day treatment:** 200 mg vaginal suppository inserted once at bedtime for 3 consecutive days.
* **7-day treatment:** 100 mg vaginal suppository inserted once at bedtime for 7 consecutive days.
* **2% cream:** Apply 1 applicatorful (approximately 5g) intravaginally once at bedtime for 7 days.
## Pediatric Dosing
The safety and efficacy of miconazole vaginal products have not been established in pediatric patients. Use with caution and consider lower doses if deemed necessary by a clinician.
## Dose Adjustments
No dose adjustments are typically necessary 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 vaginal itching, burning, irritation, and lower abdominal cramping.
## Key Drug Interactions
Miconazole is a moderate inhibitor of CYP3A4. Concomitant use with CYP3A4 substrates that have a narrow therapeutic index (e.g., certain anticoagulants, statins, immunosuppressants) may lead to increased plasma concentrations and potential toxicity. However, systemic absorption from vaginal use is minimal, making significant interactions less likely compared to oral or IV formulations.
## Monitoring
* Monitor for signs and symptoms of vaginal candidiasis.
* Assess for and manage adverse effects.
## Clinical Pearls
* Treatment duration should be based on the severity of symptoms and patient response.
* Complete the full course of therapy even if symptoms improve earlier.
* Avoid sexual intercourse during treatment to prevent irritation and potential transmission to a partner.
* If symptoms do not improve after 7 days of treatment, or if they worsen, discontinue use and consult a healthcare provider.
* Pregnancy: While generally considered low risk, pregnant individuals should discuss treatment options with their healthcare provider.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always consult the most current prescribing information and relevant literature before making treatment decisions.*
