Miconazole

A to Z Drug Facts

Miconazole

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(my-KAHN-uh-zole)

Absorbine Antifungal Foot Powder

Class: Anti-infective/antifungal

Action Alters permeability of fungal cell membrane, leading to cell death.

Indications Parenteral form: Treatment of severe systemic fungal infections. Vaginal form: Local treatment of vulvovaginal candidiasis (moniliasis). Topical form: Treatment of topical fungal infections, including tinea infections and candidiasis.

Contraindications Hypersensitivity to imidazoles.

Route/Dosage

Systemic Infections

ADULTS: IV 200–3600 mg/day. May divide into 3 doses. Treatment of meningitis is supplemented by intrathecal injections of 20 mg/dose. Treatment of bladder infections is supplemented by bladder instillations of 200 mg per dose. CHILDREN 1–12 YR: IV 20–40 mg/kg/day (maximum 15 mg/kg/dose). CHILDREN < 1 YR: IV 15–30 mg/kg/day (maximum 15 mg/kg/dose).

Vaginal Infections

ADULTS: Intravaginal 1 suppository (200 mg) at bedtime for 3 days or 1 suppository (100 mg) for 7 days or 1 applicatorful at bedtime for 7 days.

Topical Infections

ADULTS: Topical Apply to infected area bid.

Interactions

Anticoagulants, oral: May cause increased anticoagulant effect. Antihistamines, nonsedating type (eg, astemizole, terfenadine): Cardiotoxicity, including arrhythmias and death, has occurred when agents of this type were used together with azole-type antifungals.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Tachycardia; arrhythmia; cardiorespiratory arrest. DERM: Phlebitis at infusion site; pruritus; rash; skin irritation, sensitization and burning from topical preparations. GI: Nausea; vomiting; diarrhea; anorexia. HEMA: Transient decreases in hematocrit; thrombocytopenia. META: Hyperlipemia possibly caused by vehicle. OTHER: Anaphylaxis; fever; chills. Topical or vaginal forms may cause similar reactions.

Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy in children < 1 yr not studied sufficiently. Cardiac effects: Have occurred, possibly because of too-rapid administration. Cremophor-type vehicle: Present in IV formulation; may cause electrophoretic abnormalities of lipoprotein; usually reversible.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Dilute IV admixture in 200 ml of 0.9% Sodium Chloride Injection or D5W. Infuse at rate of 2 hr/amp.
Continue treatment until clinical and lab tests indicate absence of fungal infection.
Topical lotion is preferred in intertriginous areas. If cream is used, use sparingly to avoid maceration effects.
Spray or sprinkle powder liberally over affected area bid.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies. Note history of blood dyscrasias and hyperlipidemia.
Monitor hemoglobin, hematocrit, electrolytes and lipids.
Avoid having topical products come into contact with eyes.
Refrigerate suppositories.

Patient/Family Education

With topical therapy, instruct patient to use for full treatment time, even if symptoms improve. Advise patient to notify physician if there is no improvement in 2 wk.
With topical therapy, if condition worsens or if burning, itching or redness occurs, instruct patient to discontinue use and notify physician.
With vaginal therapy, instruct patient to refrain from sexual intercourse or to have partner use condom for protection and to prevent reinfection. Advise patient to apply medication at bedtime.
Suggest patient use sanitary pad to prevent staining of clothing.
With vaginal therapy, instruct patient not to discontinue use during menstruation.