Miconazole ๐
๐ About
Always check the BNF link here (or local formulary) before prescribing or recommending Miconazole.
- ๐ Phenethyl imidazole derivative.
- Used widely as a topical and oral antifungal for superficial and mucosal infections.
โ๏ธ Mode of Action
- Inhibits fungal ergosterol synthesis (essential for cell membrane integrity).
- Results in leaky cell membranes โ fungal cell death.
๐ Indications
- ๐ฆถ Cutaneous fungal infections (e.g. ringworm, tinea corporis).
- ๐ Athleteโs foot (tinea pedis).
- ๐
Fungal nail infections (onychomycosis).
- ๐ Angular cheilitis (often fungal or mixed).
- ๐ฆท Oral candidiasis (oral thrush).
- ๐ฉโ๐ฆฐ Vaginal candidiasis.
- ๐งด Combined topical (Daktacort: miconazole + hydrocortisone) for inflamed fungal lesions.
๐ Dose & Preparations
- Oral gel (Daktarin): 5โ10 mL QDS, held in mouth before swallowing.
- Buccal tablets (Loramyc): 50 mg OD, applied in morning.
- Topical cream/powder: apply BD, continue for 7โ10 days after clinical resolution to prevent relapse.
- Daktacort: apply thinly BD for inflamed fungal skin infections.
๐ Interactions
- โ ๏ธ Oral miconazole can potentiate warfarin โ check INR closely.
- Also interacts with drugs metabolised by CYP3A4 (e.g. phenytoin, ciclosporin).
โ Contraindications & Cautions
- โ ๏ธ Acute porphyria (caution).
- โ ๏ธ Hepatic impairment โ seek specialist advice (risk of hepatotoxicity).
- ๐ซ Avoid contact with eyes.
- ๐คฐ Pregnancy & ๐คฑ breastfeeding โ check BNF / local guidance before prescribing.
โ ๏ธ Side Effects
- ๐คข GI upset (oral gel).
- ๐ธ Allergic skin reactions / hypersensitivity.
- ๐งช Rare hepatotoxicity with systemic absorption.
- ๐จ Topical: local irritation, burning, or redness.