Miconazole

 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.

 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.