Affects the permeability of the fungal cell wall, allowing leakage of cellular contents. Not active against bacteria.
Therapeutic effects:
Inhibited growth and death of susceptible Candida, with decrease in accompanying symptoms of vulvovaginitis (vaginal burning, itching, discharge).
Pharmacokinetics⬆⬇
Absorption: Minimal through intact skin.
Distribution: Unknown. Action is primarily local.
Metabolism/Excretion: Negligible with local application.
Half-Life: Not applicable.
Time/Action Profile⬆⬇
ROUTE
ONSET
PEAK
DURATION
Intravag
unknown
unknown
unknown
Contraind./Precautions⬆⬇
Contraindicated in:
Hypersensitivity to active ingredients, additives, or preservatives.
Use Cautiously in:
OB: Safety not established;
Adv. Reactions/Side Effects⬆⬇
GU: cramping, itching, vulvovaginal burning
Interactions⬆⬇
Drug-drug:
Concurrent use of vaginal miconazole with warfarin↑ risk of bleeding/bruising (appropriate monitoring recommended).
Route/Dosage⬆⬇
Vag (Adults and Children ≥12 yr): Vaginal suppositories: one 100-mg suppository at bedtime for 7 days or one 200-mg suppository at bedtime for 3 days or one 1200–mg suppository as a single dose. Vaginal cream: 1 applicatorful of 2% cream at bedtime for 7 days or 1 applicatorful of 4% cream at bedtime for 3 days. Combination packs: contain a cream or suppositories as well as an external vaginal cream (may be used twice daily for up to 7 days, as needed, for symptomatic management of itching).
Inspect involved areas of skin and mucous membranes before and frequently during therapy. Increased skin irritation may indicate need to discontinue medication.
Implementation⬆⬇
Consult physician or other health care professional for proper cleansing technique before applying medication.
Applicators are supplied for vaginal administration.
Patient/Family Teaching⬆⬇
Instruct patient to apply medication as directed for full course of therapy, even if feeling better. Therapy should be continued during menstrual period.
Advise patient to avoid using tampons, douches, spermicides, or other vaginal products while using this therapy.
Instruct patient on proper use of vaginal applicator. Medication should be inserted high into the vagina at bedtime. Instruct patient to remain recumbent for at least 30 min after insertion. Advise use of sanitary napkins to prevent staining of clothing or bedding.
Advise patient to consult health care professional regarding intercourse during therapy. Vaginal medication may cause minor skin irritation in sexual partner. Advise patient to refrain from sexual contact during therapy. Advise patient that this medication may weaken latex or rubber contraceptive products. Another method of contraception should be used during treatment.
Advise patient to report to health care professional increased skin irritation or lack of response to therapy. A second course may be necessary if symptoms persist.
Advise patient to dispose of applicator after each use.
Evaluation/Desired Outcomes⬆⬇
Decrease in skin irritation and vaginal discomfort. Therapeutic response is usually seen after 1 wk. Diagnosis should be reconfirmed with smears or cultures before a second course of therapy to rule out other pathogens associated with vulvovaginitis. Recurrent vaginal infections may be a sign of systemic illness.