Miconazole, Micatin, Oravig, Monistat, M-Zole

  • Mechanism
  1. As with other azoles, inhibits the synthesis of ergosterol (key component of fungal cell wall)
    1. Blocks sterol 14-a-dimethylase (microsomal Cytochrome P450-dependent enzyme)
  • Medications
  1. Precautions
    1. Bayer Healthcare uses the Lotrimin brand name to apply to various Antifungals (e.g. Clotrimazole, Butenafine)
  2. Oral for Oropharyngeal Candidiasis (Thrush)
    1. Miconazole Buccal Tablet (Oravig) 50 mg
    2. Contraindicated in milk protein Hypersensitivity
  3. Topical Miconazole (Micatin, Zeasorb AF)
    1. Miconazole 2% cream
    2. Miconazole 2% powder
    3. Miconazole Sprays 2% (spray powder or spray liquid)
  4. Yeast Vaginitis
    1. Miconazole cream 2% and 4%
    2. Miconazole vaginal suppository/tablets 100 mg, 400 mg, 1200 mg
  1. Place 50 mg buccal tablet in the buccal space and hold in position for 30 seconds
  2. Precautions
    1. Perform after Tooth Brushing and tablet should continue to stick to mucosa after pressure released
    2. Tablet should remain in place for 6 hours, until fully dissolved (reposition against mucosa if falls off)
    3. Repeat dose if tablet is swallowed within first 6 hours of application
    4. Contraindicated in age <16 years old (Choke Hazard)
    5. Avoid chewing gum while tablet is in place
    6. May increase INR for patients on Warfarin
  • Dosing
  • Topical
  1. Topical (Dermatophyte Infection or Superficial Candida infection) for adults (and off-label in children)
    1. Apply twice daily to affected area for 2 weeks (Tinea Pedis for 4 weeks)
  2. Yeast Vaginitis
    1. Miconazole (Monistat-7) 2% cream per vagina (PV) at bedtime for 7 days
    2. Miconazole (Monistat-3) 4% cream, 5g per vagina (PV) at bedtime for 3 days
    3. Miconazole 100 mg vaginal suppository/tablet PV at bedtime for 7 days
    4. Miconazole 400 mg vaginal suppository/tablet PV at bedtime for 3 days
    5. Miconazole 1200 mg vaginal suppository/tablet PV at bedtime for 1 dose
  • Safety
  1. Unknown safety in Lactation
    1. Vaginal use is considered safe in Lactation
  2. Pregnancy
    1. Pregnancy Category C for oral Miconazole in Thrush
    2. Pregnancy Category B topically
    3. Avoid vaginal use if possible in first trimester (possible absorption)