miconazole nitrate
(mi kon' a zole) Topical:
Absorbine Antifungal Foot Powder, Breeze Mist Antifungal, Fungoid Tincture, Lotrimin AF, Maximum Strength Desenex Antifungal, Ony Clear, Tetterine, Zeasorb-AF Vaginal suppositories, topical:
Micatin, Micozole (CAN), Monazole 7 (CAN), Monistat 3, Monistat 7, Monistat-Derm, Monistat Dual Pak Pregnancy Category B Drug class
Antifungal Therapeutic actions
Fungicidal: Alters fungal cell membrane permeability, causing cell death; also may alter fungal cell DNA and RNA metabolism or cause accumulation of toxic peroxides intracellularly. Indications
Vaginal suppositories: Local treatment of vulvovaginal candidiasis (moniliasis) \u2022 Topical administration: Tinea pedis, tinea cruris, tinea corporis caused by Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum; cutaneous candidiasis (moniliasis), tinea versicolor \u2022
Contraindications and cautions
Contraindicated with allergy to miconazole or components used in preparation. \u2022 Use cautiously with pregnancy, lactation. \u2022
Available forms
Vaginal suppositories\u2014100, 200, 1,200 mg; topical cream\u20142%; vaginal cream\u20142% topical powder\u20142%; topical spray\u20142%; topical ointment\u20142%; spray powder or li \u20142%; solution\u20142% Dosages ADULTS Vaginal suppositories
Monistat 3: Insert 1 suppository intravaginally once daily hs for 3 days. Monistat 7: One applicator cream or 1 suppository in the vagina daily hs for 7 days. Repeat course if needed. Alternatively, one 1,200-mg suppository at hs for 1 dose.
Topical
Cream and lotion: Cover affected areas bid, morning and evening. Powder: Spray or sprinkle powder liberally over affected area in the morning and evening.
PEDIATRIC PATIENTS Topical
< 2 yr: Not recommended.
> 2 yr: Use adult dosage. Pharmacokinetics
Route Topical Vaginal
Onset Rapid Unknown
Peak Unknown Unknown
Metabolism: Hepatic; T1/2: 21\u201324 hr Distribution: Crosses placenta; may enter breast milk Excretion: Urine and feces Adverse effects Vaginal suppositories \u2022 Local: Irritation, sensitization or vulvovaginal burning, pelvic cramps
Other: Rash, headache Topical application \u2022 Local: Irritation, burning, maceration, allergic contact dermatitis \u2022
Nursing considerations Assessment \u2022 History: Allergy to miconazole or components used in preparation; lactation,
pregnancy \u2022 Physical: Skin color, lesions, area around lesions; T; orientation, affect; culture of area involved
Interventions
Culture fungus involved before therapy. \u2022 Insert vaginal suppositories high into the vagina; have patient remain recumbent for 10\u201315 min after insertion; provide sanitary napkin to protect clothing from stains. \u2022 Monitor response; if none is noted, arrange for further cultures to determine causative organism. \u2022 Apply lotion to intertriginous areas if topical application is required; if cream is used, apply sparingly to avoid maceration of the area. \u2022 Ensure patient receives the full course of therapy to eradicate the fungus and to prevent recurrence. \u2022 Discontinue topical or vaginal administration if rash or sensitivity occurs. \u2022
Teaching points
Take the full course of drug therapy even if symptoms improve. Continue during menstrual period even if vaginal route is being used. Long-term use will be needed; beneficial effects may not be seen for several weeks. \u2022 Insert vaginal suppositories high into the vagina. \u2022 Use hygiene measures to prevent reinfection or spread of infection. \u2022 This drug is for the fungus being treated; do not self-medicate other problems with this drug. \u2022
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Refrain from sexual intercourse, or advise partner to use a condom to avoid reinfection; with vaginal form of drug, use a sanitary napkin to prevent staining of clothing. These side effects may occur: Irritation, burning, stinging. Report local irritation, burning (topical application); rash, irritation, pelvic pain (vaginal use).
Adverse effects in Italic are most common; those in Bold are life-threatening.
