miconazole nitrate
(mi kon' a zole)
Topical:
Breeze Mist Antifungal, Fungoid Tincture, Lotrimin AF, Maximum Strength Desenex Antifungal, Micatin, Monistat Derm Cream (CAN), Tetterine, Ting, Zeasorb-AF
Vaginal suppositories, topical:
Femisol-M, Micozole (CAN), Monistat 1 (CAN), Monistat 3, Monistat 7, Monistat Dual Pak, M-Zole 3, M-Zole 7 Dual Pack
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)
· Topical administration: Tinea pedis, tinea cruris, tinea corporis caused by Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophytonfloccosum; cutaneous candidiasis (moniliasis), tinea versicolor
Contraindications and cautions
· Contraindicated with allergy to miconazole or components used in preparation.
· Use cautiously with pregnancy, lactation.
Available forms
Vaginal suppositories—100, 200, 1,200 mg; topical cream—2%; vaginal cream—2%; topical powder—2%; topical spray—2%; topical ointment—2%; spray powder or liquid—2%; solution—2%
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: Use adult dosage.
< 2 yr: Not recommended.
Pharmacokinetics
Route | Onset | Peak |
Topical | Rapid | Unknown |
Vaginal | Unknown | Unknown |
Metabolism: Hepatic; T1/2: 21–24 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Feces, urine
Adverse effects
Vaginal suppositories
· Local: Irritation, sensitization or vulvovaginal burning, pelvic cramps
· Other: Rash, headache
Topical application
· Local: Irritation, burning, maceration, allergic contact dermatitis
Nursing considerations
Assessment
· History: Allergy to miconazole or components used in preparation; lactation, pregnancy
· Physical: Skin color, lesions, area around lesions; T; orientation, affect; culture of area involved
Interventions
· Culture fungus involved before therapy.
· Insert vaginal suppositories high into the vagina; have patient remain recumbent for 10–15 min after insertion; provide sanitary napkin to protect clothing from stains.
· Monitor response; if none is noted, arrange for further cultures to determine causative organism.
· Apply lotion to intertriginous areas if topical application is required; if cream is used, apply sparingly to avoid maceration of the area.
· Ensure patient receives the full course of therapy to eradicate the fungus and to prevent recurrence.
· WARNING: Discontinue topical or vaginal administration if rash or sensitivity occurs.
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.
· Insert vaginal suppositories high into the vagina.
· Use hygiene measures to prevent reinfection or spread of infection.
· This drug is for the fungus being treated; do not self-medicate other problems with this drug.
· 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.
· You may experience these side effects: 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.
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