Miconazole
MONISTAT
Pronunciation: mi-KON-a-zoel
What it isImidazole CYP51 inhibitor; cutaneous, vulvovaginal, and oropharyngeal fungal infections.
Why this oneIts topical, vaginal, and buccal formulations treat local disease with little systemic exposure.
What limits it⚑ Even vaginal or buccal use can potentiate warfarin enough to cause bleeding; local irritation is common.
Pearls
- Vaginal products available OTC in 1-, 3- and 7-day regimens.
Miconazole prescription history
Animated chart of estimated U.S. prescriptions per year, Antifungals (1947–2026). Miconazole enters in 1974 (estimated).
FDA-approved for
- fungal infections (topical/vaginal)
Principal riskEven topical forms raise warfarin enough to cause bleeding
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityLocal irritation or hypersensitivity; systemic toxicity is minimal with correct local use.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Vaginal yeast infection | ≥12 yr | 1 applicatorful intravaginally QHS ×7 nights | ||
| External vulvar itching/irritation | ≥12 yr | apply to vulva BID ×up to 7 days PRN |
Renal Undefined
Hepatic Undefined
Instructions
- Insert 1 applicatorful into vagina at bedtime; discard applicator after use
- For external itch/irritation, apply cream to vulva twice daily up to 7 days
- Children under 12: ask a doctor
Available strengths
- cream 2, 4 %
- supp 100, 200 mg
- tab 50 mg
- powder 2 g/100 g
- powder 2.6 g/130 g
- powder 20 mg/g
- sol 1.2 g/60 g
- sol 0.3 mg/15 mL
- + 17 other marketed forms not shown
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 2 % | cream | per unit | not offered | |
| 4 % | cream | per unit | not offered | |
| 100 mg | supp | per unit | not offered | |
| 200 mg | supp | per unit | $13.89/ea | offered |
Generic entry1992
Open Miconazole in the interactive console ↗
Self-check
- Can vaginal or buccal miconazole potentiate warfarin?
Yes, enough to cause bleeding. - Which fungal enzyme does miconazole inhibit?
CYP51.