Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: miconazole

BRAND NAME: Monistat; Femizol; Vagistat; M-Zole; Micatin; Lotrimin

DRUG CLASS AND MECHANISM: Miconazole is an anti-fungal medication related to fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox), and clotrimazole (Lotrimin, Mycelex). It is used either on the skin or in the vagina for fungal infections. Miconazole was approved by the FDA in 1974.

GENERIC AVAILABLE: yes, for some formulations

PRESCRIPTION: no for most formulations; yes (Monistat-Derm)

PREPARATIONS: Vaginal suppositories: 200 mg (Monistat-3), 100 mg (Monistat-7); Vaginal cream 2% (Monistat-7; Femizol-M); Topical cream 2% (Monistat; Monistat-Derm). Vaginal suppositories: 100 mg with topical cream 2% (Monistat 7; M-Zole 7); 200 mg with topical cream 2% (Vagistat; Monistat 3; M-Zole 3); 1200 mg with topical cream 2% (Monistat 1). Ointment 2% (Tetterine); Powder 2% (Lotrimin AF); solution 2% (Fungoid Tincture); Liquid Spray 2% (Lotrimin AF); Gel 2% (Zeasorb-AF)

STORAGE: All formulations should be stored at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Miconazole is used to treat vaginal infections due to Candida albicans (yeast) and several fungal infections of the skin, including tinea versicolor, tinea pedis ("athlete's foot"), tinea cruris ("jock itch") and tinea corporis ("ringworm").

DOSING: Miconazole vaginal cream and suppositories are for use only in the vagina. These products are not to be taken by mouth. The vaginal suppositories are inserted, one per dose, in an applicator. Alternatively, the tube containing the vaginal cream is screwed onto the end of a special applicator tube, and the tube is then squeezed to fill the applicator. The patient then lies on her back with bent knees, inserts the applicator containing either the suppository or cream so that the tip of the applicator is high in the vagina, and then pushes the plunger in to deposit the suppository or cream into the vagina. The applicator should be washed with warm soap and water after each use.

Miconazole usually is used once daily at bedtime. The 200 mg suppositories (Monistat 3) are inserted once nightly for 3 nights. The100 mg suppositories (Monistat-7) and intravaginal cream are inserted once nightly for 7 nights. The 1200 mg formulation (Monistat 1) is applied once for one night.

For fungal skin infections, the topical cream is applied as a thin layer to cover the affected skin and surrounding area, usually twice daily. The hands should be washed before and after application.

DRUG INTERACTIONS: There are no known drug interactions with vaginal or topical miconazole.

PREGNANCY: There is very limited information on the use of miconazole during pregnancy. The physician must weigh the potential benefits against possible but unknown risks to the fetus.

NURSING MOTHERS: It is not known if miconazole is secreted in breast milk in amounts that can affect the infant.

SIDE EFFECTS: Irritation and burning have been reported by patients using topical or vaginal miconazole.

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