Diflucan (fluconazole) vs. Monistat 7 (miconazole)

• Diflucan (fluconazole) and Monistat 7 (miconazole) are anti-fungal medications used to treat vaginal fungal infections.
• Diflucan is also used to treat oral and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation.
• Monistat 7 is used to treat other infections (athlete's foot, ringworm) and severe fungal infections.
• Side effects of Diflucan and Monistat 7 that are similar include rash.
• Side effects of Diflucan that are different from Monistat 7 include headache, nausea, abdominal pain, diarrhea, indigestion, dizziness, low blood potassium (hypokalemia), and changes in taste.
• Side effects of Monistat 7 that are different from Diflucan include skin irritation, burning, and itching.

Diflucan (fluconazole) is an anti-fungal medication that prevents growth of fungi by preventing production of the membranes that surround fungal cells. Diflucan is used to treat vaginal, oral, and esophageal fungal infections caused by Candida; urinary tract infections, peritonitis, pneumonia and disseminated infections caused by Candida; cryptococcal meningitis; and to prevent Candida infections in patients treated with chemotherapy or radiation after bone marrow transplantation. Diflucan is related to clotrimazole (Lotrimin), ketoconazole (Nizoral), itraconazole (Sporanox), and miconazole (Micatin, Monistat).

Monistat 7 (miconazole) is an anti-fungal medication related to fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox), and clotrimazole (Lotrimin, Mycelex). Monistat 7 is used to treat vaginal infections and other infections (athlete's foot, ringworm), and severe fungal infections.

Diflucan

Common side effects of fluconazole include

• headache,
• nausea, and
• abdominal pain.

Other important side effects include

• diarrhea,
• dyspepsia,
• dizziness,
• reduced blood levels of potassium,
• rash, and
• taste disturbance.

Possible serious side effects include

• seizures,
• reduced number of white blood cells,
• reduced number of blood platelets, and
• toxic epidermal necrolysis.

Rarely, serious allergic reactions, including angioedema (swelling of tissues), may also occur. Liver dysfunction (jaundice, hepatitis) and abnormal heartbeats have been associated with fluconazole. Stevens-Johnson syndrome has also been reported.

Monistat 7

Irritation, burning, rash, and itching have been reported by patients using topical or vaginal miconazole.

Diflucan

• The usual adult dose is 50-400 mg daily depending on the type of infection. Although symptoms of oral Candida infections may subside in a few days, treatment is continued for 2 weeks.
• Esophageal Candida infections are treated for 3 weeks or longer.
• Treatment of cryptococcal meningitis may last for 10-12 weeks after cerebrospinal fluid cultures become negative.

Monistat 7

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. The 100 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 once or twice daily for 2-4 weeks. The hands should be washed before and after application.

Diflucan

• Hydrochlorothiazide increases the blood concentration of fluconazole by 40%. However, dosage modification is not recommended when both drugs are combined.
• Rifampin (Rifadin, Rimactane, Rifadin, Rifater, Rifamate) reduces the blood concentration of oral fluconazole, probably by increasing the elimination of fluconazole in the liver; therefore, reducing the effectiveness of fluconazole.
• Fluconazole may increase the concentration of warfarin (Coumadin, Jantoven) in blood by reducing the elimination of warfarin. Therefore, the effect of warfarin may increase, leading to an increased tendency to bleed.
• Fluconazole also increases the concentration of the following drugs in the blood, and as a result, the risk of side effects of these drugs may increase. These drugs include:
  • phenytoin (Dilantin),
  • cyclosporine,
  • zidovudine (Retrovir),
  • saquinavir (Invirase),
  • theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin),
  • tolbutamide,
  • glyburide (Micronase, Diabeta, Glynase),
  • glipizide,
  • triazolam (Glucotrol),
  • midazolam (Versed),
  • celecoxib (Celebrex),
  • fentanyl (Sublimaze),
  • atorvastatin (Lipitor),
  • simvastatin (Zocor), and
  • lovastatin (Mevacor).
• As a result, the risk of side effects from the above drugs may increase.
• Combining fluconazole with amiodarone (Cordarone), pimozide (Orap), bepridil (Vascor) or other drugs that affect heart rhythm may increase the risk of abnormal heart rhythms.

Monistat 7

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

Diflucan

• There are no adequate studies of Diflucan in pregnant women. There are reports of harmful effects to the fetus when high dose fluconazole was administered to pregnant women for a few months. Use of fluconazole during pregnancy is not recommended.
• Diflucan is secreted in breast milk at concentrations similar to the mother's blood level. However, fluconazole is used for treating neonates with fungal infections and for treating lactation associated Candida infections. Available evidence suggests that use of fluconazole during breastfeeding has little risk.

Monistat 7

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