Drug Guide

Generic Name

Miconazole Nitrate

Brand Names Monistat 7, Monistat-derm, Monistat 5, Monistat 3, Monistat 7 Combination Pack, Monistat 3 Combination Pack, Monistat Dual-Pak, M-zole 7 Dual Pack, M-zole 3 Combination Pack

Classification

Therapeutic: Antifungal

Pharmacological: Imidazole antifungal

FDA Approved Indications

Vaginal candidiasis (yeast infection)
Cutaneous fungal infections such as athlete's foot, ringworm, and jock itch

Mechanism of Action

Miconazole inhibits ergosterol synthesis, an essential component of fungal cell membranes, leading to increased membrane permeability and cell death.

Dosage and Administration

Adult: For vaginal use: Insert 1 suppository daily for 3, 5, or 7 days as directed. For cutaneous infections: Apply a thin layer to affected area once or twice daily.

Pediatric: Safety and efficacy not established; consult specific product labeling.

Geriatric: Use with caution; no specific adjustments required but monitor for adverse reactions.

Renal Impairment: No specific dose adjustment recommended; use with caution.

Hepatic Impairment: No specific dose adjustment necessary.

Pharmacokinetics

Absorption: Minimal systemic absorption when used topically or vaginally.

Distribution: Primarily localized at application site; systemic levels are low.

Metabolism: Metabolized in the liver via oxidative pathways.

Excretion: Metabolites excreted in urine and feces.

Half Life: Approximately 24 hours.

Contraindications

Hypersensitivity to miconazole or other imidazole antifungals.

Precautions

For vaginal use only unless specified. Avoid contact with eyes. Use with caution in active dermatitis or inflamed skin.

Adverse Reactions - Common

Vaginal burning, itching, irritation (Common)
Skin irritation, rash (Common)

Adverse Reactions - Serious

Hives, swelling, difficulty breathing (Rare)
Severe skin reactions (Rare)

Drug-Drug Interactions

Potential increase in plasma levels with drugs metabolized by CYP3A4, e.g., certain statins, benzodiazepines

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess for signs of fungal infection, hypersensitivity reactions.

Diagnoses:

Risk for allergic reaction
Impaired skin integrity

Implementation: Administer as prescribed, ensure proper application. Educate patient on correct use.

Evaluation: Monitor for resolution of infection and side effects.

Patient/Family Teaching

Use medication exactly as directed.
Complete the full course to prevent recurrence.
Report any adverse reactions or worsening symptoms.

Special Considerations

Black Box Warnings: N/A

Genetic Factors: N/A

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Gastrointestinal upset if ingested accidentally in large quantities.

Treatment: Supportive care, symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable until expiration date on packaging.