Version May 2024
Candidiasis, vulvovaginal: Children ≥12 years and Adolescents: Intravaginal:
Cream 2%: Insert 1 applicatorful (100 mg) at bedtime for 7 consecutive days
Cream 4%: Insert 1 applicatorful (200 mg) at bedtime for 3 consecutive days
Suppository, 100 mg: Insert 1 suppository at bedtime for 7 days
Suppository, 200 mg: Insert 1 suppository at bedtime for 3 days
Suppository, 1,200 mg: Insert 1 suppository (a one-time dose); may be used at bedtime or during the day
Note: Many products are available as a combination pack (contains a suppository for vaginal instillation and external cream which is applied twice daily for up to 7 days to relieve external symptoms).
Dermatologic infection, superficial: Children ≥2 years and Adolescents: Ointment: Topical: Apply to affected area twice daily
Tinea pedis: Children ≥2 years and Adolescents: Topical cream, spray, powder, aerosol powder, ointment, or solution: Topical: Apply twice daily for 4 weeks
Tinea corporis: Children ≥2 years and Adolescents: Topical cream, spray, powder, aerosol powder, ointment, or solution: Topical: Apply twice daily for 4 weeks
Tinea cruris: Children ≥2 years and Adolescents: Topical cream, spray, powder, aerosol powder, ointment, or solution: Topical: Apply twice daily for 2 weeks
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Miconazole (topical): Drug information")
Candidiasis , vulvovaginal: Note: Many products are available as a combination pack, with a suppository for vaginal instillation and cream to relieve external symptoms. A longer duration of up to 14 days may be necessary in patients with complicated infection (ie, recurrent or severe infection, infection with non-albicans Candida, or infection in an immunocompromised host) (CDC [Workowski 2021]; HHS [OI adult 2020]). Not effective against Candida glabrata (IDSA [Pappas 2016]).
Cream 2%: Intravaginal: Insert 1 applicatorful (~5 g) once daily (at bedtime) for 7 days (CDC [Workowski 2021]). May also apply externally twice daily for 7 days, as needed, for itching and irritation.
Cream 4%: Intravaginal: Insert 1 applicatorful (~5 g) once daily (at bedtime) for 3 days (CDC [Workowski 2021]). May also apply externally twice daily for 7 days, as needed, for itching and irritation.
Suppository 100 mg: Intravaginal: Insert 1 suppository once daily (at bedtime) for 7 days (CDC [Workowski 2021]).
Suppository 200 mg: Intravaginal: Insert 1 suppository once daily (at bedtime) for 3 days (CDC [Workowski 2021]).
Suppository 1.2 g: Intravaginal: Insert 1 suppository as a single dose (at bedtime or during the day) (CDC [Workowski 2021]).
Tinea infections:
Tinea corporis/tinea cruris (OTC labeling): Topical: Aerosol powder (tinea corporis only), cream, ointment, powder, solution: Apply to affected and surrounding area(s) twice daily until clinical resolution, typically 1 to 4 weeks (Goldstein 2021; van Zuuren 2015; Weinstein 2002; manufacturer's labeling).
Tinea pedis (OTC labeling)/tinea manuum (off-label use): Topical: Aerosol powder, aerosol solution, cream, ointment, powder, solution: Apply to affected and surrounding area(s) twice daily until 1 week after clinical resolution, typically for 4 weeks total (Goldstein 2021; Ongley 1978; Weinstein 2002; manufacturer's labeling).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Topical:
Dermatologic: Allergic contact dermatitis, burning sensation of skin, maceration of skin
Vaginal:
Gastrointestinal: Abdominal cramps
Genitourinary: Vulvovaginal burning, vulvovaginal irritation, vulvovaginal pruritus
OTC labeling: When used for self-medication, do not use in children <2 years of age (topical products) or <12 years of age (vaginal products), for diaper rash, nail infections, scalp infections; may be product specific (also consult manufacturer's labeling).
Concerns related to adverse effects:
• Irritation: Discontinue if sensitivity or irritation occurs.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol and/or sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol and/or benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.
• Flammable contents: Aerosol contains flammable propellants. Avoid fire, flame, and smoking during and immediately following administration.
• Fungoid tincture: Patients with diabetes, circulatory problems, renal or hepatic dysfunction should contact healthcare provider prior to self-medication (OTC use).
• Petrolatum-based: Vaginal products are petrolatum-based and may damage rubber or latex condoms or diaphragms; separate use by 3 days.
• Vaginal products: Consult with health care provider prior to self-medication (OTC use) if experiencing vaginal itching/discomfort, lower abdominal pain, back or shoulder pain, chills, nausea, vomiting, foul-smelling discharge, if this is the first vaginal yeast infection, or if exposed to HIV. Contact health care provider if symptoms do not begin to improve after 3 days or last longer than 7 days. May damage condoms or diaphragms.
Other warnings/precautions:
• Appropriate use: For topical use only; avoid contact with eyes. When used for self-medication (OTC use), contact health care provider if athlete's foot or ringworm does not improve within 4 weeks or if jock itch does not improve within 2 weeks; consult a doctor before using vaginal products if having vaginal itching or discomfort for the first time, lower abdominal pain, back or shoulder pain, fever or chills, nausea or vomiting, or foul-smelling vaginal discharge.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Aerosol Powder, External, as nitrate:
Cruex Prescription Strength: 2% (85 g)
Desenex Jock Itch: 2% (113 g)
Lotrimin AF Deodorant Powder: 2% (133 g)
Lotrimin AF Jock Itch Powder: 2% (133 g)
Lotrimin AF Powder: 2% (133 g)
Cream, External, as nitrate:
Antifungal: 2% (14 g [DSC], 28 g [DSC], 42.5 g [DSC]) [contains benzoic acid]
Antifungal: 2% (14.2 g, 28.4 g, 42.5 g) [contains cetostearyl alcohol, chlorocresol (chloro-m-cresol), edetate (edta) disodium, propylene glycol]
Antifungal: 2% (113 g, 198 g) [contains cetyl alcohol, methylparaben, propylene glycol, propylparaben]
Baza Antifungal: 2% (142 g) [alcohol free, dye free, latex free, paraben free; contains cetyl alcohol, propylene glycol]
Carrington Antifungal: 2% (141 g [DSC]) [contains disodium edta, methylparaben, propylene glycol, propylparaben]
Cavilon: 2% (56 g [DSC], 141 g [DSC]) [latex free; contains disodium edta, methylparaben, propylene glycol, propylparaben]
FT Antifungal: 2% (30 g) [contains benzoic acid]
Micaderm: 2% (30 g)
Micatin: 2% (14 g) [contains benzoic acid]
Miconazole Antifungal: 2% (30 g) [contains edetate (edta) disodium, ethylparaben, trolamine (triethanolamine)]
Remedy Antifungal: 2% (118 mL [DSC]) [contains methylparaben, propylparaben, trolamine (triethanolamine)]
Soothe & Cool INZO Antifungal: 2% (56.7 g [DSC], 141.7 g [DSC])
Generic: 2% (14 g, 15 g, 28 g, 30 g, 42.5 g)
Cream, Vaginal, as nitrate:
Miconazole 7: 2% (45 g) [contains benzoic acid]
Generic: 2% (45 g)
Kit, External, as nitrate:
Fungoid Tincture: 2% [DSC] [contains benzyl alcohol]
Kit, Vaginal, as nitrate:
GoodSense Miconazole 1: Cream, topical: 2% (9 g) and Suppository, vaginal: 1200 mg [DSC] [contains benzoic acid]
Miconazole 3 Combo-Supp: Cream, topical: 2% (9 g) and Suppository, vaginal: 200 mg (3s) [DSC]
Miconazole 3 Combo-Supp: Cream, topical: 2% (9 g) and Suppository, vaginal: 200 mg (3s) [contains benzoic acid]
Ointment, External, as nitrate:
Aloe Vesta Antifungal: 2% (56 g, 141 g)
Aloe Vesta Clear Antifungal: 2% (56 g [DSC], 141 g [DSC]) [dye free, fragrance free]
DermaFungal: 2% (113 g [DSC])
Remedy Antifungal Clear: 2% (71 g [DSC]) [contains soybean oil]
Remedy Phytoplex Antifungal: 2% (71 g [DSC]) [paraben free; contains soy protein hydrolysate]
Triple Paste AF: 2% (28.7 g [DSC], 56.7 g [DSC]) [contains polysorbate 80]
Powder, External, as nitrate:
Antifungal: 2% (85 g)
Antifungal: 2% (85 g) [paraben free]
Desenex: 2% (43 g, 85 g)
Micotrin AP: 2% (85 g) [contains sodium benzoate]
Mycozyl AP: 2% (85 g) [contains sodium benzoate]
Remedy Antifungal: 2% (85 g [DSC])
Remedy Phytoplex Antifungal: 2% (85 g [DSC]) [paraben free; contains sodium benzoate, soy protein]
Zeasorb-AF: 2% (71 g) [contains sodium benzoate]
Solution, External, as nitrate:
Azolen Anti-Fungal Wash: 2% (170 g)
Azolen Tincture: 2% (29.57 mL) [contains benzyl alcohol, isopropyl alcohol]
Fungoid Tincture: 2% (29.57 mL) [contains benzyl alcohol]
Miconi-AL: 2% (30 mL)
Generic: 2% (29.57 mL)
Suppository, Vaginal, as nitrate:
Miconazole 7: 100 mg (7 ea)
Miconazole 3: 200 mg (3 ea)
May be product dependent
Aerosol powder (Cruex Prescription Strength External)
2% (per gram): $0.06
Aerosol powder (Desenex Jock Itch External)
2% (per gram): $0.05
Cream (Micatin External)
2% (per gram): $0.36
Cream (Miconazole Nitrate External)
2% (per gram): $0.12 - $0.24
Cream (Miconazole Nitrate Vaginal)
2% (per gram): $0.25
Powder (Desenex External)
2% (per gram): $0.10
Powder (Micotrin AP External)
2% (per gram): $6.50
Powder (Mycozyl AP External)
2% (per gram): $6.50
Powder (Zeasorb-AF External)
2% (per gram): $0.09
Solution (Azolen Anti-Fungal Wash External)
2% (per gram): $0.12
Solution (Azolen Tincture External)
2% (per mL): $0.59
Solution (Fungoid Tincture External)
2% (per mL): $0.70
Solution (Miconazole Nitrate External)
2% (per mL): $0.59
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Topical: For external use only. Apply sparingly and rub gently into the cleansed, dry affected area. For tinea pedis, also apply to spaces between the toes.
Vaginal: Wash hands before using; gently insert full applicator of cream (prefilled or filled at time of use) or vaginal insert high into vagina and press the plunger to release the medication. Discard used prefilled applicators after use; wash reusable applicator with soap and water following use. Patients should not use intravaginal products (eg, tampons, douches) or engage in vaginal intercourse for the duration of treatment.
Intravaginal: Creams (with and without applicator), suppository: For vaginal use only. Not for ophthalmic or oral use. Cream may also be applied to the affected and immediate surrounding area(s). Do not use tampons, douches, spermicides, or other vaginal products or have vaginal intercourse during treatment. Wash hands following application.
Topical: Aerosol powder, aerosol solution, cream, ointment, powder, solution: For external use only. Cleanse and thoroughly dry area prior to application. Apply a thin layer to the affected and immediate surrounding area(s). For tinea pedis (athlete's foot), pay special attention to spaces between the toes; wear well fitting, ventilated shoes and change shoes and socks at least once daily. Wash hands following application. Shake aerosol well prior to use.
Store at room temperature. The aerosol is flammable; keep away from excessive heat (eg, temperatures >49°C [120°F], fire, flames). Do not puncture or incinerate container.
Topical cream, spray, powder, aerosol powder: Treatment of tinea corporis, tinea cruris, and tinea pedis and relief of associated itching, cracking, burning, and discomfort (OTC product: FDA approved in ages ≥2 years and adults). Note: Topical therapy is not effective for infection of the scalp or nails.
Ointment: Treatment of tinea corporis, tinea cruris, and tinea pedis; relief of associated itching, cracking, burning, and discomfort from tinea cruris; treatment of superficial infections due to Candida albicans (All indications: OTC product: FDA approved in ages ≥2 years and adults). Note: Topical therapy is not effective for infection of the scalp or nails.
Solution: Treatment of tinea corporis and tinea pedis and relief of itching, scaly skin between the toes (OTC product: FDA approved in ages ≥2 years and adults)
Vaginal cream (2%): Treatment of vulvovaginal candidiasis; relief of itching and irritation due to vaginal yeast infection (OTC products: FDA approved in ages ≥12 years and adults)
Vaginal cream (4%) and suppository: Treatment of vulvovaginal candidiasis (OTC products: FDA approved in ages ≥12 years and adults)
Miconazole may be confused with metroNIDAZOLE, Micronase, Micronor
Lotrimin may be confused with Lotrisone, Otrivin
Micatin may be confused with Miacalcin
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Progesterone: Antifungal Agents (Vaginal) may diminish the therapeutic effect of Progesterone. Risk X: Avoid combination
Vitamin K Antagonists (eg, warfarin): Miconazole (Topical) may increase the serum concentration of Vitamin K Antagonists. Management: Avoid using any miconazole-containing preparation in patients who are taking warfarin. If coadministration is unavoidable, consider reducing warfarin dose 10% to 20% and monitor for increased warfarin effects (eg, INR, bleeding). Risk D: Consider therapy modification
Vaginal products may weaken latex condoms and diaphragms (CDC [Workowski 2021]).
Following vaginal administration, small amounts are absorbed systemically (Stevens 2002).
Based on available data, vaginal use of miconazole is not associated with an increased risk of adverse pregnancy outcomes (Czeizel 2004; Daniel 2018; Rotem 2018).
Topical azole therapies with 7-day regimens are recommended in pregnant patients with vulvovaginal candidiasis (CDC [Workowski 2021]). Shorter courses of topical azoles are less effective (Young 2001).
Monitor for worsening symptoms
Inhibits biosynthesis of ergosterol, damaging the fungal cell wall membrane, which increases permeability causing leaking of nutrients
Absorption: Topical: Negligible; Vaginal: Small amount absorbed systemically
Distribution: Into body tissues, joints, and fluids; poor penetration into sputum, saliva, urine, and CSF
Protein binding: 91% to 93%
Metabolism: In the liver
Half-life elimination: Multiphasic degradation: Alpha: 40 minutes; Beta: 126 minutes; Terminal: 24 hours
Excretion: Feces (~50%); urine (<1%, unchanged)
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