DrugindexOnline^{2nd edition}

Pronouncation: (my-KAHN-uh-zole)
Class: Anti-infective, Antifungal agent

Trade Names:
Absorbine Antifungal Foot Powder
- Powder 2%

Trade Names:
Breezee Mist Antifungal
- Powder 2%

Trade Names:
Femizol-M
- Vaginal Cream 2%

Trade Names:
Fungoid Cream
- Cream 2%

Trade Names:
Fungoid Tincture
- Solution 2%

Trade Names:
Lotrimin AF
- Spray Liquid 2%
- Spray Powder 2%
- Powder 2%

Trade Names:
M-Zole 3 Combination Pack
- Vaginal Suppositories 200 mg
- Topical Cream 2%

Trade Names:
M-Zole 7 Dual Pack
- Vaginal Suppositories 100 mg
- Topical Cream 2%

Trade Names:
Maximum Strength Desenex Antifungal
- Cream 2%

Trade Names:
Micatin
- Cream 2%
- Spray Liquid 2%
- Spray Powder 2%
- Powder 2%

Trade Names:
Monistat 3
- Vaginal Suppositories 200 mg

Trade Names:
Monistat 7
- Vaginal Suppositories 100 mg
- Vaginal Cream 2%

Trade Names:
Monistat 7 Combination Pack
- Vaginal Suppositories 100 mg
- Topical Cream 2%

Trade Names:
Monistat-Derm
- Topical Cream 2%

Trade Names:
Monistat Dual-Pak
- Vaginal Suppositories 200 mg
- Topical Cream 2%

Trade Names:
Neosporin AF
- Topical Cream 5 mg per 5 mL

Trade Names:
Only-Clear
- Spray 2%

Trade Names:
Prescription Strength Desenex
- Spray powder 2%
- Spray liquid 2%

Trade Names:
Tetterine
- Ointment 2%

Trade Names:
Zeasorb-AF
- Powder 2%

Micozole (Canada)
Monistat 1 Combination Pack (Canada)
Monistat 1 Vaginal Ovule (Canada)
Monistat 3 Vaginal Ovules (Canada)
Monistat Derm Cream (Canada)

Mechanism of Action

Pharmacology

Alters permeability of fungal cell membrane, leading to cell death.

Indications and Usage

Parenteral form

Treatment of severe systemic fungal infections.

Vaginal form

Local treatment of vulvovaginal candidiasis (moniliasis).

Topical form

Treatment of topical fungal infections, including tinea infections and candidiasis.

Contraindications

Hypersensitivity to imidazoles.

Dosage and Administration

Systemic Infections
Adults

IV 200 to 3600 mg/day. May divide into 3 doses. Treatment of meningitis is supplemented by intrathecal injections of 20 mg/dose. Treatment of bladder infections is supplemented by bladder instillations of 200 mg per dose.

Children (1 to 12 yr)

IV 20 to 40 mg/kg/day (max, 15 mg/kg/dose).

Children (younger than 1 yr)

IV 15 to 30 mg/kg/day (max, 15 mg/kg/dose).

Vaginal Infections
Adults

Intravaginal 1 suppository (200 mg) at bedtime for 3 days or 1 suppository (100 mg) for 7 days or 1 applicatorful at bedtime for 7 days.

Topical Infections
Adults

Topical Apply to infected area bid.

Storage/Stability

Store at 59° to 86°F.

Drug Interactions

Anticoagulants, oral

May cause increased anticoagulant effect.

Antihistamines, nonsedating type (eg, astemizole, terfenadine)

Cardiotoxicity, including arrhythmias and death, has occurred when agents of this type were used together with azole-type antifungals.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; arrhythmia; cardiorespiratory arrest.

Dermatologic

Phlebitis at infusion site; pruritus; rash; skin irritation, sensitization and burning from topical preparations.

GI

Nausea; vomiting; diarrhea; anorexia.

Hematologic

Transient decreases in hematocrit; thrombocytopenia.

Metabolic

Hyperlipemia possibly caused by vehicle.

Miscellaneous

Anaphylaxis; fever; chills. Topical or vaginal forms may cause similar reactions.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy in children younger than 1 yr not studied sufficiently.

Cardiac effects

Have occurred, possibly because of too-rapid administration.

Cremophor-type vehicle

Present in IV formulation; may cause electrophoretic abnormalities of lipoprotein; usually reversible.

Patient Information

• With topical therapy, instruct patient to use for full treatment time, even if symptoms improve. Advise patient to notify health care provider if there is no improvement in 2 wk.
• With topical therapy, if condition worsens or if burning, itching or redness occurs, instruct patient to discontinue use and notify health care provider.
• With vaginal therapy, instruct patient to refrain from sexual intercourse or to have partner use condom for protection and to prevent reinfection. Advise patient to apply medication at bedtime.
• Suggest patient use sanitary pad to prevent staining of clothing.
• With vaginal therapy, instruct patient not to discontinue use during menstruation.