hydrocortisone acetate + miconazole nitrate: clinical use

Prescribing considerations

• Confirm that fungal infection and clinically relevant inflammation are both present; an antifungal without corticosteroid may be more appropriate when inflammation is absent.
• Avoid extensive areas, occlusion and prolonged continuous corticosteroid exposure because systemic absorption and adrenal suppression can occur.
• Consider age-related skin thinning in older adults.
• New blurred vision or another visual disturbance warrants assessment and possible ophthalmology referral.

Contraindications and cautions

• Hypersensitivity to miconazole, other imidazoles, hydrocortisone or an excipient.
• Tuberculous or viral skin infection, or infection caused by Gram-negative bacteria.
• Broken skin, large treatment areas, facial, ocular or mucosal use.
• Cold sores or acne.
• Ringworm, anogenital use or secondary infected dermatoses unless prescribed by a doctor.
• Use in children under 10 years unless prescribed by a doctor.

Monitoring

• Monitor anticoagulant response closely with warfarin or another vitamin K antagonist.
• Review for irritation, hypersensitivity, worsening infection or excessive corticosteroid exposure.
• Assess persistent or recurrent disease and reconsider the diagnosis or need for a corticosteroid component.

Clinical pharmacology

Miconazole is an imidazole antifungal active against dermatophytes, pathogenic yeasts and some Gram-positive bacteria. Hydrocortisone provides local anti-inflammatory and vasoconstrictor activity. Systemic absorption through the skin is limited, although miconazole can inhibit CYP3A4 and CYP2C9 and may increase hydrocortisone exposure.

Formulation and product differences

• The product is a white, homogeneous, odourless cream.
• Benzoic acid may cause local irritation; butylhydroxyanisole may cause contact dermatitis or irritation of the eyes and mucous membranes.
• Cream constituents may damage latex contraceptives and some synthetic fabrics.