miconazole nitrate: clinical use

Prescribing considerations

• Confirm that the presentation is consistent with athlete’s foot; reconsider the diagnosis if symptoms persist or worsen.
• Selected licences cover athlete’s foot only; spray powder additionally covers prevention.
• Minimise inhalation of spray powder, particularly when applying it to children.
• Consider excipient-related irritation and the potential warfarin or vitamin K antagonist interaction despite limited systemic absorption.

Contraindications and cautions

• Hypersensitivity to miconazole, another imidazole derivative or a formulation excipient.
• Do not use spray powder on broken skin or for nail or hair infections.

Monitoring

• Monitor anticoagulant effect closely if concurrent treatment with warfarin or another vitamin K antagonist cannot be avoided.
• Review persistent, spreading or painful disease, possible bacterial infection, treatment failure, diabetes or immunosuppression.

Clinical pharmacology

Topical imidazole antifungal that alters fungal membrane permeability. Skin absorption is low; absorbed miconazole is highly protein-bound and eliminated mainly in faeces as unchanged substance and metabolites.

Formulation and product differences

• Cream is rubbed into affected skin and contains benzoic acid and butylated hydroxyanisole, which may cause local irritation.
• Spray powder leaves a white residue and contains talc and ethanol. Avoid inhalation, damaged skin, flames and other ignition sources.
• Cream is licensed for treatment; spray powder is licensed for treatment and prevention.

Cream

Route: Cutaneous

Strengths: 2%, 2% w/w