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Warfarin and miconazole oral gel — GPhC CRA MCQ

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HardCardiovascular TherapeuticsWarfarin and miconazole oral gelGPhC CRA

A patient stabilised on warfarin asks to buy miconazole oral gel for suspected oral thrush. Their latest INR was within range two days ago. What is the most important interaction to flag?

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Correct answer: A — Miconazole can markedly increase INR and bleeding risk

Miconazole, including oral gel, can significantly increase warfarin anticoagulant effect. This can raise the INR and cause serious bleeding even when the INR was previously stable. The patient should be referred for an appropriate alternative and anticoagulation advice.

Reference: BNF