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Warfarin and miconazole oral gel — GPhC CRA MCQ

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HardDrug InteractionsWarfarin and miconazole oral gelGPhC CRA

A 58-year-old man taking warfarin is prescribed miconazole oral gel for oral candidiasis after antibiotics. His INR has been stable at 2.6 and he reports no bleeding. What is the most important interaction to flag?

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Correct answer: B — Miconazole oral gel can markedly increase warfarin effect

Miconazole oral gel can strongly potentiate warfarin and cause serious bleeding despite topical oral use. The interaction should be treated as clinically important and an alternative antifungal or anticoagulation plan should be discussed. The patient needs bleeding-symptom counselling and INR management if exposure occurs.

Reference: BNF; MHRA Drug Safety Update