Hydrocortisone with miconazole

How it works

Hydrocortisone dampens local inflammation through glucocorticoid receptor activation, while miconazole inhibits fungal ergosterol synthesis and also has some activity against Gram-positive bacteria.

Prescribing in practice

• Use short term for the inflammatory phase only, as the steroid can mask and aggravate untreated infection, and continue antifungal treatment until the fungal infection is cleared.
• Topical miconazole can be absorbed enough to potentiate warfarin, so monitor anticoagulation if applied extensively.
• Avoid prolonged use on the face and skin folds because of steroid atrophy risk.

Monitoring

Review after a short course and watch INR in patients on warfarin; switch to a plain antifungal once inflammation settles if treatment continues.

Counselling the patient

• Apply a thin layer to the affected area and continue antifungal use as directed even after itching settles.
• Tell your prescriber if you take warfarin.
• Keep the area clean and dry and avoid sharing towels.

Evidence & guidelines

The interaction between topical miconazole and warfarin is well recognised and reflected in MHRA and SPC safety advice.