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Imidazole antifungal

Miconazole

Brand names: Daktarin, Loramyc

Miconazole is an imidazole antifungal used topically, as an oral gel and intravaginally for candidal and dermatophyte infections including oral and vaginal thrush.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It inhibits fungal cytochrome P450-dependent 14-alpha-demethylase, impairing ergosterol synthesis and disrupting the fungal cell membrane.

Prescribing in practice

  • Oral miconazole gel can significantly potentiate warfarin and cause serious bleeding, so concurrent anticoagulation must be monitored closely or alternatives used.
  • It interacts with other CYP-metabolised drugs such as statins and certain sulfonylureas even when applied to mucous membranes.
  • The oral gel carries a choking risk in young infants and should be applied carefully and not to the back of the throat.

Monitoring

Monitor INR closely in patients taking warfarin, and review glycaemic control where relevant interacting drugs are co-prescribed.

Counselling the patient

  • If you take warfarin, tell your clinician before using the oral gel and watch for unusual bruising or bleeding.
  • After meals, hold the oral gel in the mouth for as long as possible before swallowing.
  • Complete the full course even if symptoms improve.

Evidence & guidelines

The MHRA has issued repeated warnings on the miconazole-warfarin interaction, and its antifungal efficacy is well established in current prescribing references.

Reference: MHRA Drug Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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