miconazole

Miconazole is an azole antifungal medication in the imidazole class. It works by inhibiting lanosterol 14α-demethylase, a fungal cytochrome P450 enzyme, which reduces ergosterol synthesis and disrupts the fungal cell membrane, inhibiting growth and allowing the organism to be cleared.

Miconazole is used to treat various fungal infections of the skin and mucous membranes. It is commonly applied topically for dermatophytic infections such as tinea corporis, tinea cruris, and tinea pedis, as well as for candidal skin infections and diaper dermatitis. It is also used for vulvovaginal candidiasis in the form of intravaginal creams, suppositories, or gels, and for oral candidiasis with an oral gel formulation. Formulations include creams, ointments, sprays, and powders for topical use, as well as vaginal preparations and oral preparations in some regions.

Pharmacokinetically, topical miconazole generally has limited systemic absorption, though absorption can occur with certain formulations or extensive application. The drug is a potent inhibitor of some cytochrome P450 enzymes, which can lead to drug interactions with other medications metabolized by those enzymes, such as certain anticoagulants and oral contraceptives.

Common adverse effects are local irritation, burning, or itching at the application site. Rare reactions may include hypersensitivity or dermatitis. It should be used as directed, with caution in broken or inflamed skin, and during pregnancy or lactation under medical advice. Availability ranges from over-the-counter to prescription products depending on the formulation and region. Brand names include Monistat for vaginal products and Daktarin for topical formulations.