[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Azole antifungals](https://durgical.com/en/pharmacology/classes/azole-antifungals/) › Miconazole [Pharmacology](https://durgical.com/en/pharmacology/) · [Azole antifungals](https://durgical.com/en/pharmacology/classes/azole-antifungals/) # Miconazole Imidazole antifungal used on the skin, in the vagina and on the gums for Candida and tinea. Even vaginal use can raise warfarin's effect. Updated 2026-11-01 - Class: [Azole antifungals](https://durgical.com/en/pharmacology/classes/azole-antifungals/) - Enzyme: Lanosterol 14α-demethylase (CYP51, the fungal ERG11 enzyme) - ATC code: G01AF04 - WHO Model List of Essential Medicines ✂**Lanosterol 14α-demethylase (CYP51, the fungal ERG11 enzyme)**Miconazole ⓘ The figure shows clotrimazole, a closely related imidazole, bound to CYP51 of Acanthamoeba castellanii; miconazole occupies the same site of the sterol demethylase. **Target in 3D:** Lanosterol 14α-demethylase (CYP51, the fungal ERG11 enzyme). PDB structure 6UW2 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/6UW2) · Drag to rotate · pinch to zoom ## Mechanism of action Miconazole, like other imidazoles, inhibits fungal sterol 14α-demethylase, so ergosterol is lacking and the membrane works poorly. It penetrates the outer layer of the skin well and acts locally. - Miconazole blocks the fungal sterol demethylase - Ergosterol falls and the membrane fails - Yeasts and dermatophytes stop growing on skin and mucosa ## Pharmacokinetics **Absorption** Small from skin and vagina, but enough for interactions with warfarin. **Distribution** Readily penetrates the stratum corneum and persists there. ## Indications - Vaginal yeast infection (vaginal cream or inserts). [Vulvovaginal candidiasis →](https://durgical.com/en/conditions/vulvovaginal-candidiasis/) - Tinea corporis, tinea cruris and tinea pedis (topical). [Dermatophytosis (tinea) and onychomycosis →](https://durgical.com/en/conditions/dermatophytosis-and-onychomycosis/) - Cutaneous candidiasis (topical). [Cutaneous and mucocutaneous candidiasis →](https://durgical.com/en/conditions/cutaneous-and-mucocutaneous-candidiasis/) - Oropharyngeal candidiasis (buccal tablet applied to the gum). [Candidiasis: oral, oesophageal and invasive →](https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/) ## Adverse effects ### Common - Vaginal burning, itching or irritation - Irritation or burning of the skin where applied ### Serious (rare, important) - Hives or rash: stop and seek care - Bleeding or bruising in patients on warfarin ## Contraindications - Hypersensitivity to miconazole - Self-treatment of a first vaginal yeast infection that was never diagnosed by a doctor ## Key interactions **Warfarin** Bleeding or bruising may occur, even with vaginal products; the INR is checked. **Latex condoms and diaphragms** Vaginal miconazole can damage them, so they may fail. **Spermicides and tampons** Spermicides may interfere and tampons remove part of the drug; they are avoided during vaginal treatment. ## What is monitored - Symptom response; recurrence of vaginal infection - INR in patients on warfarin ## Administration and safety - Ask about warfarin before any miconazole product, including vaginal and oral gel or buccal forms. - Vaginal inserts or cream at bedtime; use sanitary pads, not tampons, during treatment. - Warn that latex condoms and diaphragms may fail during vaginal treatment. ## Nursing care - Fever, chills, lower abdominal, back or shoulder pain, foul-smelling discharge or a missed period are not caused by yeast infection: they need medical review (STI, ectopic pregnancy). - Recurrent infections deserve a look for diabetes, antibiotics, steroids or HIV. - Teach patients on warfarin to report bruising or bleeding. ## Pregnancy and breastfeeding Pregnant women ask a health professional before using vaginal products; topical imidazoles are considered safe in pregnancy. ## Memory aid «MICONAZOLE MEETS WARFARIN»: a vaginal cream can still push the INR up. ## Test yourself Think of the answer, then tap the question to see it. ## A woman on warfarin buys vaginal miconazole over the counter. What is the risk? Enough miconazole is absorbed to increase warfarin's effect: bleeding or bruising may occur; the INR should be checked. ## Which symptoms suggest that vaginal discharge is not a yeast infection? Fever, chills, lower abdominal pain, foul-smelling discharge or a missed period. ## Why are tampons avoided during vaginal miconazole treatment? They absorb and remove part of the drug from the vagina. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/miconazole/) ## Related drugs - [Clotrimazole](https://durgical.com/en/pharmacology/clotrimazole/) - [Ketoconazole](https://durgical.com/en/pharmacology/ketoconazole/) - [Fluconazole](https://durgical.com/en/pharmacology/fluconazole/) ## Related conditions - [Vulvovaginal candidiasis](https://durgical.com/en/conditions/vulvovaginal-candidiasis/) - [Dermatophytosis (tinea) and onychomycosis](https://durgical.com/en/conditions/dermatophytosis-and-onychomycosis/) - [Cutaneous and mucocutaneous candidiasis](https://durgical.com/en/conditions/cutaneous-and-mucocutaneous-candidiasis/) - [Candidiasis: oral, oesophageal and invasive](https://durgical.com/en/conditions/candidiasis-oral-oesophageal-and-invasive/) [← Back to the class: Azole antifungals](https://durgical.com/en/pharmacology/classes/azole-antifungals/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [DailyMed - MICONAZOLE 1- miconazole nitrate kit](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c34d9917-ee79-4afb-9338-6f18e63b2b09) (DailyMed (U.S. National Library of Medicine), 2026); [Miconazole Vaginal: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a601203.html) (MedlinePlus (U.S. National Library of Medicine), 2023); [Miconazole Topical: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a618061.html) (MedlinePlus (U.S. National Library of Medicine), 2018); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 61 (McGraw Hill, 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/miconazole/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/miconazole/