Miconazole adverse effects

The two azoles most commonly used topically are clotrimazole and miconazole several others are available (see Preparations Available). Both are available over-the-counter and are often used for vulvovaginal candidiasis. Oral clotrimazole troches are available for treatment of oral thrush and are a pleasant-tasting alternative to nystatin. In cream form, both agents are useful for dermatophytic infections, including tinea corporis, tinea pedis, and tinea cruris. Absorption is negligible, and adverse effects are rare. 

Amifostine Amifostine is incompatible with many drugs such as acyclovir sodium, amphotericin, cefoperazone sodium, hydroxyzine hydrochloride, miconazole, minocycline hydrochloride, and prochlorpherazine edisylate.239 Care should be exercised when handling amyl nitrate, since it is highly flammable. Volatile nitrites, such as poppers, are abused and fatal adverse effects are reported.240,241... 

Imidazoles (ketoconazole, miconazole, fenticonazole, clotrimazole, isoconazole, tioconazole) interfere with fungal oxidative enzymes to cause lethal accumulation of hydrogen peroxide they also reduce the formation of ergosterol, an important constituent of the fungal cell wall which thus becomes permeable to intracellular constituents. Lack of selectivity in these actions results in important adverse effects. 

Among the imidazole derivatives, numerous case reports or studies have shown that ketoconazole, fluconazole, and itraconazole can inhibit ciclosporin metabolism and increase blood ciclosporin concentrations (267). Ketoconazole, which is undoubtedly the most potent inhibitor, has been used to reduce the dose, and therefore the cost or adverse effects, of ciclosporin (268-270). There was also a beneficial effect on the rate of rejection or infection. In contrast, interactions with metronidazole and miconazole have only been described in isolated case histories (SEDA-19, 351) (5). 

Topical miconazole is well tolerated. Parenteral administration carries a higher frequency of adverse effects, some probably being caused by Cremophor (polyethoxylated castor oil, the carrier). Adverse effects include fever, chills, pruritus, rash, nausea, vomiting, diarrhea, hjrpona-tremia, cardiac toxicity, phlebitis, hyperhpidemia, and central nervous system disturbances. Hypersensitivity reactions can occur. Tumor-inducing effects have not been reported. 

Miconazole readily penetrates the stratum comeum and persists there for >4 days after application. Less than 1% is absorbed into the blood. Systemic absorption from the vagina is <1.3%. Adverse effects from vaginal application include burning, itching, or irritation in -7% of recipients, and infrequently, pelvic cramps (0.2%), headache, hives, or skin rash. Irritation, burning, and maceration are rare after cutaneous application. Miconazole is considered safe for use during pregnancy. 

Ketoconazole causes a small to moderate rise in serum carbamazepine levels. A marked rise in carbamazepine levels has been seen in two patients taking fluconazole, with toxicity in one. Adverse effects were seen in another patient when carbamazepine was given with miconazole. Carbamazepine may markedly reduce the levels of itraconazole and possibly voriconazole, and is predicted to lower the levels of posaconazole. 

A brief report (32 ) of the use of systemic miconazole in the treatment of human coccidioidomycosis, showed that phlebitis occurred in more than half the patients and was severe enough to stop treatment in several. Dizziness, blurred vision, nausea, and a maculopapular rash were also reported in a few patients. All the adverse effects reversed with cessation of treatment. A second report (33 ) from the United States described thrombocytosis and anaemia in 3 patients with coccidioidomycosis treated with intravenous miconazole. The abnormalities were reproducible on rechallenge with the compound (see also Chapter 25). 

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