Miconazole

Miconazole is an imidazole antifungal agent, developed by Janssen Pharmaceutica, and commonly applied topically (to the skin) or mucus membranes to cure fungal infections. It works by inhibiting the synthesis of ergosterol, a critical component of fungal cell membranes. It can also be used against certain species of Leishmania protozoa (which are a type of unicellular parasite), as these also contain ergosterol in their cell membranes. In addition to its antifungal and antiparasitic actions, it also has some limited antibacterial properties.

Miconazole is also used in Ektachrome film developing (along with surfactants such as Photo-Flo) in the final rinse of the Kodak E-6 process and similar Fuji CR-56 process, replacing formaldehyde. Fuji Hunt also includes Miconazole as a final rinse additive in their formulation of process C-41RA rapid access color negative developing.

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Indications

Miconazole is mainly used externally for the treatment of Athlete's foot, Ringworm and Jock Itch. Internal application is used for oral or vaginal thrush (yeast infection). In addition the oral gel may also be used for the lip disorder angular cheilitis.

It has an advantage over Nystatin in the treatment of neonatal oral thrush in that the latter is only licensed in the UK for those over the age of one month; but note the possibility for drug interactions.

Side effects

Unlike nystatin, some miconazole is absorbed by the intestinal tract when used orally (and possibly if used vaginally^[1]) which may lead to drug interactions.

Of note may be interactions with anticoagulants, phenytoin, terbinafine, some newer atypical antipsychotics, cyclosporin and some statins used to treat hypercholesterolemia.

Formulations

Oral treatment: (brands: Daktarin in UK)

• Oral gel 24mg/ml (20mg/g)

External skin treatment: (brands: Micatin, Monistat-Derm, Daktarin in UK)

• Topical cream: 2%.
• Combination: 2% cream with 1% hydrocortisone (Daktacort in UK)

Vaginal treatment: (brands: Monistat, Femizol or Gyno-Daktariin in UK)

• Pessaries: 200 mg or 100 mg
• Vaginal cream: 2%
• Combination: 2% cream with either 100mg or 200 mg pessaries.

See also

• Antifungal drugs
• Cremophor EL
• Castor oil
• E-6 process
• Ektachrome

References

Photographic

• Kodak process E6 Ektachrome (color transparency) processing manual Z-119

• Kodak process E6 Q-LAB processing manual Z-6 (more details than processing manual Z119 above)