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Palliative cancer care - oral problems - Management
What drug interactions can occur with miconazole?

  • Systemic absorption of topical miconazole may occur. Potential drug interactions still need to be considered [ABPI Medicines Compendium, 2006a; BNF 52, 2006]:
    • Miconazole can inhibit the metabolism of drugs metabolized by the cytochrome P450-3A and -2C9 families. This can increase and/or prolong the effects of these drugs [ABPI Medicines Compendium, 2006a].
    • Warfarin. Interaction between miconazole oral gel and warfarin has been reported, resulting in an increase in the international normalized ratio (INR) [Pemberton et al, 2004]:
      • People prescribed warfarin should inform the INR clinic when using miconazole oral gel, especially if the medication is bought over the counter.
    • Tolbutamide and sulphonylureas. The interaction between miconazole and these antidiabetic drugs is established and clinically important, but of uncertain (and probably low) incidence [Baxter, 2006]. The interaction can result in hypoglycaemia:
      • Concurrent use need not be avoided, but it should be monitored and the dosage of the sulphonylurea reduced if necessary. People taking these antidiabetic drugs should be warned of this interaction.
    • The manufacturer of miconazole oral gel advises that CYP3A4 metabolized HMG-CoA reductase inhibitors, such as simvastatin, should not be used during treatment with the topical antifungal [ABPI Medicines Compendium, 2006a].

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