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INTRODUCTION

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miconazole (topical) (mye-kon-a-zole)

Fungoid, Lotrimin AF, Micatin, Image not available.Micozole, Monistat-Derm, Zeasorb-AF

(miconazole (vaginal) (mye-kon-a-zole)

Monistat-1, Monistat-3, Monistat-7, Vagistat-3

Classification

Therapeutic: antifungals (topical, vaginal)

Pharmacologic: imidazoles

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Indications
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Treatment of a variety of cutaneous fungal infections, including tinea pedis (athlete's foot), tinea cruris (jock itch), tinea corporis (ringworm). Treatment of vulvovaginal candidiasis.

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Action
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Affects the synthesis of the fungal cell wall, allowing leakage of cellular contents. Therapeutic Effects: Decrease in symptoms of fungal infection.

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Adverse Reactions/Side Effects
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Local: burning, itching, local hypersensitivity reactions, redness, stinging.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor symptoms and healing of skin lesions to help document drug effectiveness.

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Interventions
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  • Avoid contact with cutaneous lesions when treating patient.

  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection.

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Patient/Client-Related Instruction
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  • Advise patient to report any increased local sensitivity to this drug (pain, burning, itching, swelling).

  • Instruct patient about proper hygiene; e.g., thoroughly wash and dry the affected area, wear clean socks and ventilated shoes for tinea pedis, and so forth.

  • Advise patient to apply the drug as directed for the full course of treatment, even if feeling better.

  • Inform patient that early relief of cutaneous symptoms may be seen in 2–3 days. Full therapeutic response may take 2 wk for tinea cruris and tinea corporis and 3–4 wk for tinea pedis.

  • Vaginal infections: therapeutic response is usually seen after 1 wk. Therapy should be continued during menstrual period.

  • Advise patient to seek medical help if infections persist or recur after the full treatment. Recurrent fungal infections may be a sign of systemic illness.

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Pharmacokinetics
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Absorption: Absorption through intact skin is minimal.

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Distribution: Distribution after topical administration is primarily local.

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Metabolism and Excretion: Systemic metabolism and excretion not known following local application.

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Half-life: Not applicable.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
topical unknown unknown unknown
intravaginal unknown unknown unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to active ingredients, additives, preservatives, or bases; Some products contain alcohol or bisulfites and should be avoided in patients with known intolerance.

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Use Cautiously in: Nail and scalp infections (may require additional systemic therapy); OB/Lactation: Safety not established.

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Interactions
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Drug-Drug: Not known.

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Route/Dosage
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Topical (Adults and Children >2 yr): Apply twice daily. Treat patients with tinea cruris for 2 wk and patients with tinea pedis or tinea corporis for 4 wk.

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