INN monograph
Miconazole, skin
Antifungal · POM
Source-linked · Updated 03 Aug 2026 · Source: Local active-ingredient clinical extract; RxNorm (NLM RxNav); PubChem; Professional class pharmacology (Antifungal)
Kenya market
Wholesale / list prices where loaded
Risk first
Contraindications
- Hypersensitivity.
- Many systemic azoles contraindicated with certain CYP3A4 substrates (e.g. some statins, quinidine) — check labels.
- Terfenadine/astemizole historical QT combinations.
Precautions
- Hepatotoxicity monitoring for systemic azoles.
- QT prolongation (some azoles).
- Voriconazole: visual disturbances, photosensitivity, skin cancer risk long-term.
- Confirm species for invasive disease.
Point of care
Dosing
Adult
Adult and children: Skin: Apply OD or BD until 10days after lesions have disappeared. Nails: Apply thinly OD covering with non-perforated bandage until new nail growth is established.
Paediatric
See label paediatric section if present; otherwise use paediatric formulary — do not extrapolate adult doses.
Renal
Fluconazole dose-adjust in CKD; amphotericin nephrotoxicity high-alert.
- CrCl 0–120: Confirm renal dosing in product SmPC / primary label.
Hepatic
Monitor LFTs for courses >14 days or higher-risk patients.
Safety
Drug interactions
- Match agent to site and species.
- For tinea, continue topical beyond clearance.
- Invasive fungal disease needs ID/specialist input and source control.
Safety
Adverse effects
- GI upset, rash, raised LFTs.
- Serious: hepatitis, severe skin reactions, arrhythmias, infusion reactions (amphotericin).
Use
Indications
- Therapeutic use is agent- and indication-specific within the class (Antifungal).
- Use according to culture results, national guidelines (Kenya STG/EML where applicable) and the current product SmPC.
- Fungal skin infections.
Pharmacology
Mode of action
Azoles inhibit fungal CYP51 (lanosterol 14α-demethylase), depleting ergosterol and disrupting membrane integrity.
Full mechanism text
Azoles inhibit fungal CYP51 (lanosterol 14α-demethylase), depleting ergosterol and disrupting membrane integrity. Terbinafine inhibits squalene epoxidase. Polyenes bind ergosterol creating membrane pores. Echinocandins inhibit β-glucan synthase (cell wall).
ADME
Pharmacokinetics & PD
| Onset | Days for clinical response (varies) |
|---|---|
| Duration | Days–weeks per indication |
| Route | ORAL / TOPICAL / IV |
| Metabolism | with major interactions. Topicals: minimal systemic |
Full PK/PD text
Fluconazole: excellent bioavailability, renal excretion, CSF penetration. Itraconazole/voriconazole: complex absorption and CYP metabolism with major interactions. Topicals: minimal systemic absorption when intact skin.
Kenya
Brands & prices
| Brand | Company | Pack | KES |
|---|---|---|---|
| No brands linked yet. | |||
Special populations
Pregnancy & lactation
Pregnancy
Systemic azoles often avoided in pregnancy (fluconazole high-dose teratogenicity signal); topical clotrimazole commonly used for VVC.
Lactation
Topicals usually fine; systemic — agent-specific.
Diet
Food & alcohol
- Food
- Food
Trust
Sources & disclaimer
Source: Local active-ingredient clinical extract; RxNorm (NLM RxNav); PubChem; Professional class pharmacology (Antifungal)
Clinical review date not recorded.
Decision support only — not a substitute for clinical judgment, product SmPC, or Kenya STG/EML.