Coumadin and Miconazole vaginal

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Using warfarin together with miconazole topical has led to bleeding complications, possibly due to increased blood levels of warfarin. Following use of miconazole topical, some of the medication may be absorbed into the bloodstream and cause problems with other medications. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring of your INR to safely use both medications. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR CLOSELY: Systemically or even topically administered miconazole may increase the plasma concentrations and hypoprothrombinemic effect of warfarin. The proposed mechanism is miconazole inhibition of CYP450 2C9, the isoenzyme responsible for the metabolic clearance of the more active S(-) enantiomer of warfarin. There have been case reports of patients stabilized on warfarin who developed significantly increased prothrombin time (PT) or INR, bruising, and/or bleeding complications, including some with fatal outcomes, following the addition of miconazole. The interaction has also been reported with other oral anticoagulants and reportedly may occur up to 2 weeks after initiation of miconazole. Although the interaction is most likely to occur with systemic miconazole, it has been reported occasionally with oral gel and intravaginal formulations. In one case, a 52-year-old woman taking warfarin experienced hemorrhage of the right kidney after 12 days of using vaginal miconazole. Her PT and partial thromboplastin time were elevated upon hospitalization but returned to normal after discontinuation of miconazole use. There is also a reported case of an 80-year-old man stabilized on warfarin who developed a marked increase in his INR following application of a miconazole cream to his groin area for 2 weeks. Another 80-year-old man had a cerebral vascular accident following application of miconazole, although causality could not be established due to multiple medical problems and concurrent medications. A handful of cases involved oral miconazole gel, generally when it was applied to inflamed or compromised oral mucosa or when substantial amounts were swallowed following application, resulting in complications including epistaxis, spontaneous bruising, hematoma, hematuria, melena, and hypotension.

MANAGEMENT: Patients receiving warfarin or other oral anticoagulants should be closely monitored during concomitant therapy with miconazole. The INR should be checked frequently and anticoagulant dosage adjusted accordingly, particularly following initiation or discontinuation of miconazole therapy in patients who are stabilized on their anticoagulant regimen. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools. Some authorities consider the use of oral miconazole with warfarin to be contraindicated. Although vaginally administered miconazole is generally less than 2% absorbed in healthy women of childbearing age, increased absorption may occur in the presence of atrophic vaginal epithelium. Therefore, the same precaution is applicable when vaginal formulations of miconazole is prescribed to women receiving oral anticoagulant therapy.

Coumadin

Generic Name: warfarin

Brand name: Coumadin, Jantoven

Synonyms: n.a.

What is Coumadin?

Miconazole vaginal

Generic Name: miconazole topical

Brand name: Azolen, Baza Antifungal, Critic-Aid Clear AF, Cruex Prescription Strength, DermaFungal, Dermagran AF, Desenex Foot, Desenex Jock Itch, Fungoid, Lotrimin AF, Micaderm, Micatin, Micro-Guard, Mitrazol, NuZole, Ony-Clear, Remedy, Secura Antifungal, Soothe & Cool Inzo, Tetterine, Triple Paste AF, Zeasorb-AF Drying Gel, Aloe Vesta Antifungal, Antifungal, Azolen Tincture, Carrington Antifungal, Critic-Aid Clear AF, Desenex Spray, Desenex, Fungoid Tincture, Lotrimin AF Deodorant Powder, Lotrimin AF Jock Itch Powder, Lotrimin AF Powder, Miconazole 3, Miconazole 3 Combo Pack, Miconazole 7, Micro Guard, Miranel AF, Podactin, Remedy Antifungal, Secura Antifungal Extra Thick, Soothe & Cool INZO Antifungal, Vagistat-3, Zeasorb-AF, Micon 7, Monistat 3, Monistat 7, Monistat-1 Day or Night, M-Zole 3

Synonyms: Miconazole topical, Miconazole (Topical)

What is Miconazole vaginal?