Miconazole Oral Gel Enhances Acenocoumarol Anticoagulant Activity: A Report of Three Cases

Abstract

Miconazole oral gel enhances acenocoumarol anticoagulant activity. Although we did not observe major bleeding complications, we suggest the use of other families of antifungal drugs, such as nystatin, to treat oral candidiasis in patients taking acenocoumarol.

Miconazole and nystatin used as topical antifungal drugs interact equally strongly with warfarin

“…Although it was known that miconazole was absorbed from the gut, it was not obvious that miconazole from a topically applied product such as miconazole oral gel, could be absorbed sufficiently to interfere with warfarin activity 5 . However, several reports have alerted of this possibility, usually after 1 or 2 weeks of concomitant drug administration 4–8 . Altered warfarin anticoagulation has been reported following vaginal administration of miconazole for the treatment of candidal vaginal infections 11,12 .…”

“…Medline search disclosed 10 case reports of interactions between oral vitamin K antagonist (VKA) and miconazole oral gel, but none so far between nystatin solution and anticoagulants. In several reported cases, the patients mostly showed no sign of major bleeding 4–8 . In one case, no substantial change in habitual dosages of warfarin was required and the authors recommended that another antifungal drug such as nystatin is preferable to miconazole for the treatment of candidiasis in patients taking warfarin 6 …”

Serotonin syndrome during treatment with low dose of escitalopram associated with miconazole mucoadhesive tablet: a suspected drug interaction

“…Nonetheless, clinical cases have shown that the oral dosage gel formulation still has a systemic diffusion, which is responsible of significant interactions (Pemberton et al, 2004). Occurrences of anticoagulant overdose (antivitamin K) have been related to enzyme inhibition by miconazole (Ortín et al, 1999), and a comparable increase has also been observed with exposure to etoricoxib (Hynninen et al, 2009). This important risk of interactions resulted in discontinuation of miconazole prescriptions by a majority of physicians.…”

Interaktionen kardialer und antiretroviraler Medikation

“…Interaktion zwischen oralen Antikoagulanzien und Rifampicin/Rifabutin. In einer Kasuistik wurde sogar nach topischer Anwendung von Miconazol eine Verstärkung des gerinnungshemmenden Effektes von Acenocoumarol berichtet [34]. Interaktion zwischen oralen Antikoagulanzien und Azol-Antimykotika.…”