Nystatin and miconazole: pharmacological and clinical evidence regarding interactions with warfarin

Pemberton, M. N.

doi:10.1111/odi.12541

Cited by 7 publications

(5 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the data collection is insufficiently described, and the authors did not provide any potential mechanism to support the reported effect of nystatin on warfarin's anticoagulant activity . Overall, their findings are unlikely to reflect a representative sampling of the clinical population at risk, and contrast with the findings of the present study as well as a recent literature review and analysis of UK adverse drug reaction surveillance reports finding no evidence of a DDI between nystatin and warfarin .…”

Section: Discussioncontrasting

confidence: 94%

“…Our findings of increased INR values in warfarin users after co‐prescription of miconazole oral gel are in line with multiple case reports , a recent case series and pharmacokinetic data . Overall, current evidence thus supports the presence of a clinically relevant DDI between warfarin and topical miconazole .…”

Section: Discussionsupporting

confidence: 90%

“…Gastrointestinal absorption of miconazole occurs to some extent when administered as an oral gel . Increased values of international normalized ratio (INR) and bleedings after concomitant treatment with warfarin have been described in case reports and in a small case series of six patients . On the other hand, gastrointestinal absorption of nystatin is negligible when taken as an oral solution .…”

mentioning

confidence: 99%

See 2 more Smart Citations

Topical Antimycotics for Oral Candidiasis in Warfarin Users

Hellfritzsch

Pottegård

Pedersen

et al. 2017

Basic Clin Pharma Tox

View full text Add to dashboard Cite

Treatment for oral candidiasis in warfarin users may be complicated by drug-drug interactions (DDIs) between warfarin and topically applied antimycotics. However, current knowledge of these putative DDIs is merely based on case series. We therefore performed a cohort cross-over study with the objective to evaluate the potential DDIs between warfarin and miconazole oral gel or nystatin oral solution. The cohort consisted of individuals using warfarin in the period of 1998-2012 (n ≈ 7400). We collected data on cohort members' measurements of the international normalized ratio (INR) from a clinical database, and obtained information on their use of topically applied miconazole and nystatin from a regional prescription register. Potential DDIs were assessed by comparing INR values before and after initiation of an antimycotic drug. Among 17 warfarin users exposed to miconazole oral gel, the mean INR increased from 2.5 (95% CI: 2.1-2.8) to 3.8 (95% CI: 2.8-4.8) after exposure, corresponding to a mean INR increase of 1.4 (95% CI: 0.3-2.4). Among 30 warfarin users exposed to nystatin oral solution, the mean INR was 2.7 (95% CI: 2.3-3.1) before and 2.5 (95% CI: 2.2-2.9) after exposure. In conclusion, we found evidence supporting a clinically relevant drug-drug interaction between warfarin and miconazole oral gel. In contrast, we did not find any indication of an interaction between warfarin and nystatin oral solution. Nystatin rather than miconazole should be preferred when treating warfarin users for oral candidiasis.

show abstract

Section: Discussioncontrasting

confidence: 94%

Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

See 1 more Smart Citation

Topical Antimycotics for Oral Candidiasis in Warfarin Users

Hellfritzsch

Pottegård

Pedersen

et al. 2017

Basic Clin Pharma Tox

View full text Add to dashboard Cite

show abstract

“…4 Numerous reports of miconazole oral gel and warfarin interactions are succinctly described by Pemberton. 5 Miconazole-warfarin interactions have also been reported with topical use of miconazole on the cutaneous surface and the vaginal mucosa [Table 1]. Devaraj et al have described an alarming rise in international normalized ratio from a range of '2.2 and 3.1' to 21.4 in an 80-year-old man on long-term warfarin, following topical miconazole application for 2 weeks on the groins.…”

Section: Beware Of Miconazole -Warfarin Interactions!mentioning

confidence: 99%

Beware of miconazole – warfarin interactions!

Barve¹

2020

Indian J Dermatol Venereol Leprol

View full text Add to dashboard Cite

“…Instead, Nystatin is considered the first-line medication for treating uncomplicated oral candidiasis [ 1 ]. Each 1 mL of Nystatin oral suspension contains 100,000 International Units (IU) of Nystatin and the following components: sodium carboxymethylcellulose, methyl p-hydroxybenzoate (E218), propyl p-hydroxybenzoate (E216), sodium metabisulphite (E223), sucrose, saccharin sodium, sodium citrate, permaseal aniseed flavor, and purified water [ 22 ]. The recommended dose of Nystatin ranges from 100,000 to 200,000 IU, four times/day for newborns/infants, and 200,000 to 600,000 IU, four times/day for children and adults [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Nystatin oral rinse on oral Candida species and Streptococcus mutans among healthy adults

et al. 2023

View full text Add to dashboard Cite

Objectives To examine the effect of Nystatin oral rinse on oral Candida species and Streptococcus mutans carriage. Materials and methods Twenty healthy adults with oral candidiasis participated in the single-arm clinical trial and received Nystatin oral rinse for 7 days, 4 applications/day, and 600,000 International Units/application. Demographic-socioeconomic-oral-medical conditions were obtained. Salivary and plaque Candida species and Streptococcus mutans were assessed at baseline and 1-week and 3-month follow-ups. Twenty-four salivary cytokines were assessed. Candida albicans isolates underwent Nystatin susceptibility test. Results Half of participants (10/20) were free of salivary C. albicans after using Nystatin rinse. Salivary S. mutans was significantly reduced at 3-month follow-up (p < 0.05). Periodontal status reflected by bleeding-on-probing was significantly improved at 1-week and 3-month follow-ups (p < 0.05). Plaque accumulation was significantly reduced at 1-week follow-up (p < 0.05). Interestingly, the responses to Nystatin oral rinse were not associated with race, gender, age, oral hygiene practice, adherence to Nystatin rinse, or sweet consumption (p > 0.05). No C. albicans isolates were resistant to Nystatin. Furthermore, salivary cytokine eotaxin and fractalkine were significantly reduced at 3-month follow-up among participants who responded to Nystatin rinse (p < 0.05). Conclusions The study results indicate that oral antifungal treatment had an effect on S. mutans salivary carriage. Future clinical trials are warranted to comprehensively assess the impact of antifungal treatment on the oral flora other than S. mutans and Candida. Clinical relevance Due to the potential cariogenic role of oral Candida species, antifungal approaches shed new light on the prevention and management of dental caries from a fungal perspective.

show abstract

Nystatin and miconazole: pharmacological and clinical evidence regarding interactions with warfarin

Abstract: Miconazole and nystatin used as topical antifungal drugs do not interact equally strongly with warfarin. Miconazole oral gel can clearly interact with warfarin to cause derangement of anticoagulation. Nystatin appears unlikely to interact with warfarin.

Cited by 7 publications

References 42 publications

Topical Antimycotics for Oral Candidiasis in Warfarin Users

Topical Antimycotics for Oral Candidiasis in Warfarin Users

Beware of miconazole – warfarin interactions!

Effects of Nystatin oral rinse on oral Candida species and Streptococcus mutans among healthy adults

Contact Info

Product

Resources

About