Miconazole
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Systematic (IUPAC) name |
(RS)-1-(2-(2,4-Dichlorobenzyloxy)-2-(2,4-dichlorophenyl)ethyl)-1H-imidazole
|
Clinical data |
Trade names |
Desenex, Monistat, Zeasorb-AF |
AHFS/Drugs.com |
monograph |
MedlinePlus |
a601203 |
Pregnancy
category |
- AU: A
- US: C (Risk not ruled out)
- In Australia, it is category A when used topically. In the US, the pregnancy category is C for oral and topical treatment.
|
Legal status |
- AU: S2 (Pharmacy only)
- UK: POM (Prescription only)
- US: OTC
- Schedule 2 in Australia for topical formulations, schedule 3 (Aus) for vaginal use and for oral candidiasis, otherwise schedule 4 in Australia
|
Routes of
administration |
topical, vaginal, sublabial, oral |
Pharmacokinetic data |
Bioavailability |
n/a |
Metabolism |
n/a |
Biological half-life |
n/a |
Excretion |
n/a |
Identifiers |
CAS Number |
22916-47-8 Y |
ATC code |
A01AB09 A07AC01 D01AC02 G01AF04 J02AB01 S02AA13 |
PubChem |
CID: 4189 |
IUPHAR/BPS |
2449 |
DrugBank |
DB01110 Y |
ChemSpider |
4044 Y |
UNII |
7NNO0D7S5M Y |
KEGG |
D00416 Y |
ChEBI |
CHEBI:6923 Y |
ChEMBL |
CHEMBL91 Y |
Chemical data |
Formula |
C18H14Cl4N2O |
Molecular mass |
416.127 g/mol |
SMILES
-
Clc1ccc(c(Cl)c1)C(OCc2ccc(Cl)cc2Cl)Cn3ccnc3
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InChI
-
InChI=1S/C18H14Cl4N2O/c19-13-2-1-12(16(21)7-13)10-25-18(9-24-6-5-23-11-24)15-4-3-14(20)8-17(15)22/h1-8,11,18H,9-10H2 Y
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Key:BYBLEWFAAKGYCD-UHFFFAOYSA-N Y
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(verify) |
Miconazole is an imidazole antifungal agent, developed by Janssen Pharmaceutica, commonly applied topically to the skin or to mucous membranes to cure fungal infections. It works by inhibiting the synthesis of ergosterol, a critical component of fungal cell membranes. It can also be used against certain species of Leishmania protozoa which are a type of unicellular parasites that also contain ergosterol in their cell membranes. In addition to its antifungal and antiparasitic actions, it also has some antibacterial properties. It is marketed in various formulations under various brand names.
Miconazole is also used in Ektachrome film developing in the final rinse of the Kodak E-6 process and similar Fuji CR-56 process, replacing formaldehyde. Fuji Hunt also includes miconazole as a final rinse additive in their formulation of the C-41RA rapid access color negative developing process.
It is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.[1]
Contents
- 1 Medical uses
- 2 Side effects
- 3 Brand names and formulations
- 4 Off-label use
- 5 Pharmacology
- 6 Remyelination
- 7 Physical properties
- 8 See also
- 9 References
- 10 External links
- 10.1 Medical
- 10.2 Photographic
Medical uses
Miconazole is mainly used externally for the treatment of athlete's foot, ringworm, and jock itch. Internal application is used for oral or vaginal thrush (yeast infection). The oral gel may also be used for the lip disorder angular cheilitis.
In the UK, miconazole may be used to treat neonatal oral thrush, while the alternative nystatin is only licensed for patients over the age of one month, but drug interactions are possible.
Side effects
Unlike nystatin, some miconazole is absorbed by the intestinal tract when used orally (and possibly if used vaginally[2]); this may lead to drug interactions.
Interactions are possible with anticoagulants, phenytoin, terbinafine,[citation needed], some newer atypical antipsychotics, ciclosporin, and some statins used to treat hypercholesterolemia.
Brand names and formulations
Vaginal miconazole 20 mg/g - Brazil
Oral treatment: (brands: Daktarin in UK)
- Oral gel 24 mg/ml (20 mg/g)
- Oravig 50 mg once daily buccal tablet:
In 2010, the U.S. Food and Drug Administration approved Oravig (miconazole) buccal tablets once daily for the local treatment of oropharyngeal candidiasis, more commonly known as thrush, in adults and children age 16 and older. Oravig is the only local, oral prescription formulation of miconazole approved for this use in the U.S.[citation needed]
External skin treatment: (brands: Desenex and Zeasorb in US and Canada, Micatin, Monistat-Derm, Daktarin in India, UK, Australia, Belgium and the Philippines, Daktar in Norway, Fungidal in Bangladesh, Decocort in Malaysia)
- Topical cream: 2%
- Combination: hydrocortisone/miconazole cream with 1% and 2%, respectively (Daktacort in UK, Daktodor in Greece)
- Dusting powder: 2% powder with chlorhexidine hydrochloride (mycoDust)
Vaginal treatment: (brands: Miconazex, Monistat, Femizol or Gyno-Daktarin in UK)
- Pessaries: 200 or 100 mg
- Vaginal cream: 2% (7-day treatment), 4% (3-day treatment)
- Combination: 2% cream with either 100 or 200 mg
Off-label use
Miconazole has recently gained some popularity as a hair-growth aid,[3] although little evidence indicates its efficacy. Topical application of ketoconazole, a similar drug, has been shown to increase hair growth.[4] However, oral administration of ketoconazole has also been shown to reduce hair growth in cases of hirsutism.[5]
Pharmacology
In addition to its antifungal actions, miconazole, along with ketoconazole, is known to act as an antagonist of the glucocorticoid receptor.[6]
Remyelination
Miconazole has been shown to promote remyelination of neurons in chronic progressive multiple sclerosis mouse models.[7]
Physical properties
The solubilities of miconazole nitrate powder are 0.03% in water 0.76% in ethanol and up to 4% in acetic acid.[8]
See also
- Antifungal medication
- Castor oil
- Clotrimazole
- Cremophor EL
- Isoconazole
References
- ^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
- ^ British National Formulary '45' March 2003
- ^ "Strange Beauty: Monistat Effectively Increases Hair Growth?". Black Girl With Long Hair. Retrieved 12 April 2012.
- ^ Ju, Jiang; Tsuboi, Ryoji; Kojima, Yuko; Ogawa, Hideoki (2005). "Topical application of ketoconazole stimulates hair growth in C3H/HeN mice". Journal of dermatology 32: 243–247.
- ^ S., Venturoli; O. Marescalchi; F. M. Colombo; S. Macrelli; B. Ravaioli; A. Bagnoli; R. Paradisi; C. Flamigni (April 1999). "A Prospective Randomized Trial Comparing Low Dose Flutamide, Finasteride, Ketoconazole, and Cyproterone Acetate-Estrogen Regimens in the Treatment of Hirsutism". The Journal of Clinical Endocrinology and Metabolism 84 (4): 1304–1310. doi:10.1210/jc.84.4.1304. Retrieved 12 April 2012.
- ^ Duret C, Daujat-Chavanieu M, Pascussi JM, Pichard-Garcia L, Balaguer P, Fabre JM, Vilarem MJ, Maurel P, Gerbal-Chaloin S (2006). "Ketoconazole and miconazole are antagonists of the human glucocorticoid receptor: consequences on the expression and function of the constitutive androstane receptor and the pregnane X receptor". Mol. Pharmacol. 70 (1): 329–39. doi:10.1124/mol.105.022046. PMID 16608920.
- ^ Najm, Fadi J.; Madhavan, Mayur; Zaremba, Anita; Shick, Elizabeth; Karl, Robert T.; Factor, Daniel C.; Miller, Tyler E.; Nevin, Zachary S.; Kantor, Christopher (2015-01-01). "Drug-based modulation of endogenous stem cells promotes functional remyelination in vivo". Nature 522 (7555). doi:10.1038/nature14335.
- ^ United States Patent 5461068
External links
Medical
- Micatin
- Miconazole (National Institutes of Health)
- United States Patent 5461068 Imidazole derivative tincture and method of manufacture
Photographic
- Kodak process E6 Ektachrome (color transparency) processing manual Z-119
- Kodak process E6 Q-LAB processing manual Z-6 (more details than processing manual Z119 above)
Stomatological preparations (A01)
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Caries prophylaxis |
- Dectaflur
- Olaflur
- Sodium fluoride
- Sodium monofluorophosphate
- Stannous fluoride
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Infection and antiseptics |
- Amphotericin B
- Benzoxonium chloride
- Chlorhexidine
- Chlortetracycline
- Clotrimazole
- Domiphen bromide
- Doxycycline
- Eugenol
- Hexetidine
- Hydrogen peroxide
- Mepartricin
- Metronidazole
- Miconazole
- Minocycline
- Natamycin
- Neomycin
- Oxyquinoline
- Polynoxylin
- Sodium perborate
- Tetracycline
- Tibezonium iodide
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Corticosteroids
(Glucocorticoids) |
- Dexamethasone
- Hydrocortisone
- Triamcinolone
|
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Other |
- Amlexanox
- Acetylsalicylic acid
- Becaplermin
- Benzydamine
- Epinephrine/Adrenalone
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Index of the mouth
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Description |
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Disease |
- Congenital
- face and neck
- cleft
- digestive system
- Neoplasms and cancer
- Other
- Symptoms and signs
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Treatment |
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Antidiarrheals, intestinal anti-inflammatory and anti-infective agents (A07)
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Rehydration |
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Intestinal anti-infectives |
- Antibiotics
- Amphotericin B
- Colistin
- Fidaxomicin
- Kanamycin
- Natamycin
- Neomycin
- Nystatin
- Paromomycin
- Polymyxin B
- Rifaximin
- Streptomycin
- Vancomycin
- Sulfonamides
- Phthalylsulfathiazole
- Succinylsulfathiazole
- Sulfaguanidine
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Intestinal adsorbents |
- Charcoal
- Bismuth
- Pectin
- Kaolin
- Crospovidone
- Attapulgite
- Diosmectite
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Antipropulsives (opioids) |
- Opium tincture (laudanum)
- Codeine
- Morphine
- Camphorated opium tincture (paregoric)
- crosses BBB: Diphenoxylate (Diphenoxylate/atropine)
- Difenoxin
- does not cross BBB: Eluxadoline
- Loperamide
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Intestinal anti-inflammatory agents |
- corticosteroids acting locally
- Prednisolone
- Hydrocortisone
- Prednisone
- Betamethasone
- Tixocortol
- Budesonide
- Beclometasone
- antiallergic agents, excluding corticosteroids
- aminosalicylic acid and similar agents
- Sulfasalazine
- Mesalazine
- Olsalazine
- Balsalazide
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Antidiarrheal micro-organisms |
|
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Other antidiarrheals |
- Albumin tannate
- Ceratonia
- Crofelemer
- Octreotide
- Racecadotril
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Index of digestion
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Description |
- Anatomy
- Physiology
- Development
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Disease |
- Congenital
- Neoplasms and cancer
- Inflammatory bowel disease
- Gluten sensitivity
- Other
- Symptoms and signs
- Blood tests
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Treatment |
- Procedures
- Drugs
- anabolic steroids
- antacids
- diarrhoea and infection
- bile and liver
- functional gastrointestinal disorders
- laxatives
- peptic ulcer and reflux
- nausea and vomiting
- other
- Surgery
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Antifungals (D01 and J02)
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Wall/
membrane |
Ergosterol
inhibitors |
Azoles
(lanosterol 14
alpha-demethylase inhibitors) |
Imidazoles |
- Topical: bifonazole‡
- chlormidazole‡
- croconazole‡
- fenticonazole‡
- isoconazole‡
- luliconazole
- neticonazole‡
- omoconazole‡
- butoconazole
- clotrimazole#
- econazole
- ketoconazole
- miconazole#
- oxiconazole
- sertaconazole
- sulconazole
- tioconazole
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Triazoles |
- Topical: fluconazole#, fosfluconazole
- efinaconazole
- terconazole
- Systemic: hexaconazole‡
- isavuconazole
- fluconazole
- itraconazole
- posaconazole
- voriconazole
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Thiazoles |
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Polyene antimycotics
(ergosterol binding) |
- Topical: hamycin‡
- natamycin
- nystatin#
Systemic: amphotericin B#, hamycin‡
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Allylamines
(squalene monooxygenase
inhibitors) |
- Topical: amorolfine‡
- butenafine
- naftifine
- terbinafine
Systemic: terbinafine
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β-glucan synthase
inhibitors |
- echinocandins (anidulafungin
- caspofungin
- micafungin)
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Intracellular |
Pyrimidine analogues/
thymidylate synthase inhibitors |
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Mitotic inhibitors |
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Aminoacyl tRNA synthetase inhibitors |
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Others |
- bromochlorosalicylanilide
- methylrosaniline
- tribromometacresol
- undecylenic acid
- polynoxylin
- chlorophetanol
- chlorphenesin
- ticlatone
- sulbentine
- ethylparaben
- haloprogin
- salicylic acid
- selenium disulfide#
- ciclopirox
- amorolfine‡
- dimazole
- tolnaftate
- tolciclate
- sodium thiosulfate#
- Whitfield's ointment#
- potassium iodide#
- taurolidine
- tea tree oil
- citronella oil
- lemon grass
- orange oil
- patchouli
- lemon myrtle
- PCP: pentamidine
- dapsone
- atovaquone
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- #WHO-EM
- ‡Withdrawn from market
- Clinical trials:
- †Phase III
- §Never to phase III
Index of fungal disease
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Description |
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Disease |
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Treatment |
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Gynecological anti-infectives and antiseptics (G01)
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Antibiotics |
- Candicidin
- Chloramphenicol
- Hachimycin
- Oxytetracycline
- Carfecillin
- Mepartricin
- Clindamycin
- Pentamycin
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Arsenic compounds |
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Quinoline derivatives |
- Diiodohydroxyquinoline
- Clioquinol
- Chlorquinaldol
- Dequalinium
- Broxyquinoline
- Oxyquinoline
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Organic acids |
- Lactic acid
- Acetic acid
- Ascorbic acid
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Sulfonamides |
|
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Antifungals |
Imidazoles |
- Metronidazole
- Clotrimazole
- Miconazole
- Econazole
- Ornidazole
- Isoconazole
- Tioconazole
- Ketoconazole
- Fenticonazole
- Azanidazole
- Propenidazole
- Butoconazole
- Omoconazole
- Oxiconazole
- Flutrimazole
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Triazoles |
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Polyenes |
- Nystatin
- Natamycin
- Amphotericin B
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Other |
- Ciclopirox
- Methylrosaniline
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Other |
- Clodantoin
- Inosine
- Policresulen
- Nifuratel
- Furazolidone
- Povidone-iodine
- Protiofate
- Lactobacillus fermentum
- Copper usnate
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|
Index of reproductive medicine
|
|
Description |
- Anatomy
- Physiology
- Development
- sex determination and differentiation
|
|
Disease |
- Infections
- Congenital
- Neoplasms and cancer
- male
- female
- gonadal
- germ cell
- Other
- Symptoms and signs
|
|
Treatment |
- Procedures
- Drugs
- benign prostatic hypertrophy
- erectile dysfunction and premature ejaculation
- sexual dysfunction
- infection
- hormones
- androgens
- estrogens
- progestogens
- GnRH
- prolactin
- Assisted reproduction
- Birth control
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Drugs used for diseases of the ear (S02)
|
|
Infection |
- Acetic acid
- Aluminium acetotartrate
- Boric acid
- Chloramphenicol
- Chlorhexidine
- Ciprofloxacin
- Clioquinol
- Gentamicin
- Hydrogen peroxide
- Miconazole
- Neomycin
- Nitrofurazone
- Ofloxacin
- Polymyxin B
- Rifamycin
- Tetracycline
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Corticosteroids |
- Betamethasone
- Dexamethasone
- Fluocinolone acetonide
- Hydrocortisone
- Prednisolone
|
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Analgesics and anesthetics |
- Lidocaine
- Cocaine
- Phenazone
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Index of the ear
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|
Description |
- Anatomy
- Physiology
- Development
|
|
Disease |
- Congenital
- Other
- Symptoms and signs
- Tests
|
|
Treatment |
|
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Glucocorticoid signaling
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Receptor
(ligands) |
GR
|
Agonists
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Mixed (SEGRAs)
|
- Dagrocorat
- Fosdagrocorat
- Mapracorat
|
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Antagonists
|
- 3α-Hydroxytibolone
- 3β-Hydroxytibolone
- Aglepristone
- Asoprisnil
- C108297
- C113176
- CORT-108297
- Cyproterone acetate
- Guggulsterone
- Ketoconazole
- Lilopristone
- LLY-2707
- Miconazole
- Mifepristone
- Onapristone
- Org 34850
- Pregnenolone 16α-carbonitrile
- Spironolactone
- Telapristone
- Tibolone
- Toripristone
- Ulipristal acetate
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|
|
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Enzyme |
Modulators
|
- See here instead (modulators of 20,22-desmolase, 17α-hydroxylase/17,20-lyase, 3β-HSD, 11β-HSD, 21-hydroxylase, 11β-hydroxylase, and 18-hydroxylase).
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Others |
Precursors/prohormones
|
- Cholesterol
- 22R-Hydroxycholesterol
- 20α,22R-Dihydroxycholesterol
- Pregnenolone
- Pregnenolone sulfate
- 17-Hydroxypregnenolone
- Progesterone
- 17-Hydroxyprogesterone
- 11-Deoxycorticosterone
|
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Indirect
|
- ACTH (corticotropin)
- CRH
- DHEA
- DHEA sulfate
- Plasma proteins (albumin, transcortin)
- Vasopressin
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See also: Androgenics • Estrogenics • Mineralocorticoids • Progestogenics
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