Metronidazole + Miconazole Nitrate Vag prep

Indications

Metronidazole + Miconazole Nitrate Vag prep is used for: Vaginal candidiasis, Bacterial and trichomonal vaginitis

Adult Dose

Adult: Vag candidiasis: 100 mg every night for 7-14 days.

Child Dose

Renal Dose

Administration

Contra Indications

Hypersensitivity; hepatic impairment (oral gel). Porphyria.

Precautions

For external use only; discontinue if sensitization or irritation occurs. Pregnancy and lactation

Pregnancy-Lactation

Interactions

Metronidazole: Disulfiram-like reaction w/ alcohol. Increased oral anticoagulant effect, blood levels of phenytoin, lithium toxicity, plasma conc of astemizole & terfenadine; blood conc of carbamazepine. Decreased blood levels w/ phenobarb. Risk of CNS-related effects (eg psychotic reactions) w/ disulfiram. Increased blood levels & neurologic effects w/ cimetidine. May increase blood levels & toxicity of fluorouracil; toxicity of cyclosporine. Increased cardiotoxicity w/ amiodarone. Interference w/ blood levels of liver enzymes, glucose (hexokinase method), theophylline & procainamide. Decreased levels w/ phenytoin. Miconazole: Increased risk of bleeding w/ acenocoumarol, anisindione, dicumarol, phenindione, phenprocoumon, warfarin; plasma conc & exposure to oxybutinin. May increase risk of phenytoin, phosphenytoin, cyclosporine, trimetrexate toxicity & cardiotoxicity w/ pimozide. May inhibit metabolism of astemizole, cisapride & terfenadine. Reduced carbamazepine metabolism. Increased or prolonged effects of opioid (fentanyl). May cause hypoglycemia w/ glimepiride. Reduced clearance & increased plasma conc of oxycodone. May increase bioavailability of tolterodine (in patients w/ deficient CYP2D6 activity).

Adverse Effects

Side effects of Metronidazole + Miconazole Nitrate Vag prep : Nausea, vomiting, febrile reactions, rash, drowsiness, diarrhoea, anorexia and flushing, hepatitis. Local irritation and sensitisation, contact dermatitis.

Mechanism of Action

Metronidazole is converted to reduction products that interact w/ DNA to cause destruction of helical DNA structure and strand leading to a protein synthesis inhibition and cell death in susceptible organisms. It is active against most anaerobic protozoa, some gm+ve, gm-ve and facultative anaerobes. Miconazole inhibits ergosterol synthesis thus damaging fungal cell wall membrane and increases its permeability, allowing leakage of nutrients.