Miconazole

A potential interaction between oral miconazole and oral hypoglycemic agents leading to severe hypoglycemia has been reported. Whether this interaction also occurs with the intravenous, topical or vaginal preparations of miconazole is not known.

Miconazole: Severe hypoglycemia can occur when glimepiride and oral miconazole are used concomitantly. 7.2 Miconazole A potential interaction between oral miconazole and sulfonylureas leading to severe hypoglycemia has been reported. Whether this interaction also occurs with other dosage forms of miconazole is not known.

A potential interaction between oral miconazole and oral hypoglycemic agents leading to severe hypoglycemia has been reported. Whether this interaction also occurs with the intravenous, topical, or vaginal preparations of miconazole is not known.

A potential interaction between oral miconazole and oral hypoglycemic agents leading to severe hypoglycemia has been reported. Whether this interaction also occurs with the intravenous, topical, or vaginal preparations of miconazole is not known.

A potential interaction between oral miconazole and oral hypoglycemic agents leading to severe hypoglycemia has been reported. Whether this interaction also occurs with the intravenous, topical, or vaginal preparations of miconazole is not known.

( 7.4 ) Miconazole: Severe hypoglycemia can occur when pioglitazone and glimepiride tablets and oral miconazole are used concomitantly. 7.5 Miconazole Glimepiride A potential interaction between oral miconazole and sulfonylureas leading to severe hypoglycemia has been reported. Whether this interaction also occurs with other dosage forms of miconazole is not known.

Potent CYP3A4 inhibitor that increases tolterodine plasma concentrations. Dose reduction to 1 mg twice daily recommended.

CYP2C9 inhibitor that increases warfarin effect and INR; requires close INR monitoring

CYP2C9 inhibitor that increases warfarin effect and INR; requires closer INR monitoring.

Imidazoles may induce fungal resistance to amphotericin B. Combination therapy should be administered with caution, especially in immunocompromised patients.

In vitro and in vivo animal studies suggest imidazoles may induce fungal resistance to amphotericin B. Combination therapy should be administered with caution, especially in immunocompromised patients.

Potential interaction with ergot alkaloids metabolized through CYP2C9 and CYP3A4 cannot be ruled out due to miconazole's inhibition of these enzymes.

May increase phenytoin serum levels; monitoring of phenytoin levels recommended.

Potentially potentiates hypoglycemic action of glyburide; monitor for hypoglycemia.

CYP3A4 inhibitor may alter oxybutynin pharmacokinetic parameters (Cmax and AUC). Caution should be used when co-administered.

Antimycotic agent and CYP3A4 inhibitor that may alter oxybutynin mean pharmacokinetic parameters (Cmax and AUC). Caution should be used when co-administered.

Potential interaction with phenytoin metabolized through CYP2C9 and CYP3A4 cannot be ruled out due to miconazole's inhibition of these enzymes.

May increase phenytoin serum levels; monitoring of phenytoin levels recommended.

CYP2C9 inhibitor that decreases torsemide clearance and increases plasma concentrations; monitor diuretic effect and blood pressure.

Co-administration of vaginal miconazole nitrate and etonogestrel and ethinyl estradiol vaginal ring increases the serum concentrations of etonogestrel and ethinyl estradiol by up to 40% [see Clinical Pharmacology (12.3) ] .

Co-administration of vaginal miconazole nitrate and Etonogestrel and ethinyl estradiol vaginal ring increases the serum concentrations of etonogestrel and ethinyl estradiol by up to 40% [see Clinical Pharmacology ( 12.3 )].

Women who take a warfarin anticoagulant and use a miconazole intravaginal cream or suppository may be at risk for developing an increased prothrombin time, international normalized ratio (INR), and bleeding.

7.3 Use of Vaginal Products with ANNOVERA In a drug-drug interaction study with ANNOVERA and the concurrent use of three different formulations of vaginal miconazole, the use of water-based vaginal miconazole cream resulted in no change in exposure to EE or SA from the vaginal system. However, the use of either the 1- day or the 3-day oil-based miconazole suppository was associated with an overall increase in exposure up to 67% for EE and 32% for SA.

7 DRUG INTERACTIONS Voriconazole is metabolized by cytochrome P450 isoenzymes, CYP2C19, CYP2C9, and CYP3A4. Therefore, inhibitors or inducers of these isoenzymes may increase or decrease voriconazole plasma concentrations, respectively. Voriconazole is a strong inhibitor of CYP3A4, and also inhibits CYP2C19 and CYP2C9.