Warfarin interaction warning for miconazole oral gel

Miconazole oral gel should be prescribed with caution in patients taking warfarin, the MHRA has highlighted.

Adverse events reported in patients on warfarin using miconazole oral gel include increased INR, contusion, and haematuria. | DR P. MARAZZI/SCIENCE PHOTO LIBRARY
Adverse events reported in patients on warfarin using miconazole oral gel include increased INR, contusion, and haematuria. | DR P. MARAZZI/SCIENCE PHOTO LIBRARY

Reports of bleeding events, some fatal, have prompted the MHRA to remind prescribers about the risk of interaction between miconazole oral gel and warfarin.

Patients taking warfarin should be advised not to use miconazole oral gel purchased over the counter (Daktarin Oral Gel Sugar Free 2%). 

GPs planning to prescribe POM miconazole oral gel (Daktarin Oral Gel) for concomitant use with warfarin must ensure patients are closely monitored and the anticoagulant effect carefully titrated. Patients should be advised to stop using miconazole and seek immediate medical attention if they experience signs of over-anticoagulation, such as sudden unexplained bruising, nosebleeds, or blood in urine.

Miconazole oral gel is recommended as first-line treatment for localised or mild oral candida infection in children aged over 4 months and adults. Miconazole is systemically absorbed and inhibits several P450 isozymes, including CYP2C9, which can heighten the anticoagulant effect of warfarin.

Want news like this straight to your inbox?
Sign up for our bulletins

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register
Already registered?
Sign in

MIMS Product Slides

Product overviews prepared by the MIMS team, in a handy slide format.

Click here

Slides are initiated, funded & reviewed by the companies specified.

Register or Subscribe to MIMS

GPs can get MIMS print & online and GPonline for free when they register online – take 2 minutes, and make sure you get your free MIMS access! If you're not a GP, you can subscribe to MIMS for full access.

Register or subscribe

MIMS Dermatology

Read the latest issue online exclusively on MIMS Learning.

Read MIMS Dermatology

MIMS Adviser

Especially created for prescribing influencers.

Request free copy

Mobile apps

MIMS: access the full drug database and quick-reference tables on the go

MIMS Diagnosis and Management: concise information on signs and symptoms, investigations and diseases