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.

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