Name: Miconazole (Monistat, OTC=Micatin)
Class: Antifungal (Imidazole)
Mech.: Causes leakage of small molecules/ions across plasma membrane. Also blocks purine uptake. Fungistatic at low conc. Fungicidal at high conc.
Absorption: Good oral, but not admin due to GI irritation. Topical, IV, IT.
Distribution: Good CSF
Toxicity/S.E.s: Topical ® occasional burning and irritation. IV/IT may cause cardiorespiratory failure, thrombophlebitis.
Utility: Topical against common fungal infections of skin and vagina. Better than nystatin for vaginal candidiasis. Esp. useful in mixed skin infections featuring dermatophytes and Candida. Best topical agent for dermatophytoses (even severe). Efficacy = 90%. IV/IT as alternative for systemic Pseudallescheriasis infection (only non-topical use).
Special Features: Safe during pregnancy. Broad spectrum against fungi. Also active against gram+ bacteria.