Vaginal treatment of female urogenital trichomonas infection, prevention and local therapy of candidiasis.

Metronidazole is converted into active reduction products that interact with DNA, disrupting its helical structure and strands. This results in inhibition of protein synthesis and eventual cell death in susceptible organisms. It is active against most anaerobic protozoa, and some gram-positive, gram-negative, and facultative anaerobic bacteria.

Miconazole works by inhibiting ergosterol synthesis, which damages the fungal cell membrane. This increases membrane permeability, causing leakage of essential nutrients and leading to fungal cell death.

In trichomoniasis, concurrently with oral metronidazole treatment and 1 vaginal tablet should be inserted high up into the vagina once a day (preferably before going to bed at night) for 10 days. Long-term recovery may be expected only is response to the simultaneous oral treatment of both partners.

In candidiasis or other fungal infections, 1 vaginal tablet has to be inserted high up into the vagina for 10 days. The vaginal tablet should be slightly moistened before application.

Metronidazole: Alcohol may cause a disulfiram-like reaction. It may increase the effect of oral anticoagulants, blood levels of phenytoin, lithium toxicity, and plasma concentrations of astemizole and terfenadine. It may alter carbamazepine levels. Phenobarbital may reduce its blood levels. Risk of CNS effects (e.g., psychotic reactions) increases with disulfiram. Cimetidine may increase blood levels and neurological effects. It may increase toxicity of fluorouracil and cyclosporine. Amiodarone may increase cardiotoxicity. It may interfere with liver enzyme tests, glucose estimation, theophylline, and procainamide levels. Phenytoin may reduce its levels.

Miconazole: It increases bleeding risk with oral anticoagulants (acenocoumarol, warfarin, etc.). It may increase plasma levels and toxicity of phenytoin, cyclosporine, and trimetrexate. It may increase cardiotoxicity with pimozide. It inhibits metabolism of astemizole, cisapride, and terfenadine. It reduces carbamazepine metabolism. It may increase effects of opioids (fentanyl). It may cause hypoglycemia with glimepiride. It increases oxycodone levels and may increase tolterodine bioavailability.

Hypersensitivity; hepatic impairment (oral gel); porphyria.

Nausea, vomiting, fever reactions, rash, drowsiness, diarrhea, anorexia, flushing, hepatitis. Local irritation, sensitization, contact dermatitis.

Animal studies show either no risk or potential risk to the fetus, and adequate controlled studies in pregnant women are limited. Use may be considered if benefits outweigh risks.

For external use only. Discontinue if irritation or hypersensitivity occurs. Use with caution during pregnancy and lactation.

Drugs used in vaginal and vulval conditions.