Table 20

Miconazole buccal

Miconazole buccal
What is it?Azole anti-fungal
Mechanism of actionDisrupts the fungal cell member by inhibiting ergosterol synthesis
Starting dose2.5 mL four times a day oral gel
Time to effectUncertain17
FormulationOral gel
‘Oral gel should be held in mouth, after food’ British National Formulary (BNF)
IndicationOropharyngeal candidiasis
Common adverse effects‘Skin reactions…dry mouth; nausea; oral disorders; vomiting’16
ContraindicationsPregnancy due to teratogenicity
CautionCYP3A4 inhibitor; ‘Avoid in acute porphyrias’16
LicencingOral gel licenced and available to buy over the counter;
[N.B. muco-adhesive buccal tablet is not yet listed in the BNF; muco-adhesive buccal tablet is not recommended by Scottish Medicines Consortium (SMC)*]
BenefitsOver the counter, simple administration, licensed product
RisksChoking is listed as a side effect in children, adults with compromised swallow may therefore also be at risk of chocking, may not fully clear thrush if oesophageal involvement*
Cost£4.38 for 80g×20 mg/g oromucosal gel
  • *Level of evidence supporting its use: "miconazole muco-adhesive buccal tablets were shown to be non-inferior to another locally acting miconazole preparation in the treatment of oropharyngeal candidiasis in patients with cancer of the head and neck who had received radiotherapy. There are no data comparing miconazole buccal tablets to treatments currently used in practice in NHS Scotland. The manufacturer did not present a sufficiently robust analysis to gain acceptance by Scottish Medicines Consortium (SMC). The licence holder has indicated their intention to resubmit." 21