Miconazole buccal
| Miconazole buccal | |
| What is it? | Azole anti-fungal |
| Mechanism of action | Disrupts the fungal cell member by inhibiting ergosterol synthesis |
| Starting dose | 2.5 mL four times a day oral gel |
| Time to effect | Uncertain17 |
| Formulation | Oral gel ‘Oral gel should be held in mouth, after food’ British National Formulary (BNF) |
| Indication | Oropharyngeal candidiasis |
| Common adverse effects | ‘Skin reactions…dry mouth; nausea; oral disorders; vomiting’16 |
| Contraindications | Pregnancy due to teratogenicity |
| Caution | CYP3A4 inhibitor; ‘Avoid in acute porphyrias’16 |
| Licencing | Oral 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)*] |
| Benefits | Over the counter, simple administration, licensed product |
| Risks | Choking 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