Interaction between topical miconazole and coumarins.

摘要

The potential of miconazole to influence coumarin metabolism, which could result in overanticoagulation, has been well described for the oral and vaginal administration of this antifungal agent [1-6]. However, topical use of miconazole is thought not to be able to cause clinically relevant drug interactions because of limited systemic absorption [7]. We describe a series of cases where loss of coagulation control has occurred with simultaneous use of topical miconazole and a coumarin. These cases were reported to the Netherlands Pharmacovigilance Centre Lareb between April 2001 and July 2010. Lareb is responsible for the collection and analysis of reports of suspected adverse drag reactions in the Netherlands and covers a population of 16.5 million people [8]. hi 2008, the defined daily doses (DDDs) in this population were 64,448,438 for coumarins and 230,070 for topical miconazole [91.