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Topical miconazole interaction with warfarin

16th June 2016

MHRA have highlighted the risk of serious bleeding events in patients taking warfarin and using topical miconazole. This includes the creams, ointment, powder or oral gel formulation of miconazole. The potential for a drug interaction between oral miconazole and warfarin is well documented and is understood to be due to miconazole inhibiting the CYP2C9 enzyme involved in the metabolism of warfarin. However, due to a large number of reports of potential drug interactions involving topical miconazole (particularly the oral gel formulation) and warfarin, the MHRA are now reviewing whether further measures are needed to minimise the risks to patients. In the meantime, their advice is to carefully monitor the anticoagulant effect and reduce the dose of warfarin if necessary. As some topical formulations of miconazole are available without prescription, patients taking warfarin should be warned not to use topical miconazole without consulting their doctor.

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