Fluconazole vs Miconazole Nitrate – Which Is Better For Vulvovaginal Candidosis?

Fluconazole

It is a medication that is used orally and intravenously and is a well-established medicine typically used as a first-line management option for the treatment of C. albicans infections.

Additionally, it is efficient and well tolerated by most patients, including children, seniors,  and people with impaired immunity. It works by stopping the fungi from producing ergosterol, a substance that is an essential component of fungal cell membranes.

The medication was originally patented in 1981 and came into commercial use in 1988. Also, it is on the World Health Organization’s List of Essential Medicines.

Uses

This antifungal is typically used to prevent fungal infections in individuals with a weak immune system as well as to treat specific fungal infections in many different parts of the body, including – the genitals, urinary tract, mouth, throat, brain, lungs, and other organs.

Dosage

Take this antifungal according to your healthcare provider’s orders. However, the usual recommended adult dose is 200 mg to 400 mg once a day, for about 30 days.

The usual recommended dosage for vulvovaginal candidiasis (VVC) is 150 mg as a single oral dose. Vulvovaginal candidiasis refers to vulval and vaginal symptoms caused by a yeast, most usually Candida albicans. Typical symptoms of VVC include vaginal soreness, pruritus, external dysuria, dyspareunia, and abnormal vaginal discharge

It usually starts to work within 24 hours, nevertheless, it may take about 72 hours for the symptoms to improve. If the symptoms don’t go in one week, contact your doctor.

Note – even if you feel better after the first few doses, keep using this antifungal for the full treatment time since the fungi infection may not clear up if you stop taking the complete treatment.

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Side Effects And Precautions

Common side effects may include:

  • stomach pain;
  • headaches;
  • upset stomach;
  • severe rash, especially in people with low immunity;
  • diarrhea;
  • dizziness;
  • changes in the way food tastes;
  • vomiting;

Rare side effects may include:

  • yellowing of the skin or eyes;
  • seizures;
  • dark urine;
  • fainting;
  • heart palpitations;
  • vomiting;
  • severe skin itching;
  • severe rash;
  • skin peeling;
  • light-colored stools;
  • irregular heart rate.

Before using this antifungal, tell your healthcare provider if you have:

  • heart rhythm disorder;
  • kidney disease;
  • cancer;
  • liver disease;
  • HIV or AIDS;
  • if you are allergic to other antifungal medicine (itraconazole, miconazole, ketoconazole, posaconazole, and voriconazole);
  • a personal history of Long QT syndrome, a serious disorder of the heart’s electrical system.

Drug Interactions

This medication may negatively interact with the following drugs – cyclosporine, Glucotrol (triazolam), Dilantin (phenytoin), lovastatin, Sublimaze (fentanyl), Retrovir (zidovudine), tolbutamide, Invirase (saquinavir), midazolam, glipizide, celecoxib, simvastatin, and atorvastatin.

Miconazole Nitrate

This drug is an azole antifungal that works by stopping the growth of fungus which causes the infection. It actually kills fungi, interfering with their cell membranes by stopping the fungi from producing ergosterol, a substance which is essential in the fungal cell membranes.

Uses

It is usually prescribed for treating vaginal yeast infections ((commonly known as vaginal thrush) as well as other fungal infections including oral thrush caused by Candida albicans and those of the oropharynx (the part of the mouth at the back of the mouth).

Moreover, this antifungal is used in the treatment of jock itch or athlete’s foot. Its anti-fungal action is very effective in clearing fungal infections within the scalp, particularly tinea capitis, an infection which is analogous to ringworm.

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Although this medication has some antibacterial action, it is only effective in treating specific topical fungal infections and will not be effectively used for the treatment of bacterial infections.

Dosage

The usual recommended dose for vaginal candidosis depends on the strength of the cream:

  • 10 percent cream: 500 mg inserted into the vagina at bedtime for one night only;
  • 2 percent cream: 100 mg inserted into the vagina at bedtime for 3 nights in a row;
  • 1 percent cream: 50 mg inserted into the vagina at bedtime for 6 to 14 nights in a row.

Notes

This antifungal is typically inserted into the vagina with an applicator. Nevertheless, if you are pregnant, check with your healthcare provider before using the applicator.

Remember to wash your hands carefully after using the medicine, as this will help to prevent the fungal infection from spreading to other parts of the body.

Do not use tampons during the treatment or for one week following the treatment. In addition, do not use vaginal spermicides or douches while using this antifungal. Continue the treatment with this medication even if you are menstruating.

If your health problems or symptoms become worse or if they do not improve, call your healthcare professional.

Side Effects and Precautions

Rare side effects may include:

  • a cough;
  • body aches or pain;
  • fever or chills;
  • difficulties breathing;
  • loss of voice;
  • ear congestion;
  • nasal congestion;
  • headaches;
  • sneezing;
  • lower back pain;
  • a runny nose;
  • pale skin;
  • a sore throat;
  • unusual bleeding or bruising;
  • troubled breathing with exertion.

Rare side effects may include:

  • ulcers or white spots in the mouth;
  • unusual tiredness or weakness;
  • painful or difficult urination;
  • pale skin;
  • black, tarry stools;
  • shortness of breath.
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To make sure that this medication is safe for you, tell your healthcare professional if you have:

  • HIV or AIDS;
  • fever (high temperature);
  • type 2 diabetes mellitus;
  • foul-smelling discharge from your vagina;
  • abdominal pain.

Pregnancy

There are no conclusive clinical studies regarding the safe use of this medication for nursing women, therefore, consult your healthcare provider before use. Moreover, it is unknown how this antifungal may affect the unborn baby, hence, consult your healthcare professional before using this drug if you are pregnant or plan to get pregnant.

Alcohol

This antifungal does not affect your reaction time and does not interact with alcohol.

Drug Interactions

It may negatively interact with a number of other medications, including:

  • ergot medicine, such as – ergotamine, dihydroergotamine, methylergonovine, and ergonovine;
  • flomax;
  • a blood thinner, such as – warfarin, Jantoven, Coumadin;
  • insulin or oral diabetes medicine;
  • benadryl;
  • phenytoin (an anti-seizure medication);

Fluconazole vs Miconazole Nitrate – Which Is Better For Vulvovaginal Candidosis?

According to a 2015 study that was conducted at the Department of Obstetrics and Gynecology, Shenzhen, China, two doses of an oral fluconazole 150 mg regimen were as efficient as two doses of miconazole nitrate vaginal suppository 1,200 mg in the treatment of patients with vulvovaginal candidosis.

References

https://jamanetwork.com/journals/jama/fullarticle/2480487
https://www.hindawi.com/journals/cri/2013/673150/
https://www.omicsonline.org/stability-study-of

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