Advice for individual statins Simvastatin Do not use miconazole in combination with simvastatin. It makes no specific recommendations for other statins licensed in the UK. Combined use of miconazole and simvastatin is considered ‘off-licence’ prescribing. The SPC for miconazole oral gel contraindicates use with some drugs metabolised by CPY3A4 including simvastatin. Risk of interaction is theoretical, based on case reports of other azole antifungals and statins. Interaction case reportsĪ review of the literature, found no reports describing an interaction between miconazole and any of the statins. Whereas itraconazole and ketoconazole are potent inhibitors of CYP3A4. It is not known how strongly miconazole inhibits CYP450 isoenzymes but it is expected to interact with statins in a similar way to fluconazole, a moderate inhibitor of CYP2C9 and CYP3A4. Extent of metabolism and associated clinical significance of the interaction varies from statin to statin (see advice for individual statins below). Some statins are metabolised, to a greater or lesser extent, by these isoenzymes. It inhibits CYP450 isoenzymes CYP2C9 and CYP3A4, and may increase blood levels of drugs metabolised by these isoenzymes. use of a non-interacting treatment such as nystatin)Īccording to the SPC for miconazole oral gel miconazole, an azole antifungal, is absorbed systemically. the clinical significance of any expected interaction.Miconazole may increase blood levels of some statins, increasing risk of adverse effects such as rhabdomyolysis and myopathy.īefore prescribing miconazole to a person taking a statin consider: Complications of using miconazole with statins Therefore, nystatin is not expected to interact with statins and may be a suitable alternative to miconazole. due to clinically significant drug interactions), CKS recommends nystatin oral suspension.Īccording to the summary of product characteristics (SPC) for nystatin absorption from the gastro-intestinal tract is negligible. Adults taking immunosuppressive treatment (excluding those who are HIV positive).Adults and young people who are not immunocompromised.NICE Clinical Knowledge summaries (CKS) recommend miconazole oral gel first-line for: Treating candidiasis (oral thrush) First-line: Miconazole oral gel
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