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Nystatin and miconazole: pharmacological and clinical evidence regarding interactions with warfarin
Author(s) -
Pemberton MN
Publication year - 2016
Publication title -
oral diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.953
H-Index - 87
eISSN - 1601-0825
pISSN - 1354-523X
DOI - 10.1111/odi.12541
Subject(s) - miconazole , nystatin , warfarin , medicine , drug interaction , adverse effect , antifungal , drug , pharmacology , antifungal drug , dermatology , atrial fibrillation
Objective A retrospective case series published in 2012 concluded that miconazole and nystatin used as topical antifungal drugs appear to interact equally strongly with warfarin. If confirmed, this finding has significant implications for clinical practice. This study evaluates the evidence. Materials and methods Evidence from the pharmacology literature, the medical literature and the ‘yellow card’ adverse drug reaction surveillance reports was analysed regarding possible interactions of nystatin and miconazole with warfarin. Results There is strong evidence to support the derangement of warfarin anticoagulation by miconazole oral gel in all areas of evidence studied. No postulated mechanism of interaction, no additional published reported cases and no supportive data from adverse drug reports were identified which would corroborate the case for a significant interaction between nystatin and warfarin. Conclusion Miconazole and nystatin used as topical antifungal drugs do not interact equally strongly with warfarin. Miconazole oral gel can clearly interact with warfarin to cause derangement of anticoagulation. Nystatin appears unlikely to interact with warfarin.