Nystatin and miconazole: pharmacological and clinical evidence regarding interactions with warfarin

作者：Pemberton M N^*

来源：Oral Diseases, 2016, 22(8): 761-765.

DOI：10.1111/odi.12541

• antifungal agents
• drug interaction
• Warfarin

ObjectiveA 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 methodsEvidence 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.
ResultsThere 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.
ConclusionMiconazole 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.

• 出版日期2016-11