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Over-the-counter (OTC) miconazole oral gel (Daktarin) is now contraindicated in patients taking warfarin.1 The Medicines and Healthcare Products Regulatory Agency (MHRA) has also recommended that clinicians planning to prescribe miconazole oral gel to a patient taking warfarin should closely monitor the anticoagulant effect.
Miconazole inhibits several P450 isozymes, including CYP2C9, which can enhance the anticoagulant effect of warfarin leading to an increase in international normalised ratio (INR) values and subsequent bleeding complications.1 The potential for such an interaction has …