Miconazole buccal gel and risk for systemic bleeding: how certain topical formula can interfere with anticoagulants

Acta Clin Belg. 2015 Apr;70(2):121-3. doi: 10.1179/2295333714Y.0000000089. Epub 2014 Oct 21.


The association of miconazole and oral anticoagulants should be carried out with great caution because of potentially serious side effects. This phenomenon is well known in the case of systemic administration of miconazole, but there is limited awareness that also topical oral administration of miconazole can provoke these effects. In this paper we describe four patients followed at the Cardiology Department of the Ghent University Hospital, who used an oral mucosal miconazole preparation, and who developed an increased international normalized ratio.

Keywords: Anticoagulants,; Interaction,; Miconazoles,; Topical.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Administration, Topical
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Antifungal Agents / administration & dosage*
  • Antifungal Agents / adverse effects
  • Drug Interactions
  • Female
  • Hemorrhage / chemically induced
  • Humans
  • International Normalized Ratio
  • Miconazole / administration & dosage*
  • Miconazole / adverse effects
  • Middle Aged
  • Warfarin / administration & dosage


  • Anticoagulants
  • Antifungal Agents
  • Warfarin
  • Miconazole