Imidazole antifungal
ATC code: D01AC02 (Miconazole)
Blocks fungal ergosterol synthesis via 14-alpha-demethylase inhibition. Fungicidal against Candida albicans and other yeasts, dermatophytes. Systemic absorption ≤1% with topical use on intact skin, higher through mucosa.
First line
Nipple candidiasis. Per ABM Protocol 26 2022, topical 2% cream to nipples 4 times daily after feeds for 14 days. Alternative to nystatin, especially when non-albicans Candida is suspected. Treat the infant in parallel with oral nystatin.
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Safe in pregnancy with topical use.
Fully compatible topically. Hale L1. Systemic absorption through skin <1%. Drug of choice for nipple candidiasis.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Miconazole is evaluated for the following indications with varying evidence strength: Nipple candidiasis during lactation (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Miconazole (≥ 1 in 100): Local irritation, pruritus, Burning, Contact dermatitis. See the Safety section for uncommon and serious reactions.
FDA category C. Safe in pregnancy with topical use.
Fully compatible topically. Hale L1. Systemic absorption through skin <1%. Drug of choice for nipple candidiasis.
Miconazole is contraindicated in: Hypersensitivity to imidazoles; Combination with warfarin (increases INR). Full list in the Safety section.