ENT/Oropharyngeal preparations

Mouth & throat preparations

also: nystatin · miconazole oral gel · chlorhexidine · oral candidiasis · aphthous ulcers

Overview

Drugs for oral candidiasis, mouth ulcers and oral hygiene.

Mechanism

Nystatin (polyene) and miconazole (azole) are topical antifungals for oral candida. Chlorhexidine is an antiseptic mouthwash. Topical corticosteroids / analgesic gels relieve aphthous ulcers; saliva substitutes manage dry mouth.

Indications

Oral candidiasis (thrush)
Aphthous ulceration
Oral hygiene / mucositis

The agents

Nystatin suspensionpolyene antifungal

swish & swallow

Oral candida; not absorbed.

Miconazole oral gelazole antifungal

Oral candida; INTERACTS with warfarin (↑INR) + statins.

Chlorhexidine mouthwashantiseptic

Tooth staining; separate from toothpaste.

Fluconazolesystemic azole

oral

Extensive/refractory or immunocompromised candidiasis.

Adverse effects

Miconazole–warfarin interaction (↑INR/bleeding)serious

High-yield: even topical oral miconazole raises INR.

Chlorhexidine: reversible brown tooth staining, taste disturbancecommon

Local irritationcommon

Cautions & contraindications

Miconazole with warfarin / statinsall

CYP inhibition (bleeding / myopathy).

Interactions

Miconazole inhibits CYP2C9/3A4 → warfarin, statins, sulfonylureas

Monitoring & kinetics

INR if miconazole + warfarin,Response of candidiasis (consider underlying cause: inhaled steroid, diabetes, HIV)

Topical oral; fluconazole oral for systemic effect.

Source: NICE CKS — Candida – oral · BNF — Oropharynx