New Zealand. In a Prescriber Update article prescribers and pharmacists in New Zealand have been reminded of the potentially serious interaction between miconazole oral gel (Daktarin oral gel) and warfarin leading to clinically significant elevations in INR. Six cases of an interaction between oral miconazole and warfarin resulting in INR increases have been reported in New Zealand. In four of these cases patients presented with haemarthrosis, haematuria, haemoptysis or epistaxis. INR values ranged from 7.5 to 18 and were > 10 in all patients with bleeding symptoms. The article also highlights reports of the interaction in Australia. There has also been one report of an interaction between topical miconazole cream and warfarin in Australia.

Reference:

Medsafe Editorial Team. Miconazole - warfarin interaction reminder. Prescriber Update: Therapeutics Section 24: 12, Jun 2003.