Miconazole
1-[2-(2,4-dichlorophenyl)-2-[(2,4-dichlorophenyl)methoxy]ethyl]-1H-imidazole
Also known as: Adaxio · Aurimic · Easotic · Malaseb · Surolan · Daktarin · Miconazolum · Miconazole nitrate
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Fungal otitis | 2-12 drops in affected ear | topical | q12-24h | — | 🌍 EU |
| Fungal otitis | 1 ml per ear | topical | q24h | 5 days | 🌍 EU |
| Fungal otitis | 5 drops in affected ear | topical | q12h | — | 🌍 EU |
| Dermatophytosis | Apply a thin layer of cream topically to affected area | topical | bid | Continue for 2 weeks after a clinical cure and negative fungal cultures | 🌍 EU |
| Malassezia dermatitis | Shampoo twice weekly until the clinical signs subside and weekly thereafter or as necessary | topical | twice weekly | Until clinical signs subside, then weekly | 🌍 EU |
| Small localized skin infections | Apply a few drops to affected skin | topical | q12h | — | 🌍 EU |
- Fungal otitis: Surolan formulation
- Fungal otitis: Easotic formulation
- Fungal otitis: Aurimic formulation
- Dermatophytosis: Daktarin formulation
- Malassezia dermatitis: Malaseb, Adaxio formulations
- Small localized skin infections: Aurimic formulation
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Fungal otitis | 2-12 drops in affected ear | topical | q12-24h | — | 🌍 EU |
| Fungal otitis | 1 ml per ear | topical | q24h | 5 days | 🌍 EU |
| Fungal otitis | 5 drops in affected ear | topical | q12h | — | 🌍 EU |
| Dermatophytosis | Apply a thin layer of cream topically to affected area | topical | bid | Continue for 2 weeks after a clinical cure and negative fungal cultures | 🌍 EU |
| Dermatophytosis (generalized) | Shampoo twice weekly | topical | twice weekly | — | 🌍 EU |
| Malassezia dermatitis | Shampoo twice weekly until the clinical signs subside and weekly thereafter or as necessary | topical | twice weekly | Until clinical signs subside, then weekly | 🌍 EU |
| Small localized skin infections | Apply a few drops to affected skin | topical | q12h | — | 🌍 EU |
- Fungal otitis: Surolan formulation
- Fungal otitis: Easotic formulation
- Fungal otitis: Aurimic formulation
- Dermatophytosis: Daktarin formulation
- Dermatophytosis (generalized): Concurrent systemic itraconazole administration is required
- Malassezia dermatitis: Malaseb, Adaxio formulations
- Small localized skin infections: Aurimic formulation
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Miconazole is a broad-spectrum imidazole antifungal agent used primarily for the topical treatment of fungal skin and ear infections, including dermatophytosis (ringworm) and Malassezia dermatitis. It is frequently formulated in combination with other agents (such as chlorhexidine, corticosteroids, or antibiotics) to provide synergistic effects in treating otitis externa and pyoderma.
Clinical Pearl: While highly effective topically, miconazole is rarely used systemically in veterinary medicine due to potential toxicity and the availability of safer systemic alternatives like itraconazole or fluconazole.
Mechanism of action
Miconazole works by inhibiting the cytochrome P450-dependent enzyme 14-alpha-demethylase in fungal cells.
Inhibition of 14-alpha-demethylase → depletion of ergosterol (a vital component of the fungal cell membrane) → accumulation of toxic sterol precursors → increased cell wall permeability → leakage of cellular contents and subsequent fungal cell death.
It has potent activity against Malassezia, Cryptococcus, Candida, and Coccidioides.
Safety & warnings
Contraindications
- Hypersensitivity to miconazole or other azole antifungals
- Ruptured tympanic membrane (for certain otic preparations)
Adverse effects
- Local irritation
- Erythema
- Pruritus (rare)
Precautions
Normal precautions should be observed. Avoid contact with the patient's eyes. For otic preparations, ensure the tympanic membrane is intact before application.
Warning: When treating dermatophytosis in cats with miconazole shampoo, concurrent systemic therapy (e.g., itraconazole) is required for effective clearance.
Monitoring
- Resolution of clinical signs (pruritus, erythema, scaling)
- Fungal cultures (for dermatophytosis)
- Cytology (for Malassezia)
Pharmacokinetics
Half-life
Absorption
Minimal systemic absorption occurs following topical application to intact skin.
Distribution
Remains primarily localized in the stratum corneum of the skin.
Metabolism
Hepatic (if systemically absorbed).
Elimination
Feces and urine (if systemically absorbed).
Overdose
Overdose is highly unlikely with topical administration. Accidental ingestion of shampoos or creams may cause mild gastrointestinal upset (hypersalivation, vomiting, diarrhea). Treatment is symptomatic and supportive.
Available products
Formulations
- 2% shampoo
- 2% cream/powder
- 15.1 mg/ml suspension (with hydrocortisone and gentamicin)
- 23 mg/ml suspension (with prednisolone and polymyxin)
Veterinary
- Adaxio 2% shampoo
- Aurimic 23 mg/ml suspension
- Easotic 15.1 mg/ml ear drops (with hydrocortisone and gentamicin)
- Malaseb 2% shampoo (with chlorhexidine)
- Surolan 23 mg/ml ear drops (with prednisolone and polymyxin)
Human-labeled
- Daktarin 2% cream/powder
Regulatory status
Available as POM-V and P in the UK depending on formulation.
POM-V, P
No regulatory data for: 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store at room temperature (15-25°C). Protect from light and freezing.
Client information
Miconazole is a topical antifungal medication used to treat skin and ear infections.
- Application: Follow your veterinarian's instructions carefully. For shampoos, allow the lather to sit on the skin for 10 minutes before rinsing thoroughly.
- Ear Drops: Do not clean the ears immediately after applying the medication unless instructed by your vet.
- Safety: Prevent your pet from licking the treated area until it is completely dry. Wash your hands thoroughly after applying the medication.
- Ringworm: If treating for ringworm (dermatophytosis), continue treatment for the full duration prescribed, even if the skin looks normal, to prevent recurrence.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.