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Drug vs. Drug

Terconazole vs. miconazole: Differences, similarities, and which is better for you

Gerardo Sison medical writer headshot By | June 2, 2020

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Yeast infections (vulvovaginal candidiasis) are a common problem that impacts women’s health. Women who experience occasional or frequent yeast infections are often prescribed an antifungal medication, such as terconazole or miconazole. These antifungals work in similar ways to help treat infections caused by a yeast known as Candida albicans.

Terconazole and miconazole treat vaginal fungal infections by interrupting the fungal cell membrane. More specifically, they block an enzyme responsible for creating ergosterol, a vital part of the cell membrane’s structure. Without ergosterol, the fungal cell leaks its contents and ultimately dies.

Despite being in the same class of medications, terconazole and miconazole have some differences in usage and formulation. They may also differ in cost and availability.

What are the main differences between terconazole and miconazole?

Terconazole is the generic name for Terazol. It is a triazole antifungal drug that was approved by the FDA in 1987. Unlike miconazole, terconazole can only be obtained with a prescription from a doctor. It is available in a 0.4% and 0.8% vaginal cream as well as an 80 mg vaginal suppository.

Miconazole—also known by its brand name, Monistat—is an imidazole antifungal drug that is available over the counter. It was initially approved in 1974. Monistat comes as a 2% and 4% vaginal cream as well as a 1200 mg, 200 mg, and 100 mg vaginal suppository (Monistat Ovule). Unlike terconazole, miconazole is also available in a single-dose formulation.

Main differences between terconazole and miconazole
Terconazole Miconazole
Drug class Antifungal Antifungal
Brand/generic status Brand and generic version available Brand and generic version available
What is the brand name? Terazol Monistat
What form(s) does the drug come in? Vaginal cream
Vaginal suppository
Vaginal cream
Vaginal suppository
Buccal tablet (for oral candidiasis)
Topical cream (for skin candidiasis)
What is the standard dosage? Vaginal cream: One full applicator once daily at bedtime

Vaginal suppository: One 80 mg suppository once daily at bedtime

Vaginal cream: One full applicator once daily at bedtime

Vaginal suppository: One 1200 mg, 200 mg, or 100 mg suppository once daily at bedtime

How long is the typical treatment? 3 to 7 days 1 day (single-dose) or 3 to 7 days
Who typically uses the medication? Adults 18 years and older Adults, adolescents, and children 12 years and older

Conditions treated by terconazole and miconazole

Terconazole and miconazole are FDA approved to treat vulvovaginal candidiasis, or vaginal yeast infections. Topical miconazole cream is also approved to treat athlete’s foot (tinea pedis), ringworm (tinea corporis), and jock’s itch (tinea cruris). Miconazole skin cream can also be used with zinc oxide for diaper rash caused by yeast. Oral thrush, or candidiasis in the mouth, can be treated with miconazole buccal tablets, which are placed inside the mouth to slowly dissolve.

Condition Terconazole Miconazole
Vaginal yeast infections (vulvovaginal candidiasis) Yes Yes
Athlete’s foot Off-label Yes
Ringworm Off-label Yes
Jock’s itch Off-label Yes
Diaper rash Off-label Yes
Oral thrush Off-label Yes

Is terconazole or miconazole more effective?

Terconazole and miconazole are both effective antifungal agents for vaginal candidiasis. Whether a physician prescribes terconazole or miconazole depends on your medical history and an assessment of the infection.

According to a meta-analysis from Infection and Drug Resistance, terconazole and miconazole have similar effectiveness for treating vaginal yeast infections. The analysis reviewed over 40 randomized clinical trials that also tested the effectiveness of other antifungals, including fluconazole, clotrimazole, butoconazole, and tioconazole. Researchers found that fluconazole, also known as Diflucan, was the preferred drug for vaginal yeast infections.

In a double-blind, randomized, multicenter trial, 900 patients with vaginal yeast infections were treated with terconazole or miconazole cream. While both drugs were shown to be effective with mild side effects, the terconazole cream had a higher cure rate (87.9% for the 0.4% terconazole group, 83.8% for the 0.8% terconazole group, and 81.3% for the 2% miconazole group).

Another review from the journal of Clinical Therapeutics concluded that patients with vaginal yeast infections experienced faster relief with 0.4% terconazole cream than those who were treated with 2% miconazole cream. However, no statistically significant differences were found between treatment with 80 mg terconazole suppositories and treatment with 100 mg miconazole nitrate suppositories.

Seek medical advice from your healthcare provider for the best possible treatment option for your specific case.

Coverage and cost comparison of terconazole vs. miconazole

Terconazole is only available with a prescription from a doctor. Most people can get a 3-day or 7-day prescription for generic terconazole cream. However, the average retail cost of terconazole is well over $50. With a SingleCare terconazole coupon, the cost can be around $20 at participating pharmacies.

Miconazole is widely available as an over-the-counter (OTC) drug. It is usually found as Monistat in a single-dose, 3-day, and 7-day treatment. The average retail cost of miconazole is $18. A SingleCare miconazole coupon can lower the price to around $13, although you would need a prescription from your doctor to take advantage of SingleCare savings for OTC drugs.

  Terconazole Miconazole
Typically covered by insurance? Yes Depends on your insurance plan
Typically covered by Medicare? Yes Depends on your insurance plan
Standard dosage 1 full applicator once daily 1 full applicator once daily
Typical Medicare copay $3–$39 $4–$53
SingleCare cost $20+ $13+

Common side effects of terconazole vs. miconazole

The most common side effects associated with antifungal agents, like terconazole and miconazole, are irritation around the application site. When applied topically, these drugs may cause vaginal burning, itching, or irritation.

Other side effects may include headache, pain, or fever. These effects are usually mild and go away on their own. However, if side effects worsen or persist, consult your healthcare provider.

Serious side effects of terconazole and miconazole primarily involve allergic reactions to the drug or any inactive ingredients in the formulation. Allergic reactions may include severe rash, itching, and irritation.

  Terconazole Miconazole
Side effect Applicable? Frequency Applicable? Frequency
Burning, itching, and irritation around the application site Yes N/A Yes N/A
Headache Yes 26% Yes N/A
Body pain Yes 2.1% Yes N/A
Fever Yes 0.5% Yes N/A

This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Terconazole), DailyMed (Miconazole)

Drug interactions of terconazole vs. miconazole

Since terconazole and miconazole creams are applied topically in and around the vagina, the active drugs are rarely absorbed into the bloodstream. This means that drug interactions are rare. Most cases of drug interactions occur when these antifungal agents are taken orally.

Miconazole buccal tablets (Oravig) may interact with warfarin and increase the risk of bleeding. Vaginal miconazole creams and suppositories may interact with intravaginal contraceptives, such as NuvaRing, which contain ethinyl estradiol. Although the clinical significance is minimal, miconazole can potentially increase ethinyl estradiol levels in the body.

Talk to your doctor about other possible drug interactions with terconazole or miconazole.

Drug Drug Class Terconazole Miconazole
Warfarin Anticoagulants No Yes
Ethinyl estradiol Contraceptives No Yes

*Consult a healthcare professional for other drug interactions.

Warnings of terconazole and miconazole

Those who have a known sensitivity to the ingredients in terconazole or miconazole creams should avoid these agents or use them with caution. Otherwise, these drugs may cause a potentially severe allergic reaction.

Women who are experiencing back pain, abdominal pain, fever, chills, nausea, vomiting, foul-smelling vaginal discharge, or recurrent vaginal discomfort should only use azole antifungals with guidance from a healthcare provider. These symptoms could indicate a more severe condition complicated by other factors, such as a weakened immune system or diabetes.

Those who experience frequent vaginal yeast infections should also consult a healthcare professional before starting antifungal treatment. Frequent yeast infections include those that occur once a month or three times over six months.

Women on intravaginal antifungals should avoid vaginal sex, tampons, douches, spermicides, or other vaginal products during the treatment period.

Frequently asked questions about terconazole vs. miconazole

What is terconazole?

Terconazole is an antifungal agent that treats vulvovaginal candidiasis. It is available as a vaginal cream or suppository. Terconazole comes in a three-day treatment pack called Terazol 3 as well as a seven-day treatment pack called Terazol 7.

What is miconazole?

Miconazole is an antifungal medication available as a topical cream, vaginal cream, vaginal suppository, and buccal tablet. It is primarily used to treat vulvovaginal candidiasis. However, it can also treat fungal infections caused by Candida on the skin and in the mouth.

Are terconazole and miconazole the same?

Terconazole and miconazole are not the same. Terconazole is a triazole antifungal drug that is only available with a prescription. Miconazole is an imidazole antifungal drug that is available with a prescription or over the counter. Miconazole also comes in other formulations and is approved to treat fungal skin and mouth infections.

Is terconazole or miconazole better?

Both terconazole and miconazole are comparable in effectiveness when treating vaginal yearel=”noopener noreferrer nofollow”rel=”noopener noreferrer”>clinical trials have shown better results with terconazole. However, real-world applications will depend on your doctor’s clinical judgment, the severity of the infection, and what, if any, antifungal agent you’ve tried in the past. Many women may prefer miconazole for its convenient single-dose option.

Can I use terconazole or miconazole while pregnant?

During pregnancy, terconazole can be absorbed from the vagina and potentially cause adverse effects in an unborn baby. Therefore, it’s not recommended during the first trimester. Consult a healthcare provider before using terconazole or miconazole while pregnant.

Can I use terconazole or miconazole with alcohol?

Since terconazole and miconazole are usually applied topically, they have a low risk of interacting with alcohol. Still, it’s not generally recommended to drink alcohol while ill. Alcohol may indirectly affect how well the immune system can fight off infections.

What kind of yeast does terconazole treat?

Terconazole is only effective for vaginal infections caused by a species of yeast called Candida. It is not effective for other infections, such as bacterial vaginosis.

What is the strongest medicine for yeast infections?

The strongest medicine for a yeast infection is an antifungal agent belonging to the azole class. The usual treatment of choice is a single dose of Diflucan (fluconazole). OTC antifungals like miconazole are also effective for mild, infrequent yeast infections. For more serious yeast infections, an oral antifungal drug may be necessary.