Pharmacology: Mechanism of Action: Miconazole is an imidazole antifungal agent which interferes with ergosterol synthesis and therefore alters the permeability of the cell membrane of sensitive fungi. It has a broad antifungal spectrum; it is fungicidal to Trichophyton, Epidermophytes, Microsporum, Candida, Cryptococcus and Aspergillus.
Hydrocortisone is a glucocorticoid whose principal pharmacological actions include gluconeogenesis, glycogen deposition, and protein, lipid, and calcium metabolism, together with anti-inflammatory activity. It is effective topically because of its anti-inflammatory, antipruritic and vasoconstrictive actions.
Pharmacokinetics: There is little absorption of miconazole nitrate through skin or mucous membranes when it is applied topically. If taken orally, miconazole is incompletely absorbed from the gastrointestinal tract. It is metabolised in the liver to inactive metabolites. From 10 to 20% of an oral dose is excreted in the urine as metabolites. About 50% of an oral dose may be excreted mainly unchanged in the faeces.
Hydrocortisone is readily absorbed from the gastrointestinal tract and peak blood concentrations are attained in about an hour. It is also absorbed through the skin, particularly under an occlusive dressing or in denuded areas. Hydrocortisone is metabolised in the liver and most body tissues to hydrogenated and degraded forms such as tetrahydrocortisone and tetrahydrocortisol. These are excreted in the urine, mainly conjugated as glucuronides, together with a very small proportion of unchanged hydrocortisone.