1. Introduction
Clotrimazole, commonly marketed as Canesten, is an antifungal medication used to treat vaginal and vulval thrush (candidiasis) caused by Candida species. It is available in various formulations, including creams, pessaries, and vaginal tablets. Clotrimazole works by disrupting fungal cell membranes, leading to fungal cell death and resolution of symptoms.
2. Indications
- Approved Indications:
- Vaginal thrush (vaginal candidiasis).
- Vulval thrush (vulvitis caused by Candida).
- Mixed infections involving Candida and other dermatophytes.
3. Dosage
- Clotrimazole Vaginal Tablets or Pessaries:
- 500 mg as a single dose (single pessary or tablet).
- 200 mg once daily for 3 days.
- 100 mg once daily for 6 days.
- Clotrimazole Cream (External Use):
- Apply a thin layer to the vulval area 2–3 times daily until symptoms resolve.
4. Administration
- Vaginal Tablets or Pessaries:
- Insert into the vagina using the applicator provided, preferably at bedtime to prevent leakage.
- Ensure hands are clean before and after use.
- Cream:
- Apply externally to the vulva and surrounding areas, avoiding internal application unless directed by a healthcare professional.
5. Forms Available
- Vaginal pessaries: 100 mg, 200 mg, 500 mg.
- Vaginal tablets: 100 mg, 500 mg.
- External cream: 1% (10 mg/g).
6. Side Effects
6.1. Common Side Effects
- Vaginal irritation (burning or itching).
- Redness or discomfort.
6.2. Less Common Side Effects
- Abdominal cramps.
- Mild swelling or discharge.
6.3. Rare but Serious Side Effects
- Severe allergic reactions (e.g., rash, swelling, difficulty breathing).
7. Warnings
- Avoid use during menstruation, as the medication may not be effective.
- Discontinue use if symptoms worsen or severe irritation occurs.
- Sexual intercourse may reduce the effectiveness of the treatment and can irritate the area.
- Inform sexual partners to seek medical advice if they exhibit symptoms of fungal infections.
8. Precautions
- Avoid using tampons, douches, spermicides, or other vaginal products during treatment.
- Use with caution in pregnant women, especially in the first trimester.
- Wash the vulval area gently with water; avoid soaps or perfumed products that may worsen irritation.
9. Interactions
- Drug-Drug Interactions:
- No significant systemic interactions due to minimal absorption of clotrimazole.
- Drug-Food Interactions:
- Not applicable for vaginal or external use.
10. Monitoring Parameters
- Improvement in symptoms such as itching, discharge, and irritation.
- Ensure complete resolution of symptoms; partial relief may indicate incomplete treatment or resistant infection.
11. Use in Children
- Approved for use in girls over 12 years for vaginal thrush under medical supervision.
12. Use in Pregnancy
- Generally considered safe for use during pregnancy.
- Vaginal tablets or pessaries should be inserted without the applicator in pregnant women to minimise risk of cervical trauma.
13. Use in Elderly
- No specific precautions; use as directed for vulvovaginal thrush.
14. Use in Kidney Disease
- Safe for use, as systemic absorption is negligible.
15. Use in Liver Disease
- Safe for use due to minimal systemic absorption.
16. Patient Counselling Points
- Use the medication exactly as prescribed, completing the full course even if symptoms improve.
- Insert pessaries or vaginal tablets at bedtime to reduce leakage.
- Avoid sexual intercourse during treatment, as it may reduce efficacy and irritate the area.
- Wear loose-fitting, breathable cotton underwear to reduce moisture and irritation.
- If symptoms persist beyond 7 days or recur within 2 months, consult a healthcare professional.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Canesten Pessary | Bayer | $10–15 (single 500 mg pessary) |
Canesten Cream | Bayer | $8–12 (20 g, 1%) |
Generic Options | Various | $5–10 (similar formulations) |
18. FAQs (15 Questions)
- What is clotrimazole used for?
It is used to treat vaginal and vulval thrush caused by fungal infections. - How does clotrimazole work?
It kills fungi by disrupting their cell membrane, leading to fungal death. - How long does clotrimazole take to work?
Symptoms usually improve within 1–3 days, but full resolution may take up to 7 days. - Can clotrimazole be used during pregnancy?
Yes, it is generally safe during pregnancy, but consult a doctor before use. - Can I have intercourse while using clotrimazole?
It is advised to avoid intercourse during treatment as it may reduce efficacy and irritate the area. - What should I do if I miss a dose?
Apply the missed dose as soon as you remember, but do not double up. - Can clotrimazole treat bacterial infections?
No, clotrimazole is only effective against fungal infections. - Does clotrimazole cream require a prescription?
Many clotrimazole products, including Canesten, are available over the counter. - Can clotrimazole cause irritation?
Yes, mild irritation or burning may occur but usually resolves quickly. - Can clotrimazole be used for recurrent thrush?
Yes, but recurrent infections may require further evaluation by a doctor. - How should clotrimazole cream be stored?
Store at room temperature, away from light and moisture. - Can clotrimazole pessaries leak?
Yes, minor leakage may occur; using the treatment at bedtime helps minimise this. - Can clotrimazole cream be used externally and internally?
External cream is for the vulva, while vaginal tablets or pessaries are for internal use. - What should I do if symptoms persist after using clotrimazole?
Consult your doctor, as persistent symptoms may indicate a resistant infection or another underlying condition. - How can I prevent thrush?
Wear breathable clothing, avoid excessive moisture, and maintain good hygiene to reduce the risk of thrush.