Topical / vaginal imidazole antifungal Pregnancy: Can be used during pregnancy but only under supervision of a physician or midwife; during pregnancy insert the vaginal tablet without using an applicator. Breast-feeding: may be used during lactation (systemic absorption minimal after vaginal administration).

Clotrimazole

Brand names: Canesten, Canesten Combi (with hydrocortisone — Canesten HC)

Clotrimazole is a topical imidazole antifungal used to treat dermatophyte infections, candidiasis and pityriasis versicolor of the skin.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One 500 mg vaginal tablet, inserted as a single dose

Route: Vaginal (intravaginal, using applicator provided)

Frequency: At night (single insertion); a second treatment may be carried out if necessary

Insert the 500 mg tablet as high as possible into the vagina at bedtime using the applicator (best lying back with legs bent up). Tablet needs vaginal moisture to dissolve completely. Do not treat during menstruation (risk of wash-out); finish treatment before onset of menstruation. May be used again if candidal infection returns after 7 days; consult physician if infection recurs more than twice within six months. Not for use in children under 16 years of age. NOTE: source is the 500 mg vaginal tablet SPC only — dosing for other clotrimazole formulations (topical cream, etc.) is not covered here; verify separately.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Anaphylactic reaction, angioedema, hypersensitivity (frequency not known)
Vulvovaginal burning sensation, pruritus, pain, erythema, discomfort
Vaginal exfoliation, vaginal discharge, vaginal haemorrhage
Rash, urticaria, pruritus
Abdominal pain, nausea

Interactions

Latex contraceptives — may be damaged; effectiveness reduced (use alternative precautions for at least 5 days after use)
Oral tacrolimus (FK-506) — may increase tacrolimus plasma levels; monitor for overdosage
Sirolimus — similarly may increase plasma levels; monitor for overdosage

Clinical monograph

How it works

It inhibits fungal cytochrome P450-dependent 14-alpha-demethylase, blocking ergosterol synthesis and disrupting the fungal cell membrane.

Prescribing in practice

Continue treatment for the recommended period after lesions clear to prevent relapse, as premature discontinuation is a common cause of treatment failure.
It is for external use only; avoid contact with the eyes and review the diagnosis if there is no improvement after an adequate course.
Where significant inflammation accompanies the infection a combined antifungal-corticosteroid preparation may be considered for short-term use.

Monitoring

Monitoring is clinical, based on resolution of the rash and any local irritation at the application site.

Counselling the patient

Apply to the affected area and surrounding skin and keep using it for the full recommended duration even once it looks better.
Wash and dry the area before application and avoid sharing towels to limit spread.
Local stinging or redness can occur; stop and seek advice if marked irritation develops.

Evidence & guidelines

Topical imidazoles are recommended first-line for localised fungal skin infections in current prescribing references and NICE guidance.

Reference: SmPC Canesten; NICE CKS Candida (vulvovaginal); BAD Fungal Skin Infections Guidance; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways