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Topical azole antifungal Pregnancy: §4.6, verbatim. Pregnancy: 'There is a limited amount of data from the use of clotrimazole in pregnant women. Animal studies with clotrimazole have shown reproductive toxicity at high oral doses (see section 5.3). At the low systemic exposures of clotrimazole following topical treatment, harmful effects with respect to reproductive toxicity are not predicted. Clotrimazole can be used during pregnancy but only under the supervision of a physician or midwife.' Lactation: 'There are no data on the excretion of clotrimazole into human milk. However, systemic absorption is minimal after administration and is unlikely to lead to systemic effects. Clotrimazole may be used during lactation.' Fertility: 'No human studies of the effects of clotrimazole on fertility have been performed; however, animal studies have not demonstrated any effects of the drug on fertility.'

Clotrimazole 1% Cream / Solution

Brand names: Canesten (1% cream, 1% solution, powder spray)

Clotrimazole cream and solution are topical imidazole antifungals applied to the skin to treat dermatophyte infections (such as tinea/ringworm and athlete's foot), cutaneous candidiasis and pityriasis versicolor.

Adult dose

Dose: Apply thinly and evenly to the affected area 2–3 times daily and rub in gently; a ½ cm strip of cream is enough for an area about the size of the hand
Route: Topical — cutaneous application to the affected skin (1% w/w cream). §4.2 Method of administration, verbatim: 'The cream should be applied thinly and evenly to the affected area 2 – 3 times daily and rubbed in gently.'
Frequency: 2–3 times daily — §4.2, verbatim: 'applied thinly and evenly to the affected area 2 – 3 times daily'.
§4.2 in full, verbatim: 'Posology There is no separate dosage schedule for the young or elderly. Method of administration The cream should be applied thinly and evenly to the affected area 2 – 3 times daily and rubbed in gently. A strip of cream (½ cm long) is enough to treat an area of about the size of the hand. If the feet are infected, they should be thoroughly washed and dried, especially between the toes, before applying the cream. Treatment should be continued for at least one month for dermatophyte infections, or for at least two weeks for candidal infections.' NO MAXIMUM: the SPC states no ceiling on the amount applied or on the number of applications beyond '2 – 3 times daily', so maxDose is left empty rather than invented. NOT FOR: §4.3, verbatim: 'Do not use the cream to treat nail or scalp infections.' EXCIPIENT AND FIRE WARNINGS (§4.4, verbatim): 'This product contains cetostearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis). The cream also contains benzyl alcohol which may cause allergic reactions and mild local irritation. Instruct patients not to smoke or go near naked flames - risk of severe burns. Fabric (clothing, bedding, dressings etc) that has been in contact with this product burns more easily and is a serious fire hazard. Washing clothing and bedding may reduce product build-up but not totally remove it.' LATEX (§4.5, verbatim): 'Laboratory tests have suggested that, when used together, this product may cause damage to latex contraceptives. Consequently the effectiveness of such contraceptives may be reduced. Patients should be advised to use alternative precautions for at least five days after using this product.'

Paediatric dose

Route: Topical — cutaneous application to the affected skin (1% w/w cream)
Frequency: 2–3 times daily
NOT A WEIGHT-BASED DOSE — dosePerKg is null, so no volume or milligram figure can be calculated. §4.2, verbatim: 'There is no separate dosage schedule for the young or elderly', i.e. the SPC gives children the same application as adults. concentration is null because the product is a 1% w/w cream, not a mg/mL liquid; a numeric mg/mL value would be meaningless here. The SPC states no minimum age and no paediatric restriction in the retrieved sections — verify paediatric use against a children's formulary.

Dose adjustments

Renal

Not stated — no renal-impairment statement appears in any retrieved section (§4.2–4.8). §4.6 (Lactation) notes that 'systemic absorption is minimal after administration and is unlikely to lead to systemic effects', but the SPC draws no dosing conclusion from that for renal impairment.

Hepatic

Not stated — no hepatic-impairment statement appears in any retrieved section (§4.2–4.8).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 — §4.3, verbatim.
  • Nail or scalp infections — §4.3, verbatim: 'Do not use the cream to treat nail or scalp infections.'
  • §4.4 precaution, not an absolute contraindication: the cream contains cetostearyl alcohol, 'which may cause local skin reactions (e.g. contact dermatitis)', and benzyl alcohol, 'which may cause allergic reactions and mild local irritation'.

Side effects

  • §4.8 preamble, verbatim: 'As the listed undesirable effects are based on spontaneous reports, assigning an accurate frequency of occurrence for each is not possible.' No frequency category can therefore be quoted for any of the reactions below.
  • Skin and subcutaneous tissue disorders (§4.8): blisters, contact dermatitis, erythema, paraesthesia, skin exfoliation, pruritus, rash, urticaria, stinging/burning sensation of the skin.
  • General disorders and administration site conditions (§4.8): application site irritation, application site reaction, oedema, pain.
  • Immune system disorders (§4.8): anaphylactic reaction, angioedema, hypersensitivity.
  • Vascular disorders (§4.8): syncope, hypotension.
  • Respiratory, thoracic and mediastinal disorders (§4.8): dyspnoea.

Monitoring

  • Treatment duration against the SPC minimum — §4.2, verbatim: 'Treatment should be continued for at least one month for dermatophyte infections, or for at least two weeks for candidal infections.'
  • Local tolerance at the application site — §4.4 flags cetostearyl alcohol (contact dermatitis) and benzyl alcohol (allergic reactions, mild local irritation); §4.8 lists application site irritation, contact dermatitis, blisters and skin exfoliation.
  • Contraceptive cover if the cream is used near latex devices — §4.5: 'Patients should be advised to use alternative precautions for at least five days after using this product.'
  • Fire-risk counselling and fabric contamination — §4.4: patients must be instructed 'not to smoke or go near naked flames' and told that contaminated clothing and bedding 'burns more easily and is a serious fire hazard'.
  • No laboratory monitoring is specified in any retrieved section of the SPC.

Clinical monograph

How it works

Clotrimazole inhibits fungal cytochrome P450-dependent 14-alpha-demethylase, impairing ergosterol synthesis and disrupting the integrity and function of the fungal cell membrane.

Prescribing in practice

  • Continue treatment for the full recommended period and for a time after the rash clears to prevent relapse, as stopping early is a common cause of treatment failure.
  • It is for external use only and should be kept away from the eyes; the solution suits hairy or large areas while the cream suits localised lesions.
  • Clotrimazole can damage latex condoms and diaphragms, reducing their reliability.

Monitoring

No routine monitoring is needed; reassess if the rash has not improved after an adequate course or recurs.

Counselling the patient

  • Apply to the affected area and a margin of surrounding skin as directed, and keep using it for the full course even once the skin looks better.
  • Avoid contact with the eyes and stop if marked irritation or a rash develops.
  • Be aware it may weaken latex contraceptives.

Evidence & guidelines

Topical imidazoles such as clotrimazole are established first-line treatment for uncomplicated superficial fungal skin infections in UK practice.

Reference: NICE CKS Fungal Skin Infection; BAD Dermatophyte Infection Guidelines; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways