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Antifungal (Azole) — Topical/Vaginal Pregnancy: Safe in pregnancy — topical clotrimazole pessary (not oral azoles)

Clotrimazole (Vulvovaginal Candidiasis)

Brand names: Canesten, Canesten Combi

Adult dose

Dose: Pessary: 500 mg single dose vaginally (stat), or 200 mg vaginally once nightly for 3 nights, or 100 mg once nightly for 6 nights. External cream: 1% clotrimazole BD–TDS for 1–2 weeks to vulva
Route: Vaginal pessary or intravaginal cream + topical external cream
Frequency: Single dose (500 mg) or multi-night course
Max: 500 mg single pessary or 200 mg × 3 nights
Canesten Combi: 500 mg pessary + 2% external cream combined pack (convenient). Recurrent VVC (≥4 episodes/year): induction then 150 mg fluconazole oral weekly for 6 months (or clotrimazole 500 mg pessary weekly). Clotrimazole preferred in pregnancy (oral fluconazole — see contraindications).

Paediatric dose

Route: N/A
Frequency: N/A
Max: N/A
Not applicable in obstetric/gynaecological indication

Dose adjustments

Renal

No dose adjustment required (topical/local action)

Hepatic

No dose adjustment required (topical/local action)

Clinical pearls

  • VVC (thrush) first-line treatment — clotrimazole pessary or oral fluconazole 150 mg stat (equally effective)
  • Oral fluconazole contraindicated in pregnancy — use clotrimazole pessary only (topical safe throughout pregnancy)
  • BASHH: first-line for uncomplicated VVC is single-dose clotrimazole 500 mg pessary or fluconazole 150 mg oral
  • Latex warning: all oil-based vaginal treatments (creams, pessaries) weaken latex condoms and diaphragms — counsel patients
  • Recurrent VVC: rule out diabetes, immunosuppression, antibiotics as triggers before commencing suppressive therapy

Contraindications

  • Latex condom or diaphragm use (clotrimazole damages latex — avoid intercourse or use non-latex contraception during treatment)
  • Known hypersensitivity

Side effects

  • Local vaginal irritation or burning (transient)
  • Vulval erythema
  • Mild abdominal cramps (rare)

Interactions

  • Latex contraceptives — damages latex (use non-latex or abstain)

Monitoring

  • Symptom resolution at 1 week
  • Recurrence assessment
  • Underlying conditions if recurrent (e.g., diabetes, HIV)

Reference: BNFc; BASHH VVC Guideline 2019; NICE CKS Thrush (Vaginal); BNF. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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