Clotrimazole (Vulvovaginal Candidiasis)

How it works

It inhibits fungal ergosterol synthesis, disrupting the cell membrane of Candida species and producing a fungistatic to fungicidal effect locally within the vagina.

Prescribing in practice

• The pessary or vaginal cream base can damage latex condoms and diaphragms, so warn that barrier contraception may fail during use.
• Intravaginal clotrimazole is suitable in pregnancy for confirmed thrush, though an applicator should be used with care; oral azoles are avoided in pregnancy.
• Investigate or seek review for recurrent, atypical or treatment-failing symptoms rather than repeated empirical courses.

Monitoring

No laboratory monitoring is required; review symptom resolution and consider a swab if treatment fails or symptoms recur.

Counselling the patient

• Insert the pessary high into the vagina, ideally at night.
• Do not rely on latex condoms or diaphragms during and for a few days after treatment.
• Some accompanying vulval cream may be needed for external itching.

Evidence & guidelines

Intravaginal clotrimazole is a well-established, effective treatment for uncomplicated vulvovaginal candidiasis and is the preferred topical option in pregnancy.