Clotrimazole (Vulvovaginal Candidiasis)
Brand names: Canesten, Canesten Combi
This is intravaginal clotrimazole, an imidazole antifungal supplied as pessaries, vaginal tablets or internal cream for the treatment of vulvovaginal candidiasis (thrush).
Adult dose
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 (eMC 4.3)
- Not for use in children under 16 years of age (eMC 4.2)
Side effects
- Vulvovaginal burning sensation, pruritus, pain, erythema and discomfort (frequency not known)
- Vaginal exfoliation, vaginal discharge, vaginal haemorrhage
- Application site irritation, oedema and pain
- Rash, urticaria, pruritus; abdominal pain and nausea
- Anaphylactic reaction, angioedema, hypersensitivity; syncope, hypotension, dyspnoea
Interactions
- Latex contraceptives - laboratory tests suggest the product may cause damage to latex contraceptives and reduce their effectiveness; advise alternative precautions for at least five days after use (eMC 4.5)
- Oral tacrolimus (FK-506) - concomitant use might lead to increased tacrolimus plasma levels; monitor closely for signs of overdosage, if necessary by plasma level determination (eMC 4.5)
- Sirolimus - similarly may increase plasma levels; monitor for signs and symptoms of overdosage (eMC 4.5)
Clinical monograph
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.
Reference: BASHH VVC Guideline 2019; NICE CKS Thrush (Vaginal); 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.
- Spinal Anaesthesia Hypotension Management · AAGBI; ASA
- Pre-Eclampsia / Eclampsia in ED · NICE NG133; RCOG Green-top 10A
- Suspected Ectopic Pregnancy · NICE NG126; RCOG Green-top 21
- Polycystic Ovary Syndrome (PCOS) · International PCOS Guideline 2023; NICE CKS
- Pre-eclampsia Management · NICE NG133 2019
- Ectopic Pregnancy · NICE CG154 / RCOG GTG 21