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Antifungal (Azole) — Topical/Vaginal Pregnancy: eMC 4.6: there are limited data from use in pregnant women; animal studies have shown reproductive toxicity at high oral doses, but at the low systemic exposures following vaginal treatment harmful effects are not predicted. Clotrimazole can be used during pregnancy, but only under the supervision of a physician or midwife, and during pregnancy the vaginal tablet should be inserted WITHOUT using an applicator. Breast-feeding: no data on excretion into human milk, but systemic absorption is minimal and systemic effects are unlikely - clotrimazole may be used during lactation.

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).

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 the applicator provided)
Frequency: At night (single insertion); a second treatment may be carried out if necessary
eMC 4.2 (Clotrimazole 500 mg Vaginal Tablet SPC). Place one 500 mg tablet into the holder of the applicator and insert as high as possible into the vagina at bedtime, best achieved lying back with legs bent up; push the plunger slowly in as far as it will go, then remove and dispose of the applicator carefully out of the reach of children. The tablet needs moisture in the vagina to dissolve completely, otherwise undissolved pieces may crumble out (more likely with vaginal dryness). Do not treat during the menstrual period because of the risk of the tablet being washed out by menstrual flow - treatment should be finished before the onset of menstruation. Do not use tampons, intravaginal douches, spermicides or other vaginal products during treatment, and avoid vaginal intercourse while infection is present and while using this product. May be used again if the candidal infection returns after 7 days; if infection recurs more than twice within six months the patient should consult her physician. Consult a physician if symptoms are not relieved within one week. Not for use in children under 16 years of age. SCOPE LIMIT: this SPC covers the 500 mg vaginal tablet only - the 200 mg for 3 nights, 100 mg for 6 nights and 1% external cream regimens shown on this page are NOT covered by the fetched labelling and must be sourced from their own SPCs. The openFDA record in this bundle is a US topical clotrimazole cream for athlete's foot, jock itch and ringworm (thin layer twice daily), a different indication, and was not used.

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.