Clotrimazole

Brand Names:  Canesten Topical Cream Canesten 6 Vaginal Cream Canesten 1 ComforTab Combi-Pak Canesten 1 Cream Combi-Pak Canesten 3 ComforTab Combi-Pak Canesten 3 Cream Combi-Pak Canesten Spray Clotrimaderm Lotriderm

Drug category: antifungal

Prescription Needed: Only in some cases. Otherwise this drug is available over-the-counter.

What is this drug used for?


Clotrimazole is used to treat vaginal fungal infections (also called yeast infections) ringworm athlete's foot jock itch diaper rash and fungal infections of other skin areas.

Your doctor may prescribe clotrimazole in the form of a lozenge or troche to treat a fungal infection of the mouth or throat - you would place the lozenge in your mouth and suck on it like a candy. Such a dosage form is not readily available but your pharmacist may be able to compound it for you.

Is there any reason why I shouldn't take this drug?

Do not use clotrimazole if you have a history of an allergic reaction to it. 

Tell your doctor specifically if you have or have ever had:
  • a history of alcohol abuse or liver disease (important only if you have been prescribed clotrimazole for oral use)
  • diabetes
  • HIV or AIDS
What about possible side effects?

This medication is usually well tolerated but you should be aware of some potential side effects. The following side effects are more common and are usually mild.
  • Milk skin irritation itching or redness at the area where applied
  • Mild stomach upset ( when using lozenges for oral use)
Less common side effects include:
  • Minor skin peeling blistering or stinging at the area where applied
These side effects may be related to the dose the use of other medications and other factors (e.g. older age other medical conditions).  As well these side effects could be confused with the symptoms of the fungal infection that clotrimazole is treating. These side effects should not last much longer than a few days. If these side effects last longer than a few days or worsen stop using clotrimazole and contact your doctor. Remember clotrimazole may take a few days to start to work to treat your condition.

If you experience any of the following symptoms call your doctor immediately:
  • Serious skin irritation of a large area including blisters hives redness or itching
  • fever
  • foul-smelling discharge (when using the vaginal product)
  • stomach pain  or vomiting (when using the lozenges for oral use)
  • yellowing of the skin or eyes or darkening of the urine (when using the lozenges for oral use)
This is not a complete list of side effects. If you are concerned about these or other unusual symptoms while taking this medication ask your doctor and/or pharmacist for more information and advice.

What if I am taking other drugs?

Always provide your doctor with a list of all other drugs you are taking (including over-the-counter medications and herbal/natural products) as they may interact with and/or may change the safety or effectiveness of either drug.

When using clotrimazole skin and vaginal products drug interactions are unlikely because it is not absorbed by the body. However tell your doctor specifically if you are taking any of the following as he/she may need to make changes or monitor you more closely:
  • antibiotics (e.g. amoxicillin penicillin clarithromycin tetracycline sulfamethoxazole/trimethoprim erythromycin ciprofloxacin)
  • other topical medications applied to the same area of the skin (e.g. hydrocortisone cream betamethasone cream)
  • When using clotrimazole lozenges or troches by mouth tell your doctor specifically if you are taking any of these drugs as he/she may need to make changes or monitor you more closely:
  • other medications to treat high blood pressure or angina (e.g.bisoprolol diltiazem verapamil felodopine isosorbide dinitrate isosorbide mononitrate amlodipine nifedipineclotrimazole taken by mouth may increase your chances of experiencing low blood pressure or having other similar side effects
  • quinidine procainamide amiodarone disopyramide digoxin cyclosporine theophylline simvastatin carbamazepine atorvastatin lovastatin - clotrimazole taken by mouth can increase the amount of these drugs in the blood and increase the chance for side effects
  • medications to help with anxiety mood or sleep (e.g. venlafaxine diazepam triazolam trimipramine alprazolam bromazepam chlordiazepoxide citalopram doxepin escitalopram clonazepam zopiclone mirtazapine) - clotrimazole taken by mouth may increase chances of side effects from these drugs 
  • This is not a complete list of drug interactions. Ask your doctor or pharmacist to review your list of medications.
  • Other Information:
Special instructions:

If you are applying clotrimazole to a skin area (e.g. feet groin) - wash hands well before and after applying apply a thin layer avoid contact with your eyes. In general symptom relief can take between a few days up to 2 weeks and often a full course can be as long as 4 weeks or longer. Once symptoms are gone treatment should be continued for at least 2 weeks or else the infection could return. Do not cover the area with bandages or dressings unless the bandage is breathable.

If you are using a clotrimazole vaginal cream product - wash hands well before use fill applicator (long thin tube with a plunger) with cream insert applicator gently into vagina then gently push the plunger to fully expel cream. If you are using a vaginal tablet product the tablet can be inserted into the vagina using the applicator gently pushing the plunger to expel the tablet. Remain lying down for 30 minutes afterwards so best to use at bedtime. Some of the product may come out of the vagina so there is a risk of staining clothing and bed sheets. Wash hands well after use. Avoid sexual activity during treatment - your partner may experience clotrimazole-related side effects. Clotrimazole may reduce the effectiveness of condoms diaphragms and vaginal spermicides. Do not use tampons during treatment. For symptoms on the outer area of the vagina some clotrimazole combination products come with a small tube of cream for external use which can be applied as a thin layer.

If you are using clotrimazole lozenges or troches by mouth do not swallow the lozenge or troche whole but suck on it like a candy for 15-30 minutes for best effects.

Children: Skin products are safely used as directed in children of any age but products given by mouth should not be used in children less than 3 years old. If you suspect your teenager or child (under age 18) has a vaginal yeast infection you must consult with your doctor first before attempting to self-medicate with an over the counter product.

Seniors: Safely used.

Pregnant women: There is little absorption of clotrimazole from vaginal products or skin products so risks are low. Consult with your doctor about using any medications during the first trimester of pregnancy. 

Women who are nursing: There is little absorption of clotrimazole from vaginal products or skin products so risks are low. However it is not known if this drug passes into breast milk. Talk to your doctor.

People who drive or operate machinery: No known problems. 

Alcohol: Do not drink alcoholic beverages if you are using clotrimazole oral products such as lozenges or troches. 

Overdose: Applying too much will reduce how well the cream works. If you take a high dose of clotrimazole lozenges or troches you may get symptoms of stomach upset. If you experience any unusual reactions call your doctor or 911.  
 
Stopping the drug:  Clotrimazole should be stopped if side effects are suspected. However if clotrimazole is helping your condition continue to take for the prescribed duration otherwise there is a risk that the infection will return. Even if symptoms appear to improve the underlying infection could still be present.
 
If you miss a dose: If you are using an external skin product apply as soon as you remember but if it is close to your next scheduled application time just apply as usual do not apply double the amount. If you are using a vaginal product and you miss your bedtime dose you could insert the missed dose the next morning then have that evening's dose as late as possible. If it is already the afternoon or evening skip the missed dose then resume the regular treatment schedule. If you are using the lozenges or troches for use by mouth take the dose as soon as you remember. If it is close to the time that you would take your next dose then skip the missed one and return to your regular dosing schedule. Never take a double dose. If you are unsure of what to do talk to your doctor or pharmacist.
  
Storage conditions: Clotrimazole products are sensitive to heat so store in a  cool (below 25C) area but do not refrigerate. Store in a dry location away from excess moisture (not in the bathroom); direct light always out of reach of children.

Dietary precautions: None