Version July 2025
Note: Use for the treatment of bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis is based on studies utilizing boric acid powder compounded in a gelatin capsule for intravaginal use; commercially available boric acid suppositories have not been evaluated for these indications (Ref).
Bacterial vaginosis, recurrent infection (off-label use):
Note: Treatment is generally not warranted for patients who are asymptomatic (Ref).
Intravaginal: 600 mg once daily at bedtime for 3 to 4 weeks, in combination with or after 7 days of an oral nitroimidazole, followed by suppressive topical antibacterial therapy (Ref).
Vaginal pH balance (OTC labeling): Intravaginal: 1 suppository (600 mg) once daily at bedtime for 7 days; if symptoms persist, may repeat for another week. May be used twice daily if needed.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
There are no adverse reactions listed in the manufacturer's labeling.
Postmarketing:
Dermatologic: Erythema of skin (Prutting 1998), skin irritation (sexual partner) (Prutting 1998)
Genitourinary: Vaginal discharge (watery) (Mittelstaedt 2021; Prutting 1998)
Local: Local irritation (Mittelstaedt 2021; Prutting 1998)
Nervous system: Burning sensation (Prutting 1998)
Other warnings/precautions:
• Appropriate use: Do not take orally; suppositories and compounded capsules are for vaginal use only. Acute toxicity (sometimes fatal) may occur if boric acid is ingested orally (ACOG 2020; Hadrup 2021). Do not use on broken or irritated vaginal mucosa. Discontinue use and contact a health care provider if symptoms persist or worsen or if irritation or burning develop.
Note: Not all available formulations may be represented in Dosage Forms. Additional boric acid suppository products may be available from other manufacturers/suppliers.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Suppository, Vaginal [preservative free]:
Maintain Boric Acid: 600 mg (30 ea) [dye free, fragrance free, perfume free]
No
Suppository (Maintain Boric Acid Vaginal)
600 mg (per each): $0.64
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Intravaginal: For intravaginal use only; do not administer orally. Use at bedtime as there may be watery leakage; if used during the day, use with a panty liner.
Vaginal pH balance: Balance vaginal pH and control odor.
Bacterial vaginosis, recurrent infection; Candidiasis, vulvovaginal, azole-resistant infection; Trichomoniasis, refractory or resistant infection
Baricitinib.
Do not take orally; suppositories and compounded capsules are for vaginal use only. Acute toxicity (sometimes fatal) may occur if boric acid is ingested orally (ACOG 2020; Hadrup 2021).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Progesterone: Antifungal Agents (Vaginal) may decrease therapeutic effects of Progesterone. Risk X: Avoid
Patients should use reliable contraception during treatment with boric acid vaginal suppositories (ACOG 2020).
Outcome data following maternal use of boric acid vaginal suppositories during pregnancy are limited (Acs 2006; Heinonen 1977).
Due to limited human data and lack of animal reproduction studies (Mittelstaedt 2021), vaginal boric acid is only recommended for patients who are not pregnant (ACOG 2020). Agents other than boric acid are recommended for the treatment of bacterial vaginosis or vulvovaginal candidiasis in patients who are pregnant (CDC [Workowski 2021]; IDSA [Pappas 2016]).
Boric acid is present in breast milk (Manakova 2008; Wiley 1907).
Boric acid concentrations in breast milk may vary based on route of exposure (Manakova 2008; Wiley 1907).
Boric acid has weak bacteriostatic and fungistatic properties when used vaginally (Prutting 1998).
Absorption: Oral: ~100%, vaginal: limited (up to 6% in uninfected volunteers) (Mittelstaedt 2021).
Excretion: Renal (Mittelstaedt 2021).
