Candidiasis, vulvovaginal:
Children ≥12 years and Adolescents:
Cream: 1%: Intravaginal: Insert 1 applicatorful of 1% vaginal cream once daily (preferably at bedtime) for 7 consecutive days; some patients may require 14 days (Ref). May also apply externally twice daily for up to 7 days as needed for itching and irritation.
Cream: 1% (Canesten 6-day intravaginal cream 1% [Canadian product]): Intravaginal: Insert 1 applicatorful (~5 g) once daily (preferably at bedtime) for 6 consecutive days. May also apply externally twice daily for up to 7 days as needed for itching and irritation.
Cream: 2% (Canesten 3-day intravaginal cream 2% [Canadian product]): Intravaginal: Insert 1 applicatorful once daily (preferably at bedtime) for 3 consecutive days. May also apply externally twice daily for up to 7 days as needed for itching and irritation.
Cream: 10% (Canesten 1-day intravaginal cream 10% [Canadian product]): Intravaginal: Insert 1 applicatorful (~5 g) as a single dose (preferably at bedtime). May also apply 1% or 2% cream externally 1 to 2 times daily as needed for up to 7 days for itching and irritation.
Tablet (Canadian product): Note: When tablets are used in conjunction with an external cream (1% or 2%), apply cream 1 to 2 times/day as needed for up to 7 days for itching and irritation.
200 mg tablet: Intravaginal: Insert 1 vaginal tablet once daily for 3 days (preferably at bedtime).
500 mg tablet: Intravaginal: Insert 1 vaginal tablet as a single dose (preferably at bedtime).
Cutaneous candidiasis: Children ≥2 years and Adolescents: Topical ointment: 1%: Topical: Apply twice daily (morning and night) for 2 weeks.
Tinea corporis (ringworm): Children and Adolescents: Limited data available in ages <2 years: Topical cream, lotion, ointment, solution: 1%: Topical: Apply to affected and surrounding area(s) twice daily until clinical resolution, typically 2 to 4 weeks (Ref).
Tinea cruris (jock itch): Children and Adolescents: Limited data available in ages <2 years: Topical cream, lotion, ointment, solution: 1%: Topical: Apply to affected and surrounding area(s) twice daily until clinical resolution, typically 2 weeks (Ref).
Tinea pedis (athlete's foot): Children and Adolescents: Limited data available in ages <2 years: Topical cream, lotion, ointment, solution: 1%: Topical: Apply to affected and surrounding area(s) twice daily until clinical resolution, typically 4 weeks (Ref).
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely needed due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely needed due to low systemic absorption.
(For additional information see "Clotrimazole (topical): Drug information")
Candidiasis, vulvovaginal: Note: A longer duration of 7 to 14 days may be necessary in patients with complicated infection (ie, recurrent or severe infection, infection with non-albicans Candida, pregnancy, or infection in an immunocompromised host) (Ref). Not effective against Candida glabrata (Ref).
Cream 1%: Intravaginal: Insert 1 applicatorful (~5 g) once daily (at bedtime) for 7 days (Ref). May also apply externally twice daily for 7 days, as needed, for itching and irritation.
Canesten 6-day intravaginal cream 1% [Canadian product]: Intravaginal: Insert 1 applicatorful (~5 g) once daily (at bedtime) for 6 days.
Cream 2%: Intravaginal: Insert 1 applicatorful (~5 g) once daily (at bedtime) for 3 days (Ref). May also apply externally twice daily for 7 days, as needed, for itching and irritation.
Cream 10% [Canadian product]: Intravaginal: Insert 1 applicatorful (~5 g) as a single dose (at bedtime). May also apply a thin layer of 1% or 2% cream externally to the irritated area 1 to 2 times/day, as needed, for up to 7 days.
Tablet [Canadian product]: Note: When tablets are used in conjunction with an external cream (1% or 2%), apply cream over the irritated area 1 to 2 times/day, as needed, for up to 7 days.
200 mg tablet: Intravaginal: Insert 1 vaginal tablet once daily for 3 days (at bedtime).
500 mg tablet: Intravaginal: Insert 1 vaginal tablet as a single dose (at bedtime).
Cutaneous candidiasis: Topical:
Cream 1%, solution 1%: Apply to affected area twice daily; if no improvement occurs after 4 weeks of therapy, re-evaluate diagnosis.
Ointment 1% (OTC labeling): Apply to affected area twice daily for 2 weeks.
Otomycosis (off-label use): Topical: Solution 1%: Instill 4 to 5 drops into the affected ear(s) twice daily for 10 to 14 days (Ref); application should begin after thorough cleansing of the ear canal by the provider. Reassess after completion of therapy; if fungal elements are still present, repeat cleansing of the ear canal followed by another 10- to 14-day course of clotrimazole and reassessment. Several cycles of ear cleansing followed by topical therapy and reassessment may be required; persistent otomycosis should be managed by an otolaryngologist (Ref).
Tinea infection:
Tinea corporis/tinea cruris (OTC labeling): Topical: Cream 1%, lotion 1%, ointment 1%, solution 1%: Apply to affected and surrounding area(s) twice daily until clinical resolution, typically 1 to 4 weeks (Ref).
Tinea pedis (OTC labeling)/tinea manuum (off-label use): Topical: Cream 1%, lotion 1%, ointment 1%, solution 1%: Apply to affected and surrounding area(s) twice daily until 1 week after clinical resolution, typically for 4 weeks total (Ref).
Tinea versicolor (pityriasis versicolor): Topical: Cream 1%, solution 1%: Apply to affected area(s) and immediate surrounding skin twice daily for 2 weeks (Ref).
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustment unlikely due to low systemic absorption.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Vaginal:
Postmarketing: Dermatologic: Burning sensation of skin, contact dermatitis (Abhinav 2015), contact hypersensitivity (Roller 1978), desquamation, erythema of skin, pruritus, skin blister, skin edema, skin irritation, stinging of the skin, urticaria
Hypersensitivity to clotrimazole or any component of the formulation.
OTC labeling: When used for self-medication, do not use vaginal cream if you have never had a vaginal yeast infection diagnosed by a doctor.
Concerns related to adverse effects:
• Local irritation: If irritation/sensitivity develops, discontinue therapy and institute appropriate alternative therapy.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
Other warnings/precautions:
• Appropriate use: Topical: For external use only; avoid contact with the eyes. Not effective for treatment of scalp or nails. When used for self-medication, discontinue use and contact a healthcare provider if there is no improvement in 2 weeks (jock itch) or 4 weeks (athlete's foot, ringworm).
• Self-medication (OTC use): Vaginal: When used for self-medication (OTC), consult a health care provider before use if experiencing vaginal itching and discomfort for the first time, frequent vaginal yeast infections (eg, monthly, 3 in 6 months), or exposure to HIV. A mild increase in vaginal itching, burning, or irritation may occur with use; a health care provider should be consulted before switching to another agent if patient does not experience complete relief. Discontinue use and contact a health care provider if symptoms do not improve in 3 days or last more than 7 days, or if symptoms of a more serious condition occur (eg, abdominal pain, back/shoulder pain, fever, chills, nausea, vomiting, foul-smelling vaginal discharge). For vaginal use only; do not use tampons, douches, spermicides, or other vaginal products or have vaginal intercourse during treatment.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External:
Antifungal (Clotrimazole): 1% (14.2 g, 28.4 g, 113 g) [contains cetostearyl alcohol, methylparaben, propylene glycol, propylparaben]
Antifungal Clotrimazole: 1% (14 g [DSC], 28 g [DSC]) [contains cetyl alcohol, edetate (edta) trisodium, isopropyl alcohol, methylparaben, propylparaben, trolamine (triethanolamine)]
Clotrimazole GRx: 1% (14 g [DSC]) [contains benzyl alcohol, cetyl alcohol, polysorbate 80]
Desenex: 1% (30 g)
GoodSense Athletes Foot: 1% (14 g) [contains cetyl alcohol, edetate (edta) trisodium, isopropyl alcohol, methylparaben, propylparaben, trolamine (triethanolamine)]
Micotrin AC: 1% (85 g) [contains cetearyl alcohol, disodium edta, propylene glycol]
Mycozyl AC: 1% (85 g) [contains cetostearyl alcohol, disodium edta, glycerin (soy), propylene glycol]
Pro-Ex Antifungal: 1% (42 g) [contains cetyl alcohol, edetate (edta) trisodium, methylparaben, trolamine (triethanolamine)]
TM-Clotrimazole: 1% (30 g) [contains cetyl alcohol, edetate (edta) disodium, ethylparaben]
Generic: 1% (15 g, 28 g, 30 g, 45 g)
Cream, Vaginal:
3 Day Vaginal: 2% (21 g) [contains benzyl alcohol, cetyl alcohol]
Clotrimazole 3 Day: 2% (22.2 g)
Gyne-Lotrimin: 1% (45 g [DSC]) [contains benzyl alcohol]
Gyne-Lotrimin 3: 2% (21 g [DSC]) [contains benzyl alcohol, cetyl alcohol]
Generic: 1% (45 g), 2% (21 g)
Lotion, External:
Votriza-AL: 1% (30 mL) [contains cetearyl alcohol, trolamine (triethanolamine)]
Ointment, External:
Alevazol: 1% (56.7 g)
Solution, External:
Generic: 1% (10 mL, 29.57 mL, 30 mL)
Yes
Cream (Clotrimazole External)
1% (per gram): $0.37 - $1.16
Cream (Clotrimazole Vaginal)
1% (per gram): $0.11 - $0.18
Cream (Desenex External)
1% (per gram): $0.26
Cream (Micotrin AC External)
1% (per gram): $23.47
Cream (Mycozyl AC External)
1% (per gram): $23.47
Cream (Trimazole External)
1% (per gram): $11.71
Solution (Clotrimazole External)
1% (per mL): $0.59 - $16.16
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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External:
Canesten: 1% (15 g, 30 g) [contains benzyl alcohol, cetostearyl alcohol]
Canesten External Antifungal: 1% (15 g) [contains benzyl alcohol, cetostearyl alcohol]
Canesten Extra Strength External Antifungal: 2% (15 g) [contains benzyl alcohol, cetostearyl alcohol]
Clotrimaderm Topical: 1% (20 g, 30 g, 50 g, 500 g) [contains benzyl alcohol, cetostearyl alcohol]
Generic: 1% (15 g, 30 g), 2% (15 g)
Cream, Vaginal:
Canesten 1 Day: 10% (5 g) [contains benzyl alcohol, cetostearyl alcohol]
Canesten 3 Day: 2% (25 g) [contains benzyl alcohol, cetostearyl alcohol]
Canesten 6 Day: 1% (50 g) [contains benzyl alcohol, cetostearyl alcohol]
Clotrimaderm Vaginal 3: 2% (25 g) [contains benzyl alcohol, cetostearyl alcohol]
Clotrimaderm Vaginal 6: 1% (50 g) [contains benzyl alcohol, cetostearyl alcohol]
Generic: 1% (50 g), 2% (25 g)
Kit, Vaginal/Topical:
Canesten Combi 1 Day Internal + External: Cream for vaginal use 10% (5 g) and cream for external use 1% (10 g)
Canesten Combi 1 Day: Vaginal tablet 500 mg (1s) and cream for external use 1% (10 g) [tablet contains lactose; cream contains benzyl alcohol, cetostearyl alcohol]
Canesten Combi 3 Day: Vaginal tablet 200 mg (3s) and cream for external use 1% (10 g) [tablet contains lactose; cream contains benzyl alcohol, cetostearyl alcohol]
Solution, External:
Clotrimaderm Topical: 1% (20 mL) [contains polyethylene glycol 400]
Topical: Cream, Lotion, Ointment, Solution: For external use only; avoid contact with eyes. Cleanse and thoroughly dry area prior to application. Apply a thin layer and rub gently into affected area; for tinea infections, also apply to surrounding areas (~1 to 2 cm beyond lesion border) (Ref). For tinea pedis (athlete's foot), pay special attention to the spaces between the toes.
Vaginal:
Cream:
Internal use (1%, 2%, or 10% [Canadian product]): Insert full applicator into vagina gently, and slowly expel cream into vagina. Wash applicator with soap and water following use. Do not use tampons, douches, spermicides, or other vaginal products or have vaginal intercourse during treatment.
External use (1%, 2%): Cream may be applied externally for itching and irritation of vaginal and surrounding areas.
Vaginal tablet (Canadian product): Insert deep into the vagina using the applicator to ensure tablet dissolves completely. Administration at bedtime is preferred. If tablet does not dissolve completely within 1 night, consider use of vaginal cream.
Intravaginal: For vaginal use only
Cream: Internal use (1%, 2%, or 10% [Canadian product]): Insert deep into the vagina via manufacturer provided applicator. External use (1% or 2%): May be applied externally for itching and irritation of surrounding areas. Do not use tampons, douches, spermicides, or other vaginal products or have vaginal intercourse during treatment.
Vaginal tablet [Canadian product]: Insert deep into the vagina to ensure tablet dissolves completely. If tablet does not dissolve completely within one night, consider use of a vaginal cream.
Topical: For external use only; avoid contact with eyes and application to severely cracked or irritated areas. Cleanse and thoroughly dry area prior to application. Apply a thin layer to affected area. For treatment of athlete's foot, pay special attention to spaces between the toes; wear well-fitting, ventilated shoes and change shoes and socks at least once a day.
Recommendations vary by manufacturer. Some products are only recommended to be stored at controlled room temperature and others may be stored under refrigeration or at room temperature; refer to manufacturer's labeling for product-specific storage recommendations.
Topical cream, lotion, and solution: Topical treatment of tinea corporis, tinea cruris, and tinea pedis and relief of associated itching, cracking, burning, and discomfort (OTC product: FDA approved in ages ≥2 years and adults). Note: Topical therapy is not effective for infection of the scalp or nails.
Topical ointment: Topical treatment of cutaneous candida albicans, tinea corporis, and tinea cruris; relief of associated itching, scaling, cracking, burning, redness, soreness and irritation; management of tinea pedis (discomfort, scaly skin between the toes or burning feet) (OTC product: All indications: FDA approved in ages ≥2 years and adults). Note: Topical therapy is not effective for infection of the scalp or nails.
Vaginal cream: Treatment of vulvovaginal candidiasis and relief of associated external itching (FDA approved in ages ≥12 years and adults).
Note: Approved ages and uses for generic products may vary; consult labeling for specific information.
Clotrimazole may be confused with co-trimoxazole
Lotrimin may be confused with Lotrisone
Cloderm: Brand name for clotrimazole [Germany], but also brand name for alclomethasone [Indonesia]; clobetasol [China, India, Malaysia, Singapore, Thailand]; clocortolone [US, Canada]
Canesten: Brand name for clotrimazole [multiple international markets] may be confused with Canesten Bifonazol Comp brand name for bifonazole/urea [Austria]; Canesten Extra brand name for bifonazole [China, Germany]; Canesten Extra Nagelset brand name for bifonazole/urea [Denmark]; Canesten Fluconazole brand name for fluconazole [New Zealand]; Canesten Oasis brand name for sodium citrate [Great Britain]; Canesten Once Daily brand name for bifonazole [Australia]; Canesten Oral brand name for fluconazole [United Kingdom]; Cenestin brand name for estrogens (conjugated A/synthetic) [US, Canada]
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.
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
Progesterone: Antifungal Agents (Vaginal) may decrease therapeutic effects of Progesterone. Risk X: Avoid
Sirolimus (Conventional): Clotrimazole (Topical) may increase serum concentration of Sirolimus (Conventional). Risk C: Monitor
Tacrolimus (Systemic): Clotrimazole (Topical) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor
Vaginal products may weaken latex condoms and diaphragms (CDC [Workowski 2021]).
Clotrimazole is minimally absorbed following topical or vaginal administration.
Based on available data, vaginal use of clotrimazole is not associated with an increased risk of adverse pregnancy outcomes (Czeizel 1999; Czeizel 2004; Daniel 2018; Farr 2021; Papadopoulos 2024; Rotem 2018).
Topical azole therapies with 7-day regimens are recommended in pregnant patients with vulvovaginal candidiasis (CDC [Workowski 2021]). Shorter courses of topical azoles are less effective (Young 2001).
Hypersensitivity, local irritation.
Binds to phospholipids in the fungal cell membrane altering cell wall permeability resulting in loss of essential intracellular elements
Absorption: Topical: Negligible through intact skin; Intravaginal: 3% to 10% of dose is absorbed
Time to peak, serum: Vaginal cream: ~24 hours