- Treatment for vaginal and vulval thrush with clotrimazole 500 mg soft gel pessary and 2% external cream
- Access this product following an online medical consultation
- What is in this pack?
- Thrush symptoms and what this pack treats
- How clotrimazole works
- How to use each component
- When to seek assessment before using this product
- Side effects and precautions
- What to expect and how this compares to other clotrimazole formats
- How DoktorABC works
- Active substances and excipients
Treatment for vaginal and vulval thrush with clotrimazole 500 mg soft gel pessary and 2% external cream
This combination pack contains two separate clotrimazole products designed to treat thrush affecting both the inside of the vagina and the external skin of the vulva. The soft gel pessary (500 mg clotrimazole) is inserted vaginally as a single dose at night to treat internal candidal vaginitis. The external cream (clotrimazole 2%) is applied to the vulva and surrounding area two to three times daily as an adjunct treatment for candidal vulvitis.
The pack is intended for adults who have previously had thrush diagnosed by a doctor and who are experiencing both internal and external symptoms. It is not intended for first-time symptoms, and a clinical assessment is required before use if this is the case.
Access this product following an online medical consultation
Start the online consultation and complete the medical questionnaire. A UK-registered prescriber will review your answers and, where appropriate, issue a prescription.
Important information
DoktorABC UK is a digital health platform that connects patients with independent, UK-registered prescribers. DoktorABC UK does not itself provide medical care, issue prescriptions, or dispense medicines. All clinical decisions are made by the UK-registered prescriber following an individual medical assessment.
What is in this pack?
This pack contains two products manufactured by Bayer plc, both containing clotrimazole as the active ingredient at different concentrations for different routes of use.
Clotrimazole 500 mg soft gel pessary: A single soft gel capsule designed for vaginal insertion. Licensed for the treatment of candidal vaginitis. Supplied in a blister pack with one reusable applicator.
Clotrimazole 2% external cream: A white topical cream in a 10 g tube. Licensed for the treatment of candidal vulvitis and used as an adjunct to the pessary. For external skin use only.
Both products are for use on the same occasion of treatment. The pessary addresses the internal infection and the cream addresses external vulval symptoms. They work through the same antifungal mechanism but treat different sites.
The pack is classified as a General Sales List (GSL) medicine, meaning it is available without a prescription in certain circumstances. However, it should only be used by people who have had thrush previously diagnosed by a doctor, and a prescriber assessment is required where any of the cautions described below apply.
Thrush symptoms and what this pack treats
Thrush caused by Candida can affect both the inside of the vagina (candidal vaginitis) and the external skin of the vulva (candidal vulvitis). When both sites are affected simultaneously, a combined internal and external treatment addresses both aspects of the infection in a single course.
Typical symptoms of candidal vulvovaginitis include:
- Itching, soreness, and redness of the vulva and vagina
- A white, thick, usually odourless vaginal discharge
- Stinging or discomfort when urinating or during sex
- External skin irritation and swelling around the vulva
Thrush is not a sexually transmitted infection.
This combination pack treats both the internal vaginal infection and the external vulval symptoms. It does not treat infections at other sites such as the throat or rectum, and it does not treat bacterial vaginosis or sexually transmitted infections, which can cause overlapping symptoms.
Important: Seek assessment from your GP or a sexual health clinic before using this product if:
- This is the first time you have had these symptoms
- You have had the infection more than twice in the past six months
- You or your partner have had a sexually transmitted infection
- You are under 16 or over 60
- You are pregnant or breastfeeding
- You notice discharge with an unusual or unpleasant smell
- You have vaginal bleeding outside of your normal period
- You have sores, ulcers, or blisters; you have fever, vomiting, pelvic pain, or pain on urination.
These symptoms may indicate a different condition requiring different treatment.
How clotrimazole works
Both products in this pack contain clotrimazole, an imidazole antifungal that works by inhibiting the production of ergosterol, a key component of the Candida fungal cell membrane. Without ergosterol, the cell membrane becomes defective and the fungus cannot survive or reproduce.
The pessary delivers clotrimazole directly to the site of internal vaginal infection, where it dissolves and acts locally. The external cream delivers clotrimazole to the surface skin of the vulva, treating the external component of the infection.
Most people find symptoms begin to improve during or shortly after completing the pessary and within a few days of starting the cream. Individual responses vary. If symptoms have not improved within seven days of using the pessary, contact your prescriber.
How to use each component
The following guidance is based on the current UK SmPC and PIL for Canesten Thrush Combi Soft Gel Pessary and External Cream (Bayer plc, medicines.org.uk). Always read the full PIL supplied with your specific pack before use.
Clotrimazole 500 mg soft gel pessary
Preparation:
- Wash your hands thoroughly before handling the blister pack and applicator.
- Remove the soft gel pessary from the foil blister.
- Attach the pessary to the applicator as directed in the PIL.
Insertion:
- Lie on your back with your knees bent, or adopt whichever position is most comfortable.
- Gently insert the applicator as far as is comfortable into the vagina.
- Push the plunger to release the pessary as high up into the vagina as possible.
- Remove the applicator carefully.
- Wash your hands again after use.
The pessary should be inserted at bedtime so it remains in place overnight. One pessary is the complete internal treatment.
Important: The soft gel pessary requires vaginal moisture to dissolve. Some residue may be present the morning after. This does not mean the treatment has not worked, as the active ingredient is released on contact with vaginal tissue. The applicator cannot be flushed down the toilet; dispose of it in household waste.
Menstruation: Do not use the pessary during your period, as there is a risk of it being washed out by menstrual flow. Finish treatment before the onset of menstruation. If your period starts during treatment, contact your prescriber or pharmacist.
Other intravaginal products: Do not use tampons, intravaginal douches, spermicides, or other vaginal products while using the pessary.
Pregnancy: If you are pregnant, the pessary should be inserted by hand rather than using the applicator, as directed in the PIL and on the advice of your doctor or midwife.
Clotrimazole 2% external cream
Application:
- Wash your hands before applying the cream.
- Clean the external vulval area gently and allow it to dry.
- Apply a thin layer of cream to the vulva and surrounding area and rub in gently.
- Apply two to three times daily.
- Wash your hands thoroughly after each application.
Duration: Continue applying the cream until external symptoms resolve. If symptoms have not improved after seven days of combined treatment, contact your prescriber.
Important: The external cream is for use on the skin of the vulva only. Do not insert it inside the vagina. Do not apply near the eyes or mouth.
Use by a partner: According to the SmPC, the cream can also be used to treat a sexual partner's penis to help prevent reinfection. If a partner has symptoms, they should seek their own medical assessment.
When to seek assessment before using this product
The SmPC states this product should only be used if candidal vulvovaginitis has been previously diagnosed by a doctor. Seek assessment before use if any of the following apply.
First episode: A clinical assessment is needed to confirm the diagnosis.
Recurrent thrush: If you have had the infection more than twice in the past six months, seek assessment. The SmPC advises consulting a physician if the infection recurs more than twice within six months.
Pregnancy and breastfeeding: Speak to your GP or midwife before use. If advised to proceed with the pessary during pregnancy, insert it by hand rather than using the applicator.
Age: Not recommended for use in those under 16 or over 60 without medical assessment.
Diabetes or weakened immune system: Seek medical assessment, as thrush may be more persistent in these groups.
Tacrolimus or sirolimus: Concomitant use of vaginal clotrimazole with tacrolimus or sirolimus may increase plasma levels of these medicines. Speak to your doctor before use if you are taking either of these medicines.
Allergies: Do not use if you are allergic to clotrimazole or any other ingredient listed in the PIL. The external cream contains cetostearyl alcohol, which may cause local skin reactions such as contact dermatitis, and benzyl alcohol, which may cause allergic reactions and mild local irritation.
Side effects and precautions
As with all medicines, this product can cause side effects, although not everyone will experience them. The following is based on the current UK SmPC for this pack (medicines.org.uk, last updated July 2022).
Local reactions
The most commonly reported side effects are local reactions at the site of use, including mild burning, stinging, or itching following insertion of the pessary or application of the cream. These are usually temporary.
Gastrointestinal effects
Abdominal pain and nausea have been reported in association with vaginal clotrimazole use.
Allergic reactions
Anaphylactic reactions, angioedema, and hypersensitivity reactions have been reported. If you experience signs of a serious allergic reaction, including swelling of the face, lips, tongue or throat, difficulty breathing, or a widespread skin reaction, stop using both products immediately and seek emergency medical help.
Effect on latex contraception
Both the pessary and the cream can damage latex condoms and diaphragms, reducing their reliability as contraception. Use alternative contraception during treatment and for a period afterwards. Check the PIL supplied with your pack for the specific recommended duration.
Important: Do not smoke or go near naked flames during use of the external cream. Fabric that has been in contact with this product burns more easily and is a serious fire hazard.
Report any suspected side effects to the MHRA via the Yellow Card scheme.
What to expect and how this compares to other clotrimazole formats
Expected improvement: Most people find that internal symptoms begin to improve within a day or two of using the pessary. External symptoms typically improve within a few days of starting the cream. If symptoms have not improved within seven days, contact your prescriber.
Comparison with other clotrimazole formats
| Product | Internal treatment | External treatment | Course |
|---|---|---|---|
| Clotrimazole 500 mg pessary alone | Yes | No | Single pessary |
| Clotrimazole 200 mg pessaries | Yes | No | Three consecutive nights |
| This pack (500 mg pessary and 2% cream) | Yes | Yes | Single pessary plus cream until symptoms resolve |
| Canesten Combi Duo (pessary and fluconazole) | Yes (vaginal clotrimazole pessary) | No (oral fluconazole treats systemically) | Single pessary plus single oral capsule |
Important: This pack is different from Canesten Duo. Canesten Duo contains a clotrimazole pessary alongside an oral fluconazole capsule, which works systemically. This pack contains a clotrimazole pessary alongside a clotrimazole external cream. Both products in this pack are clotrimazole; neither component is an oral tablet or capsule. If you are unsure which product is most appropriate for your symptoms, a prescriber or pharmacist can advise.
How DoktorABC works
DoktorABC UK is a digital health platform that connects patients with independent, UK-registered healthcare professionals through a secure online process.
- Complete a short medical questionnaire covering your symptoms, medical history, and any relevant medicines.
- An independent UK-registered prescriber reviews your information and determines whether this product is clinically appropriate for you.
- If treatment is considered suitable, a prescription is approved by the UK-registered prescriber in accordance with UK regulations.
- Your medication is dispensed by a GPhC-registered pharmacy and delivered to your door in discreet packaging.
DoktorABC UK does not itself provide medical care, issue prescriptions, or dispense medicines. All clinical decisions are made by the independent prescribing healthcare professional following an individual assessment.
Active substances and excipients
Soft gel pessary:
Active substance: Clotrimazole 500 mg. Other ingredients include macrogol 400, macrogol 1500, gelatin, glycerol 85%, titanium dioxide, and iron oxide yellow. Please refer to the PIL for the full excipient list.
External cream:
Active substance: Clotrimazole 2% w/w (20 mg per gram). Other ingredients include benzyl alcohol, cetostearyl alcohol, and purified water. Please refer to the PIL for the full excipient list.
Product PIL: Available at medicines.org.uk/emc/product/8225/pil
