Canesten Thrush Duo

Canesten Thrush Duo - Oral capsule and external cream

Treatment for vaginal thrush with Canesten Thrush Duo

Canesten Thrush Duo is a dual-component pack manufactured by Bayer plc, containing one fluconazole 150 mg oral capsule and one tube of clotrimazole 2% external cream (10 g). The two components treat different aspects of thrush simultaneously. The oral capsule works systemically to treat the internal vaginal infection, while the external cream is applied to the vulva to relieve external symptoms.

The pack is classified as a Pharmacy medicine in the UK. The PIL advises that it should only be used by people who have previously had thrush diagnosed by a doctor. Medical advice should be sought if this is the first time symptoms have been experienced.

Access Canesten Thrush Duo 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, approve a prescription for Canesten Thrush Duo.

What is in this pack?

Canesten Thrush Duo contains two separate products, each with a different active ingredient, route of administration, and licensed indication.

Fluconazole 150 mg oral capsule (Canesten Thrush Oral Capsule): An opaque light blue hard capsule containing fluconazole 150 mg, an oral azole antifungal. Licensed for the treatment of candidal vaginitis, acute or recurrent, and for the treatment of partners with associated candidal balanitis.

Clotrimazole 2% external cream (Canesten Thrush External Cream): A white topical cream in a 10 g tube containing clotrimazole 2% per gram of cream. Licensed for the treatment of candidal vulvitis, used as an adjunct to treatment of candidal vaginitis. Can also be used on a sexual partner's penis to help prevent reinfection.

The capsule shell contains gelatin, titanium dioxide, and brilliant blue FCF (E133). The cream contains cetostearyl alcohol and benzyl alcohol, which are noted as potential causes of local skin reactions in some people.

This product contains lactose in the capsule. If your doctor has told you that you have an intolerance to some sugars, speak to your doctor before taking this medicine.

Thrush symptoms and when to seek assessment first

Vaginal thrush typically causes itching, soreness, redness, and a white, thick, usually odourless discharge. In women, external symptoms affecting the vulva are common alongside the internal infection. In men, candidal balanitis causes redness, itching, and irritation affecting the head of the penis.

Thrush is not a sexually transmitted infection. It can affect people regardless of sexual activity.

These symptoms can overlap with bacterial vaginosis, sexually transmitted infections, and other conditions. Matching symptoms to a description of thrush does not confirm the diagnosis.

How each component works

Both fluconazole and clotrimazole belong to the azole antifungal class and work by inhibiting the production of ergosterol, a key component of the Candida fungal cell membrane. Without ergosterol, the fungal cell membrane becomes defective and the Candida cannot reproduce.

Fluconazole (oral capsule)

After swallowing, fluconazole is absorbed into the bloodstream and distributed systemically throughout the body. This allows it to reach the internal site of vaginal infection and treat the source of the overgrowth from within.

Clotrimazole (external cream)

Applied topically to the vulva, the cream acts locally at the skin surface, treating the external component of the infection at the point of contact.

Together, the two components address both the internal and external aspects of candidal vulvovaginitis through complementary routes.

How to use each component

The following guidance is based on the current UK PIL for Canesten Thrush Duo (Bayer plc, medicines.org.uk, last updated October 2024). Always read the full PIL supplied with your pack before use.

Fluconazole 150 mg oral capsule

• Swallow the capsule whole with a glass of water
• It can be taken at any time of day, with or without food
• One capsule is the complete oral treatment; do not take a second capsule without clinical guidance
• The capsule can be taken at the same time as you first apply the external cream, or at a different time of day according to your preference

Clotrimazole 2% external cream

• Wash your hands before each application
• Apply a thin layer of cream to the vulva and surrounding external area only
• Rub in gently
• Apply two to three times daily
• Wash your hands thoroughly after each application
• Continue applying the cream until external symptoms have resolved

If symptoms do not improve: If external symptoms have not resolved within seven days, or if internal symptoms have not improved within this timeframe following the oral capsule, contact your GP or prescriber. Do not repeat the oral capsule without clinical guidance.

Suitability: who should seek assessment before use

Pregnancy and trying to conceive

Fluconazole must not be taken during pregnancy or when trying to conceive. There is evidence of an association between fluconazole use in pregnancy and congenital abnormalities. Women who could become pregnant should use effective contraception during treatment.

Breastfeeding

Fluconazole passes into breast milk. You should not breastfeed if you are taking a repeated dose of fluconazole. For a single dose, discuss with your prescriber or pharmacist whether breastfeeding should be temporarily paused and for how long.

Age

Fluconazole 150 mg for vaginal candidiasis is for adults aged 16 to 60 years only. It is not recommended in patients aged over 60. Seek medical assessment if you are under 16 or over 60. 

First episode

Medical advice should be sought if this is the first time the patient has experienced symptoms of candidal vaginitis.

Recurrent thrush

More than two episodes in the past six months warrants clinical assessment.

Liver or kidney conditions

Fluconazole is processed by the liver and excreted by the kidneys. People with liver or kidney disease should seek medical assessment before use.

Heart rhythm conditions and electrolyte problems

Fluconazole can affect heart rhythm (QT interval). People with known QT prolongation, heart conditions, or electrolyte disturbances such as low potassium or magnesium should seek medical assessment before use.

Diabetes or weakened immune system

Seek medical assessment, as thrush may be more persistent in these groups.

Previous severe skin or drug reaction

If you have previously experienced a severe skin reaction to any medicine, including Stevens-Johnson syndrome or toxic epidermal necrolysis, seek medical advice before taking fluconazole.

Allergies

Do not use if you are allergic to fluconazole, clotrimazole, other medicines taken to treat fungal infections, or any other ingredients including lactose monohydrate, cetostearyl alcohol, or benzyl alcohol. 

Drug interactions

Fluconazole interacts with a number of medicines. This section covers the most clinically important interactions based on the current UK SmPC. It is not a complete list. Always disclose your full medication list to a prescriber or pharmacist before use.

Contraindicated combinations

Do not take this product if you are taking astemizole or terfenadine (antihistamines), cisapride (for stomach upsets), pimozide (for mental health conditions), quinidine (for heart arrhythmia), or erythromycin (an antibiotic). These combinations are contraindicated due to the risk of serious heart rhythm effects.

Other clinically important interactions to discuss with your prescriber or pharmacist:

• Anticoagulants (e.g. warfarin): Fluconazole significantly increases anticoagulant effect and bleeding risk. Close INR monitoring is required.
• Antidiabetic medicines (sulphonylureas): Fluconazole may increase blood levels and the risk of low blood sugar.
• Antiepileptic medicines (e.g. phenytoin): Fluconazole may increase levels in the blood, raising the risk of toxicity.
• Ciclosporin and tacrolimus: Fluconazole may significantly increase levels of these immunosuppressant medicines.
• Statins metabolised by CYP3A4 (e.g. simvastatin, atorvastatin): Fluconazole may increase statin levels, raising the risk of muscle-related side effects.
• QT-prolonging medicines: Fluconazole itself can prolong the QT interval and should be used with caution alongside other medicines with this effect.

Side effects and precautions

As with all medicines, Canesten Thrush Duo can cause side effects, although not everyone will experience them.

Fluconazole oral capsule

Common side effects (may affect up to 1 in 10 people):

• Headache
• Nausea, abdominal discomfort, diarrhoea, wind
• Skin rash

Uncommon side effects (may affect up to 1 in 100 people):

• Dizziness
• Vomiting
• Taste disturbance
• Elevated liver enzymes

Clotrimazole 2% external cream

Local reactions at the site of application, including mild burning, stinging, or itching, are the most commonly reported side effects. The cream contains cetostearyl alcohol, which may cause contact dermatitis in some people, and benzyl alcohol, which may cause allergic reactions and mild local irritation.

Urgent symptoms requiring immediate medical attention

Stop using both products and seek emergency help immediately if you experience:

• Signs of a severe allergic reaction: swelling of the face, lips, tongue or throat, difficulty breathing or swallowing, widespread rash or hives
• Severe skin reactions: blistering, peeling, or widespread redness
• Signs of liver problems: yellowing of the skin or eyes, dark urine, persistent nausea, or unusual fatigue
• Signs of a serious drug hypersensitivity reaction: skin rash, fever, swollen glands, or feeling generally unwell

Effect on latex contraception

The clotrimazole external cream can damage latex condoms and diaphragms, reducing their reliability as contraception. Use alternative contraception during the period of cream use and for a period afterwards. Check the PIL for the specific recommended duration.

Report any suspected side effects to the MHRA via the Yellow Card scheme.

Comparing Canesten Thrush Duo with Canesten Thrush Combi

The names Canesten Duo and Canesten Combi are similar and easy to confuse. The key difference is in the internal treatment component.

For people who prefer not to take an oral antifungal, who have drug interactions with fluconazole, or who are pregnant, a clotrimazole pessary combined with external cream may be a more appropriate option. A prescriber or pharmacist can advise on the most suitable approach for your individual circumstances.

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 Canesten Thrush Duo 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

Oral capsule:
Active substance: Fluconazole 150 mg. Other ingredients: colloidal silicon dioxide, lactose monohydrate, magnesium stearate, maize starch, sodium lauryl sulphate. Capsule shell: brilliant blue FCF (E133), titanium dioxide (E171), gelatin.

External cream:
Active substance: Clotrimazole 2% w/w. Other ingredients include benzyl alcohol 20 mg per gram, cetostearyl alcohol 100 mg per gram, and purified water. Please refer to the PIL for the full excipient list.

Product PIL: Available at medicines.org.uk/emc/product/9076/pil