- Treatment for vaginal thrush with clotrimazole 200 mg pessaries
- Access clotrimazole 200 mg pessaries following an online medical consultation
- What is clotrimazole?
- Vaginal thrush: symptoms and when to seek assessment first
- How clotrimazole works
- How to use clotrimazole 200 mg pessaries
- Missed dose, incomplete course, and what to do if symptoms persist
- Suitability and contraindications
- Side effects and precautions
- How DoktorABC works
- Clotrimazole 200 mg pessary active substance and excipients
- Clotrimazole 200 mg pessary patient information leaflet
Treatment for vaginal thrush with clotrimazole 200 mg pessaries
Clotrimazole 200 mg pessaries are a three-dose antifungal treatment for vaginal thrush (candidal vaginitis). Each pack contains three pessaries and one reusable applicator. One pessary is inserted into the vagina at bedtime on each of three consecutive nights. Clotrimazole is the active ingredient found in branded products such as Canesten, but generic clotrimazole pessaries contain the same active substance at the same strength and are licensed for the same indication.
Access clotrimazole 200 mg pessaries 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 clotrimazole 200 mg pessaries.
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 clotrimazole?
Clotrimazole is an antifungal medicine belonging to the azole class. It is licensed for the treatment of vaginal thrush (candidal vaginitis) and is available in several formulations and strengths. The 200 mg pessary formulation delivers the treatment directly to the site of infection over three consecutive nights.
Generic clotrimazole 200 mg pessaries contain the same active ingredient as Canesten 200 mg pessaries at the same dose. The choice between a branded and generic product does not affect clinical efficacy.
Each pack contains three pessaries in a blister pack and one reusable applicator, enclosed in a cardboard carton.
Vaginal thrush: symptoms and when to seek assessment first
Vaginal thrush is caused by an overgrowth of Candida, a yeast naturally present in the vagina. It is not caused by poor hygiene and is not a sexually transmitted infection. Common symptoms include a white, thick discharge that is usually odourless, itching, soreness or redness of the vulva and vagina, and stinging when urinating or during sex.
These symptoms can overlap with other conditions, including bacterial vaginosis and sexually transmitted infections. Matching your symptoms to a description of thrush does not confirm the diagnosis.
Important: Seek assessment from your GP or a sexual health clinic before using this product if: this is your first episode; you have had more than two episodes in the last six months; you or your partner have ever had an STI; you are under 16 or over 60; you are pregnant or breastfeeding; or you have discharge with an unusual smell, bleeding outside your normal period, sores or blisters, fever, pelvic pain, or pain on urination. These symptoms may indicate a different condition requiring a different treatment.
How clotrimazole works
Clotrimazole works by disrupting the cell membrane of the Candida fungus, causing it to break down and die. Applied directly inside the vagina, it reaches the site of infection and acts locally to clear the yeast overgrowth. The three-night course at 200 mg delivers the treatment in stages, allowing the active ingredient to work progressively over consecutive nights.
Most people find symptoms begin to improve during or shortly after the course. Individual responses vary, and complete resolution may take a few days after the final pessary. If symptoms have not improved within seven days of completing the course, contact your GP or prescriber.
Good to know: Clotrimazole 200 mg pessaries treat the internal vaginal infection only. They do not relieve itching or soreness on the vulva or surrounding skin. If external symptoms are also present, a separate antifungal cream applied to the vulva may be considered alongside internal treatment. A prescriber or pharmacist can advise.
How to use clotrimazole 200 mg pessaries
The following guidance is based on the current UK patient information leaflet and SmPC for clotrimazole 200 mg pessaries (Canesten 200 mg pessary, Bayer plc, medicines.org.uk, last revised February 2023). Always read the full PIL supplied with your specific product before use, as instructions may vary between manufacturers.
Preparation
- Wash your hands thoroughly before handling the applicator and the foil blister pack.
- Remove one pessary from the blister.
- Attach the pessary to the applicator as directed in the PIL.
Inserting the pessary
- Lie on your back with your knees bent, or adopt whichever position is most comfortable for you.
- 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 that it remains in place overnight. Repeat on each of the following two nights so that three pessaries are used in total over three consecutive nights.
Applicator care
The applicator is reusable across the three-night course. After each use, store it in a clean and safe place. Ensure the red lock is replaced on the plunger before reuse. The applicator cannot be flushed down the toilet; dispose of it in household waste after the course is complete.
Additional guidance:
- Moisture and dissolution: The pessary requires vaginal moisture to dissolve. Some residue may be visible the morning after insertion. This does not mean the treatment has not worked, as the active ingredient is released on contact with vaginal tissue.
- Menstruation: Do not use this product during your period, as it may be less effective. If your period starts during the course, contact your prescriber or pharmacist for guidance.
- Tampons and intravaginal products: Do not use tampons, douches, spermicides, or other intravaginal products during the course of treatment.
- Sex during treatment: Clotrimazole can damage latex condoms and diaphragms. Avoid sex during treatment, or use a non-latex alternative method of contraception. This precaution applies for the duration of the course.
Important: If you accidentally insert more than one pessary at the same time, you may experience discomfort or irritation. Stop using the pessaries and contact your GP or NHS 111 if the discomfort does not resolve.
Missed dose, incomplete course, and what to do if symptoms persist
- Missed dose: If you forget to insert a pessary on one of the three nights, insert it as soon as you remember. Then continue the remaining pessaries on the following consecutive nights. Do not insert two pessaries on the same night to make up for a missed dose.
- If the course is not completed: Complete all three pessaries even if symptoms improve before the course ends. Stopping early may mean the infection is not fully cleared.
- If symptoms do not improve: If your symptoms have not improved within seven days of completing the three-night course, contact your GP or prescriber. Do not repeat the course without clinical guidance.
- If symptoms return: Recurrent thrush, defined as more than two episodes in six months or more than four in twelve months, warrants clinical assessment rather than repeated self-treatment. A prescriber can investigate whether there is an underlying cause and advise on appropriate management.
Suitability and contraindications
Clotrimazole 200 mg pessaries are not appropriate for everyone without medical guidance. A prescriber assessment is required in the following circumstances.
- First episode: If this is the first time you have had these symptoms, seek assessment before treating to confirm the diagnosis.
- Recurrent thrush: More than two episodes in the past six months requires clinical review.
- Age: Not recommended for use in girls under 16 years of age without medical advice. Seek assessment if you are over 60.
- Pregnancy and breastfeeding: Clotrimazole 200 mg pessaries can be used in pregnancy and breastfeeding, but you should tell your doctor or midwife before use and follow their instructions carefully. If you are pregnant, the pessary should be inserted by hand rather than using the applicator.
- Diabetes or weakened immune system: Medical assessment is recommended, as thrush may be more persistent and harder to treat in these groups.
- Allergies: Do not use if you are allergic to clotrimazole or any other ingredient listed in the PIL supplied with your product.
- Tacrolimus or sirolimus: An interaction between clotrimazole and tacrolimus or sirolimus has been reported. If you are taking either of these medicines, speak to your doctor before using clotrimazole.
Side effects and precautions
As with all medicines, clotrimazole 200 mg pessaries can cause side effects, although not everyone will experience them.
Local reactions
The most commonly reported side effects are local reactions in the vaginal area, including mild burning, stinging, or itching after insertion. These are usually temporary.
Allergic reaction
As with all medicines, some people may be allergic to the pessary. If you are allergic, a reaction will occur soon after use. Stop using the product immediately and contact your doctor or go to your nearest A&E if you experience any of the following: swelling of your lips, face, throat or tongue; difficulty swallowing or breathing; widespread rash or hives; dizziness or feeling faint. These may be signs of a serious allergic reaction.
If redness, burning, pain, itching or swelling at the site of use gets worse rather than better after insertion, stop using the product and contact your doctor.
Effect on latex contraception
Clotrimazole can damage latex condoms and diaphragms, reducing their reliability as contraception. Use alternative contraception during the course of treatment and for a period afterwards. Check the PIL supplied with your specific product for the recommended duration.
Report any suspected side effects to the MHRA via the Yellow Card scheme.
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 clotrimazole 200 mg pessaries are 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.
Clotrimazole 200 mg pessary active substance and excipients
Active substance: Clotrimazole 200 mg per pessary.
Other ingredients vary by manufacturer.
Please refer to the patient information leaflet supplied with your specific product for the full list of excipients.
Clotrimazole 200 mg pessary patient information leaflet
Canesten 200 mg pessary PIL available at medicines.org.uk/emc/product/2204/pil. Generic clotrimazole product information may vary; always read the PIL supplied with your medication.
