Clotrimazole is an antifungal medicine.

It's used to treat yeast infections including thrush in women and men, although thrush is more common in women.

Thrush is caused by a fungus (yeast) and can affect the vagina and area around the vagina, breasts and nipples or the end of the penis. It can also affect other areas of skin, such as the armpits, top of the inner thighs (groin) and between the fingers.

Clotrimazole comes as an external cream, an internal cream and a pessary (a tablet you insert into your vagina).

For vaginal thrush you can use pessaries or cream or both at the same time. The pessaries and internal cream are sometimes sold together.

For thrush on the penis, breasts, armpits, groin or between the fingers you would use the external cream.

Clotrimazole is available to buy in pharmacies and shops. Some stronger treatments are only available with a prescription.

• Clotrimazole works by killing the yeast that causes the fungal infection.
• It usually treats thrush within 7 days but it's best to treat the infection for at least 2 weeks to stop it coming back.
• The most common side effect is an itching or burning feeling in the area being treated.
• Clotrimazole is also known by the brand name Canesten, including Canesten pessaries and cream. However, not all Canesten products contain clotrimazole, and some contain clotrimazole combined with another medicine.

Clotrimazole creams can be used by most adults and children.

However, some creams and pessaries are not recommended for children under the age of 16 years or adults aged 60 and above. Thrush affecting the vagina is rare in these age groups so a doctor will need to check what's causing your symptoms before you start any treatment.

Clotrimazole may not be suitable for some people. To make sure clotrimazole is safe for you, tell a pharmacist or doctor if:

• this is the first time you've had thrush
• you've had thrush more than twice in the past 6 months
• you or your partner have ever had a sexually transmitted infection (STI)
• you're a man with thrush but your sexual partner does not have it
• you have an abnormal discharge from your penis
• you have sores, ulcers or blisters on your penis
• you have abnormal or irregular bleeding from your vagina, or bloody discharge
• you have sores, ulcers or blisters on, or around, your vagina

Do not use clotrimazole pessaries if:

• you're allergic to clotrimazole or any of the ingredients in the medicine
• you have an intolerance to some sugars unless your doctor has said it's OK (the pessary contains lactose)
• you're having your period; wait until it's finished

1. Wash your hands before you start.
2. Put the cream on in a thin layer and rub it in gently. A strip of cream (0.5cm long) is enough to treat an area the size of the hand.
3. Put the cream onto the affected area 2 or 3 times a day for at least 2 weeks. The cream will work better if you can use it 3 times a day.

What if I forget to use it?

If you forget to put your cream on, just do it as soon as you remember. Use the cream as soon as possible and then go back to putting it on 2 to 3 times a day as usual.

What if I use too much?

If you use too much clotrimazole cream or use it more often than you need to, it may make your skin red or irritated. Use less cream the next time if this happens.

Pessaries and internal cream are made to go into your vagina only. Do not swallow them.

Pessaries need moisture in the vagina to dissolve completely. If they do not dissolve, pieces of the pessary may crumble and fall out of the vagina. You may notice this if you have vaginal dryness.

To help the pessary dissolve, insert it as far as possible into your vagina at bedtime.

How much to use

Clotrimazole pessaries are available in different strengths: 100mg, 200mg and 500mg.

• 100mg – use 1 pessary every night for 6 nights in a row
• 200mg – use 1 pessary every night for 3 nights in a row
• 500mg – use 1 pessary for 1 night only

If you're using the 100mg clotrimazole pessary, you can use 2 pessaries for 3 nights in a row.

5g of vaginal cream contains 500mg clotrimazole (10%). It's a single application to be used once.

Do not use pessaries during your period. Wait until your period has finished.

How to use a pessary

Each pessary comes in a foil blister pack, together with an applicator to help you insert it. Make sure the foil is not broken before you use it.

1. Wash your hands before you start.
2. Remove the applicator from the packet.
3. Pull the plunger (the thinner end of the applicator) out as far as it will go.
4. Take the pessary out of the blister pack.
5. Gently squeeze the holder (the wider end of the applicator) to open it.
6. Push the pessary into the application following the instructions that come in the medicine packet.
7. Lie on your back, bend your knees then let your knees fall to each side.
8. Gently put the applicator into your vagina and push it in as far as you can comfortably.
9. Holding the applicator in place, slowly press the plunger in until it stops moving.
10. Remove the applicator.
11. Throw the applicator away safely, out of the reach of children. Do not flush it down the toilet.
12. Wash your hands thoroughly when you've finished.

Only insert 1 pessary at a time. Do not use tampons or other vaginal products while you're using the pessary. Do not use pessaries during your period – wait until your period has finished.

How to use internal cream

1. Wash your hands before you start.
2. Remove the applicator from the packet.
3. The "internal" vaginal cream is already in the applicator. You will need to put the plunger into the applicator.
4. Carefully twist and pull off the cap following the instructions that come in the medicine packet.
5. Lie on your back, bend your knees then let your knees fall to each side.
6. Gently put the applicator into your vagina and push it in as far as you can comfortably.
7. Holding the applicator in place, slowly press the plunger in until it stops moving.
8. Remove the applicator.
9. Throw the applicator away safely, out of the reach of children. Do not flush it down the toilet.
10. Wash your hands thoroughly when you've finished.

It's quite common to notice a slight discharge after using the cream so it may help to wear a panty liner. This does not mean that the treatment has not worked.

What if I forget to use it?

If you forget to use a pessary or internal cream at bedtime, use it during the night if you remember. If you only remember the next day, wait until bedtime for your next dose. Pessaries and internal cream work best at night.

If you have forgotten for more than 1 day, your infection may not be treated properly. If you still have symptoms after you finish your course, speak to a doctor.

What if I use too much?

If you insert too many pessaries at once you may feel discomfort or irritation. Stop using the pessaries and see a doctor if the discomfort or irritation does not go away.

Only use 1 pessary a night, unless you're using a 100mg pessary, then you can use 2.

Like all medicines, clotrimazole can cause side effects in some people, although not everyone gets them.

Common side effects

Side effects from the external cream

Talk to a doctor or pharmacist if these side effects bother you or do not go away:

• red, irritated skin
• pain, burning or stinging sensation

If the side effects do not go away, try using smaller amounts of the cream or stop using it completely.

Side effects from the pessary or internal cream

Talk to your doctor or pharmacist if these side effects bother you or do not go away:

• discomfort or swelling in or around your vagina
• pain or burning/stinging after putting the pessary in
• lower stomach pain or pain in the pelvic area
• bleeding from the vagina

Side effects will usually go away when you stop using the pessaries or internal cream.

Serious allergic reaction

In rare cases, clotrimazole can cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of clotrimazole. For a full list, see the leaflet inside your medicine packet.

Clotrimazole pessaries and internal and external cream are generally considered safe to use during pregnancy.

Find out more about how clotrimazole can affect you and your baby during pregnancy by Best Use of Medicines in Pregnancy (BUMPS).

Clotrimazole and breastfeeding

Clotrimazole cream is generally considered safe to use while you're breastfeeding.

If you are using clotrimazole on your breasts, wash off any cream from your breasts before feeding your baby. Then wash your hands before you touch your nipple to your baby's mouth.

If your baby is being treated for oral thrush, you can carry on breastfeeding, but you'll need to be treated at the same time. Apply clotrimazole cream on and around your nipples after each time you breastfeed.

There are no known problems with using clotrimazole creams and taking other medicines.

However, tell a doctor before using clotrimazole pessaries if you are taking any of the following medicines:

• amphotericin, or other antifungal medicines like nystatin
• tacrolimus or sirolimus (given after transplant surgery, or to treat psoriasis or rheumatism)

Mixing clotrimazole with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements while using clotrimazole.