lSIDE-EFFECTS
▶Common or very commonPelvic discomfort.vulvovaginal
candidiasis.vulvovaginal disorders
▶UncommonMenstrual cycle irregularities.vaginal
haemorrhage
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Vaginal gel
EXCIPIENTS:May contain Disodium edetate, hydroxybenzoates
(parabens), propylene glycol
▶Metronidazole (Non-proprietary)
Metronidazole 7.5 mg per 1 gramMetronidazole 0. 75 % vaginal gel
| 40 gramPsDT = £ 4. 31
▶Zidoval(Meda Pharmaceuticals Ltd)
Metronidazole 7.5 mg per 1 gramZidoval 0. 75 % vaginal gel|
40 gramP£ 4. 31 DT = £ 4. 31
CARBOXYLIC ACIDS
Lactic acid
lINDICATIONS AND DOSE
BALANCE ACTIV RX®GEL
Prevention of bacterial vaginosis
▶BY VAGINA
▶Child: 5 mL 1 – 2 times a week, insert the content of 1
tube ( 5 mL)
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
shellfish allergy.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Products without form
EXCIPIENTS:May contain Propylene glycol
▶Balance Activ(BBI Healthcare Ltd)
Balance Activ BV vaginal pH correction gel| 7 device £ 5. 25
4.1b Vaginal and vulval fungal
infections
Other drugs used for Vaginal and vulval fungal infections
Fluconazole, p. 374
ANTIFUNGALS›IMIDAZOLE
Clotrimazole
lINDICATIONS AND DOSE
Superficial sites of infection in vaginal and vulval
candidiasis (dose for 1 %or 2 % cream)
▶BY VAGINA USING CREAM
▶Child:Apply 2 – 3 times a day, to be applied to
anogenital area
Vaginal candidiasis (dose for 10 % intravaginal cream)
▶BY VAGINA USING VAGINAL CREAM
▶Child: 5 gfor 1 dose, one applicatorful to be inserted
into the vagina at night, dose can be repeated once if
necessary
Vaginal candidiasis
▶BY VAGINA USING PESSARIES
▶Child: 200 mg for 3 nights, course can be repeated once
if necessary, alternatively^500 mg for^1 night, dose can
be repeated once if necessary
Recurrent vulvovaginal candidiasis
▶BY VAGINA USING PESSARIES
▶Child: 500 mg every week for 6 months, dose to be
administered following topical imidazole for
10 – 14 days
lUNLICENSED USEConsult product literature for individual
preparations.
lCAUTIONSAvoid intravaginal preparations (particularly
those that require use of an applicator) in young girls who
are not sexually active, unless there is no alternative
lINTERACTIONS→Appendix 1 : antifungals, azoles
lSIDE-EFFECTSAbdominal pain.discomfort.dyspnoea.
genital peeling.hypotension.oedema.paraesthesia.
pelvic pain.skin reactions.syncope.vaginal haemorrhage
lCONCEPTION AND CONTRACEPTIONCream and pessaries
may damage latex condoms and diaphragms.
lPREGNANCY
Dose adjustmentsPregnant women need a longer duration
of treatment, usually about 7 days, to clear the infection.
Oral antifungal treatment should be avoided during
pregnancy.
lEXCEPTIONS TO LEGAL CATEGORYBrands for sale to the
public includeCanesten®Internal Cream.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Pessary
EXCIPIENTS:May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), polysorbates
▶Clotrimazole (Non-proprietary)
Clotrimazole 500 mgClotrimazole 500 mg pessaries| 1 pessaryp
£ 3. 57 DT = £ 3. 57
▶Canesten (clotrimazole)(Bayer Plc)
Clotrimazole 100 mgCanesten 100 mg pessaries| 6 pessaryp
£ 3. 50 DT = £ 3. 50
Clotrimazole 200 mgCanesten 200 mg pessaries| 3 pessaryp
£ 3. 10 DT = £ 3. 10
Clotrimazole 500 mgCanesten 500 mg Soft Gel pessaries|
1 pessaryp£ 6. 99 DT = £ 3. 57
Canesten 500 mg pessaries| 1 pessarypsDT = £ 3. 57
Canesten Vaginal 500 mg pessaries| 1 pessaryP£ 2. 00 DT = £ 3. 57
Cream
EXCIPIENTS:May contain Benzyl alcohol, cetostearyl alcohol (including
cetyl and stearyl alcohol), polysorbates
▶Clotrimazole (Non-proprietary)
Clotrimazole 10 mg per 1 gramClotrimazole 1 % cream|
20 gramp£ 2. 06 DT = £ 0. 72 | 50 gramp£ 5. 45 DT = £ 1. 80
▶Canesten (clotrimazole)(Bayer Plc)
Clotrimazole 10 mg per 1 gramCanesten 1 % cream| 20 gramp
£ 2. 20 DT = £ 0. 72 | 50 gramp£ 3. 50 DT = £ 1. 80
Canesten Antifungal 1 % cream| 20 gramp£ 1. 85 DT = £ 0. 72
Clotrimazole 20 mg per 1 gramCanesten 2 % thrush cream|
20 gramp£ 4. 76 DT = £ 4. 76
Clotrimazole 100 mg per 1 gramCanesten 10 % VC cream|
5 gramP£ 4. 50 DT = £ 6. 23
Econazole nitrate
lINDICATIONS AND DOSE
GYNO-PEVARYL®ONCE
Vaginal and vulval candidiasis
▶BY VAGINA
▶Child: 1 pessary for 1 dose, pessary to be inserted at
night, dose to be repeated once if necessary
GYNO-PEVARYL®PESSARY
Vaginal and vulval candidiasis
▶BY VAGINA
▶Child: 1 pessary daily for 3 days, pessary to be inserted
at night, course can be repeated once if necessary
BNFC 2018 – 2019 Vaginal and vulval fungal infections 515
Genito-urinary system
7