clotrimazole + fluconazole: clinical use

Prescribing considerations

• Confirm symptoms are consistent with candidiasis; investigate first presentations, uncertain diagnosis, frequent recurrence, possible sexually transmitted infection or atypical symptoms.
• The selected pharmacy product is not recommended for people younger than 16 or older than 60 without medical assessment.
• Review liver or kidney disease, previous azole reactions, cardiac disease, electrolyte disturbance and concomitant medicines.
• Consider non-albicans Candida or reduced fluconazole susceptibility when treatment fails.

Contraindications and cautions

• Hypersensitivity to fluconazole, clotrimazole, related azoles or product excipients.
• Concurrent cisapride, astemizole, terfenadine, pimozide, quinidine or erythromycin because of QT-related cardiotoxicity.

Monitoring

• Routine laboratory monitoring is not normally required for straightforward pharmacy use, but assess promptly if hepatic, severe cutaneous, neurological or cardiac symptoms occur.
• For clinically relevant interacting medicines, monitor the appropriate parameter, such as INR, creatine kinase, drug concentration, renal function or clinical toxicity.
• Consider ECG and electrolyte assessment when significant proarrhythmic risk factors or interacting QT-prolonging medicines are present.

Clinical pharmacology

Fluconazole is a systemically absorbed triazole with high oral bioavailability and mainly renal elimination. Clotrimazole is a locally acting imidazole with minimal systemic absorption from external application. Both inhibit fungal ergosterol synthesis.

Formulation and product differences

• The oral capsule treats infection systemically; the cream is for external genital skin and symptom control.
• The capsule contains lactose. The cream contains cetostearyl alcohol and benzyl alcohol, which can cause local or allergic reactions.
• The cream is external only and may impair latex contraceptives.