Affects the permeability of the fungal cell wall, allowing leakage of cellular contents. Not active against bacteria.
Therapeutic effects:
Inhibited growth and death of susceptible Candida, with decrease in accompanying symptoms of vulvovaginitis (vaginal burning, itching, discharge).
Pharmacokinetics⬆⬇
Absorption: Minimal through intact skin.
Distribution: Unknown. Action is primarily local.
Metabolism/Excretion: Negligible with local application.
Half-Life: Not applicable.
Time/Action Profile⬆⬇
ROUTE
ONSET
PEAK
DURATION
cream
Unknown
8–24 hr
Unknown
tablet
Unknown
1–2 days
Unknown
Contraind./Precautions⬆⬇
Contraindicated in:
Hypersensitivity to active ingredients, additives, or preservatives;
Lactation: Safety not established.
Use Cautiously in:
Patients with recurrent vulvovaginal yeast infections.
Adv. Reactions/Side Effects⬆⬇
GU: itching, soreness, vulvovaginal burning
Interactions⬆⬇
Drug-drug:
Not known.
Route/Dosage⬆⬇
(Adults and Children > 12 yr): Vaginal tablets: 200 mg at bedtime for 3 nights or 500 mg as single dose at bedtime. Vaginal cream: 1 applicatorful (5 g) of 1% cream at bedtime for 7 days or 1 applicatorful (5 g) of 2% cream at bedtime for 3 days.
Availability⬆⬇
(Generic available)
Vaginal tablets: 200 mgOTC; 500 mgOTC
Vaginal cream: 1%OTC; 2%OTC; 10%OTC
Assessment⬆⬇
Inspect involved areas of skin and mucous membranes before and frequently during therapy. Increased skin irritation may indicate need to discontinue medication.
Implementation⬆⬇
Consult health care professional for proper cleansing technique before applying medication.
Applicators are supplied for vaginal administration.
Patient/Family Teaching⬆⬇
Instruct patient to apply medication as directed for full course of therapy, even if feeling better. Therapy should be continued during menstrual period.
Advise patient to avoid using tampons while using this product.
Instruct patient on proper use of vaginal applicator. Medication should be inserted high into the vagina at bedtime. Instruct patient to remain recumbent for at least 30 min after insertion. Advise use of sanitary napkins to prevent staining of clothing or bedding.
Advise patient to dispose of applicator after each use.
Advise patient to refrain from sexual contact during therapy. Vaginal medication may cause minor skin irritation in sexual partner. Advise patient that this medication may weaken latex or rubber contraceptive products, including condoms and diaphragms. Another method of contraception should be used during treatment.
Caution patient to avoid using tampons, douches, spermacides, or other vaginal products during therapy.
Advise patient to report to health care professional increased skin irritation or lack of response to therapy. A second course may be necessary if symptoms persist.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Advise patient that therapeutic response is usually seen after 1 wk. Before a second course of therapy is initiated, diagnosis should be reconfirmed with smears or cultures to rule out other pathogens associated with vulvovaginitis. Recurrent vaginal infections may be a sign of systemic illness.
Evaluation/Desired Outcomes⬆⬇
Decrease in skin irritation and vaginal discomfort.