Clotrimazole

Administration

• Type: Antifungal, azole
• Dosage Forms
  • Topical:1% cream
  • Vaginal: 100mg supp, 200mg supp; 1% cream, 2% cream
  • Oropharyngeal: 10mg troche
• Routes of Administration: topical, oropharyngeal, vaginal
• Common Trade Names
  • Topical: Anti-Fungal Liquid, Desenex AF Prescription Strength, FungiCURE Pump Spray, Lotrimin AF Cream, Lotrimin AF For Her, Lotrimin AF Jock Itch, Lotrimin AF Solution, Lotrimin Jock Itch Powder, MPM Anti-Fungal, Prescription Strength Cruex
  • Vulvovaginal: Clotrimazole-3, Clotrimazole-7, Femcare, Gyne-Lotrimin, Gyne-Lotrimin 3 Day, Gyne-Lotrimin Combo Pack
  • Oropharyngeal: Mycelex Troche

Adult Dosing

• Topical
  • Candidiasis, cutaneous
    • Apply bid
  • Tinea
    • Apply bid
    • 2-4 wks for best results with corporis, cruris, pedis, versicolor
• Vulvovaginal
  • candidiasis, vulvovaginal
    • 200mg PV qhs x3 days
    • Alt: 100mg PV qhs x7 days
    • Alt: 1 applicatorful 2% PV qhs x3 days
    • Alt: 1 applicatorful 1% PV qhs x7-14 days
• Oropharyngeal
  • candidiasis treatment, oropharyngeal
    • 10mg PO 5x/day x14 days
      • slowly dissolve in mouth; do not chew or swallow whole
  • candidiasis prophylaxis, oropharyngeal
    • 10mg PO tid
      • continue for duration of chemo or high-dose steroid; slowly dissolve in mouth; do not chew or swallow whole

Pediatric Dosing

Same as adult

Special Populations

• Pregnancy Rating: B (topical, vulvovaginal), C (oropharyngeal)
• Lactation risk: Probably safe (topical, vulvovaginal), Safety unknown (oropharyngeal)

Renal Dosing

• Adult:
• Pediatric:

Hepatic Dosing

• Adult: Precaution with troches. Monitor LFTs.
• Pediatric:

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

may occur but none reported

Common

• Topical
  • irritation
  • burning/stinging
  • pruritus
  • erythema
  • localized edema
  • urticaria
  • peeling
  • blistering
• Vulvovaginal
  • vulvovaginal burning
  • vulvovaginal pruritus
  • vulvovaginal soreness
  • vulvovaginal swelling
  • pelvic pain
  • pelvic cramps
  • abdominal pain
• Oropharyngeal
  • vomiting
  • nausea
  • abdominal cramps
  • abnormal LFTs

Pharmacology

• Half-life: Unknown
• Metabolism: liver; CYP450: unknown; Info: minimal systemic absorption
• Excretion: bile/feces primarily, urine

Mechanism of Action

• Exact mechanism of action unknown
• Azole antifungal
  • Inhibits 14-alpha demethylase, reducing fungal cell membrane ergosterol synthesis and increasing cellular permeability

References

• Epocrates: clotrimazole-oropharyngeal
• Epocrates:clotrimazole-topical
• Epocrates: clotrimazole-vaginal

Authors

Amr Badawy, Ross Donaldson, Daniel Ostermayer, Neil Young