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(kloe-TRIM-uh-zole)
Cruex, Desenex, Fungoid, Gyne-Lotrimin 3, Gyne-Lotrimin 3 Combo Pack, Gyne-Lotrimin 7, Gyne-Lotrimin Combination Pack, Lotrimin, Lotrimin AF, Mycelex, Mycelex-7, Mycelex 7 Combo Pack, Mycelex-G, Mycelex Twin Pack, Sweet’n fresh Clotrimazole,  Canesten, Clotrimaderm, Myclo
Class: Topical/Antifungal

 Action Inhibits yeast growth by increasing cell membrane permeability in susceptible fungi.

 Indications

Topical use: Treatment of tinea pedis (athlete’s foot), tinea cruris (jock itch), tinea corporis (ringworm), candidiasis and tinea versicolor. Oral use (troche): Treatment of oropharyngeal candidiasis; prophylaxis of oropharyngeal candidiasis in specific groups of immunocompromised patients. Vaginal use: Treatment of vulvovaginal candidiasis.

 Contraindications Standard considerations.

 Route/Dosage

Oropharyngeal Candidiasis

ADULTS & CHILDREN > 3 YR: PO One 10 mg troche (lozenge) dissolved slowly in mouth 5 times/day for 14 days.

Prophylaxis

PO One 10 mg troche dissolved slowly in mouth tid.

Dermal Infections

Topical cream Apply thin layer to affected and surrounding areas bid, AM and PM. Topical lotion Apply thin layer to affected areas twice daily.

Vaginal Infections

WOMEN & GIRLS > 12 YR: Intravaginal Insert 1 applicatorful (5 g) of cream or one 100 mg tablet at bedtime for 7–14 days (treatment for 14 days may yield higher cure rate), or insert one 500 mg tablet one time only, preferably at bedtime. Gyne-Lotrimin Combination Pack Insert tablet intravaginally at bedtime for 7 consecutive days. Apply topical cream to affected areas twice daily (morning and evening) for 7 consecutive days. Mycelex 7 Combination Pack Insert suppository intravaginally at bedtime for 7 consecutive days. Apply topical cream to affected area twice daily (morning and evening) for 7 consecutive days.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

EENT: Unpleasant mouth sensations (troche). GI: Nausea (troche); vomiting; abdominal cramps; bloating. HEPA: Abnormal liver function test results. DERM: Topical and vaginal products: Erythema; stinging; blistering; peeling; edema; pruritus; urticaria; burning; general skin irritation; rash.

 Precautions

Pregnancy: Category C (troches); Category B (topical and vaginal use). Lactation: Undetermined. Children: Safety not established in children < 3 yr. Recurrent infections: May indicate underlying medical cause, including diabetes or HIV infection. Systemic or ophthalmic infections: Do not use for these conditions.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Ensure that patient dissolves troche slowly in mouth over 15–30 min.
  • Apply topical cream or solution to affected and surrounding areas. Wear latex gloves for application.
  • Store drug at room temperature. Do not freeze.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Troche: Assess for nausea and vomiting, abdominal cramps, discomfort or unpleasant mouth sensations.
  • Topical and vaginal products: Assess for blistering, edema, pruritus, burning or rash.
  • Patients with diabetes mellitus, patients taking antibiotics, oral contraceptives or steroids and people with decreased immunity may experience recurrent vaginal candidiasis.

 Patient/Family Education

  • Instruct patient to practice birth control by refraining from sexual intercourse. Caution patient to avoid use of oral contraceptives.
  • Teach pregnant woman in second and third trimesters to manually insert tablets (not to use applicator).
  • Instruct patient in good hygiene practice (eg, handwashing before and after each application) and methods of preventing spread of fungus to other parts of body and to others in household (especially if ringworm or athlete’s foot is source of infection).
  • Emphasize importance of avoiding contact of medication with eyes.
  • Explain to patient using vaginal cream or tablets that to reduce risk of reinfection it is important to refrain from sexual intercourse during therapy.
  • Instruct patient to stop using medication if burning or blistering occurs and to contact physician.
  • Advise patient to use medication continuously, even during menses. Emphasize that tampons should not be used.
  • Tell patient that if symptoms do not improve in 1 wk, to discontinue medication and notify physician.

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