Clotrimazole (clotrimazole)
Also sold as: Candid, Clotrin, Canesten, Fungizone
Pregnancy
Cat B
Lactation
Safe
Schedule
OTC
Forms
Cream 1% +8
Indications
- Tinea pedis (athlete's foot)
- Tinea corporis (ringworm)
- Tinea cruris (jock itch)
- Tinea versicolor (pityriasis versicolor)
- Cutaneous candidiasis
- Vulvovaginal candidiasis
- Oropharyngeal candidiasis (oral lozenge)
- Otomycosis (fungal ear infection)
- Nappy rash with fungal component (in combination)
Adult Dosing
Tinea corporis / tinea cruris / tinea pedis / cutaneous candidiasis (topical)
Apply 1% cream, solution, or powder thinly to affected area and 2 cm surrounding skin
Twice to three times daily for 2–4 weeks; tinea pedis may require up to 4 weeks
Continue for at least 2 weeks after symptoms clear to prevent relapse
Vulvovaginal candidiasis — short course
500mg vaginal pessary
Single insertion at bedtime
Single-dose treatment; may be used any time except during menstruation
Vulvovaginal candidiasis — standard course
100mg vaginal pessary once nightly or 200mg for 3 nights
6 nights (100mg) or 3 nights (200mg)
Vulvovaginal candidiasis — cream
2% vaginal cream, one applicatorful (5g)
Once nightly for 3–7 days
Oropharyngeal candidiasis (oral lozenge)
10mg lozenge dissolved slowly in mouth (do not chew)
Five times daily for 14 days
Dissolution should take 15–30 minutes; no food or water for 30 minutes after
Otomycosis (ear infection)
Apply 2–3 drops of 1% solution to ear canal
Twice to three times daily for 2–3 weeks
Pediatric Dosing
Topical clotrimazole is safe for infants and children. Vaginal forms not appropriate for prepubertal girls. Oral lozenge in children ≥3 years for oropharyngeal candidiasis (HIV/immunocompromised).
Pregnancy & Lactation
Pregnancy: Category B
Topical clotrimazole is considered safe throughout pregnancy — systemic absorption is negligible (<3%). Widely used for vulvovaginal candidiasis in pregnancy (preferred over oral azoles). Vaginal applicator should be used gently in pregnancy; pessary insertion by hand preferred in third trimester.
Lactation: Safe
Negligible systemic absorption from topical or vaginal use makes clotrimazole safe during breastfeeding. Avoid applying cream to nipple area just before feeding to prevent infant ingestion.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Tacrolimus (topical) | Theoretical additive immunosuppression at application site when used concurrently; clinical significance minimal | Minor |
| Condoms / diaphragms (latex) | Clotrimazole cream and pessaries contain oils that can damage latex condoms and diaphragms — contraceptive failure possible | Moderate |
| Oral CYP3A4 substrates (oral lozenge use) | Oral lozenge with systemic absorption may weakly inhibit CYP enzymes; clinically significant interactions rare with lozenges but theoretically possible | Minor |
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Side Effects
Common
- Local burning or stinging on application (transient)
- Itching or redness at application site
- Mild skin peeling or dryness (topical)
- Vaginal burning or discharge (vaginal forms)
- Nausea or vomiting (oral lozenge)
- Altered taste (oral lozenge)
Serious / Discontinue If
- Contact dermatitis (hypersensitivity) — rare, requires discontinuation
- Systemic allergic reaction — extremely rare given minimal absorption
- Liver enzyme elevation — reported with oral lozenge (5x use daily) due to some systemic absorption; usually mild and reversible
Contraindications
- Hypersensitivity to clotrimazole or imidazole antifungals
- Oral lozenge: not for systemic fungal infections (topical mucosal action only)
- Ophthalmic use (not suitable for eye infections)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Candid cream 1% | Glenmark | ₹85 for 15g tube |
| Canesten cream 1% | Bayer | ₹95 for 20g tube |
| Candid-B cream (clotrimazole + beclomethasone) | Glenmark | ₹68 for 15g tube |
Monitoring Required
- Clinical response at 2 weeks — if no improvement, reconsider diagnosis (non-dermatophyte infection, bacterial superinfection, or incorrect diagnosis)
- Skin tolerance at application site — watch for contact dermatitis
- For vaginal use: symptom resolution within 3–7 days; recurrent candidiasis (≥4 episodes/year) warrants investigation (diabetes, HIV, immunosuppression)
- Oral lozenge: LFTs if used long-term (>2 weeks) due to mild systemic absorption
Patient Counseling Points
- Wash and thoroughly dry the affected area before applying cream or powder
- Apply a thin layer — excessive application does not improve efficacy
- For vaginal pessary: insert at bedtime; lie down for at least 30 minutes after insertion for optimal distribution
- Vaginal cream/pessary may damage latex condoms and diaphragms — use alternative contraception during treatment and for 3 days after
- Complete the full course even if symptoms improve within 1–2 days — stopping early leads to relapse
- For athlete's foot: keep feet clean and dry, change socks daily, avoid sharing footwear
- For oral lozenge: dissolve slowly in mouth (15–30 min); do not chew or swallow whole; avoid eating or drinking for 30 minutes after
- Avoid covering treated skin with tight occlusive dressings unless advised
- Tinea versicolor: skin colour may take months to normalise even after successful treatment
- Recurrent vaginal thrush (>3 episodes/year) warrants a medical evaluation for underlying causes
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Clinically reviewed by: Dr. Meera Krishnan, MD (Medicine), DM (Infectious Diseases), PGIMER Chandigarh
Last reviewed: 2026-04-01
References
- Bayer Canesten (clotrimazole) Summary of Product Characteristics
- WHO Essential Medicines List — Antifungals section
- Central Drugs Standard Control Organisation (CDSCO) India prescribing information
- ACOG Practice Bulletin: Vaginitis including Vaginal Candidiasis (2020)
- UpToDate: Vulvovaginal candidiasis — treatment (2025)
- Indian Journal of Obstetrics and Gynaecology: Management of vulvovaginal candidiasis in pregnancy