INN monograph
Clotrimazole: 1% cream 20gm and 500mg pessary
Antifungal · POM
Verified · Updated 01 Aug 2026 · Source: Local active-ingredient clinical extract; Professional class pharmacology (Antifungal)
Kenya market
Wholesale / list prices where loaded
Risk first
Contraindications
- Hypersensitivity.
- Many systemic azoles contraindicated with certain CYP3A4 substrates (e.g. some statins, quinidine) — check labels.
- Terfenadine/astemizole historical QT combinations.
Precautions
- Hepatotoxicity monitoring for systemic azoles.
- QT prolongation (some azoles).
- Voriconazole: visual disturbances, photosensitivity, skin cancer risk long-term.
- Confirm species for invasive disease.
Point of care
Dosing
Adult
Insert the pessary high into the vagina preferably at night The cream should be thinly and evenly applied to the area around the entrance of the vagina, 2-3 times a day and rubbed in until the symptoms disappear
Paediatric
See label paediatric section if present; otherwise use paediatric formulary — do not extrapolate adult doses.
Renal
Fluconazole dose-adjust in CKD; amphotericin nephrotoxicity high-alert.
- CrCl 0–120: Confirm renal dosing in product SmPC / primary label.
Hepatic
Monitor LFTs for courses >14 days or higher-risk patients.
Safety
Drug interactions
- Match agent to site and species.
- For tinea, continue topical beyond clearance.
- Invasive fungal disease needs ID/specialist input and source control.
Safety
Adverse effects
- GI upset, rash, raised LFTs.
- Serious: hepatitis, severe skin reactions, arrhythmias, infusion reactions (amphotericin).
Use
Indications
- Treatment of candidal vaginitis and vulvitis Clinical selection for Clotrimazole: 1% cream 20gm and 500mg pessary should follow culture results where relevant, Kenya STG/EML recommendations, and the current product SmPC.
- Class context: Antifungal.
- Confirm site-specific dose, duration and monitoring before prescribing.
Pharmacology
Mode of action
Azoles inhibit fungal CYP51 (lanosterol 14α-demethylase), depleting ergosterol and disrupting membrane integrity.
Full mechanism text
Azoles inhibit fungal CYP51 (lanosterol 14α-demethylase), depleting ergosterol and disrupting membrane integrity. Terbinafine inhibits squalene epoxidase. Polyenes bind ergosterol creating membrane pores. Echinocandins inhibit β-glucan synthase (cell wall).
ADME
Pharmacokinetics & PD
| Onset | Days for clinical response (varies) |
|---|---|
| Duration | Days–weeks per indication |
| Route | ORAL / TOPICAL / IV |
| Metabolism | with major interactions. Topicals: minimal systemic |
Full PK/PD text
Fluconazole: excellent bioavailability, renal excretion, CSF penetration. Itraconazole/voriconazole: complex absorption and CYP metabolism with major interactions. Topicals: minimal systemic absorption when intact skin.
Kenya
Brands & prices
| Brand | Company | Pack | KES |
|---|---|---|---|
| Unisten Combi Pack | Regal Pharmaceuticals | Standard Commercial Pack | — |
Special populations
Pregnancy & lactation
Pregnancy
Systemic azoles often avoided in pregnancy (fluconazole high-dose teratogenicity signal); topical clotrimazole commonly used for VVC.
Lactation
Topicals usually fine; systemic — agent-specific.
Diet
Food & alcohol
- Food
- Food
Trust
Sources & disclaimer
Source: Local active-ingredient clinical extract; Professional class pharmacology (Antifungal)
Last reviewed: 01 Aug 2026
Decision support only — not a substitute for clinical judgment, product SmPC, or Kenya STG/EML.