CLOTRIMAZOLE

CLOTRIMAZOLE
(kloe-trim'a-zole)
Canesten , Gyne-Lotrimin, Gyne-Lotrimin-3, Lotrimin, Mycelex, Mycelex-G
Classifications: antibiotic; azole antifungal;
Therapeutic: antibiotic
; antifungal, azole
Prototype: Fluconazole
Pregnancy Category: B (topical); C (oral)

Availability

1% cream, solution, lotion; 10 mg troches; 100 mg, 200 mg, 500 mg vaginal tablets; 1% vaginal cream

Action

Acts by altering fungal cell membrane permeability, permitting loss of phosphorous compounds, potassium, and other essential intracellular constituents with consequent loss of ability to replicate.

Therapeutic Effect

Has broad-spectrum fungicidal activity. Active against a wide variety of fungi, yeast, dermatophytes and certain gram-positive bacteria.

Uses

Dermal infections including tinea pedis, tinea cruris, tinea corporis, tinea versicolor; also vulvovaginal and oropharyngeal candidiasis.

Unlabeled Uses

Trichomoniasis.

Contraindications

Ophthalmic uses; systemic mycoses. Safe use during pregnancy (category C for oral troches, category B for topical preparations), and in children <3 y not established.

Cautious Use

Hyersensitivity to other azole antifungals; hepatic impairment, diabetes mellitus; HIV; lactation.

Route & Dosage

Dermal Infections
Adult: Topical Apply small amount onto affected areas b.i.d. a.m. and p.m.

Vulvovaginal Infections
Adult: Intravaginal Insert 1 applicator full or one 100 mg vaginal tablet into vagina at bedtime for 7 d, or one 500 mg vaginal tablet at bedtime for 1 dose

Oropharyngeal Candidiasis
Adult/Child: PO 1 troche (lozenge) 5 times/d q3h for 14 d

Administration

  • Instruct patient taking the oral lozenge to allow it to dissolve slowly in mouth over 15–30 min for maximum effectiveness.
  • Apply skin cream and solution preparations sparingly. Protect hands with latex gloves when applying medication.
  • Avoid contact of clotrimazole preparations with the eyes.
  • Do not use occlusive dressings unless directed by physician to do so.
  • Consult physician about skin cleansing procedure before applying medication. Regardless of procedure used, dry skin thoroughly.
  • Store cream and solution formulations at 15°–30° C (59°–86° F); do not store troches or vaginal tablets above 35° C (95° F) unless otherwise directed.

Adverse Effects (≥1%)

GI: Abnormal liver function tests; occasional nausea and vomiting (with oral troche). Skin: Stinging, erythema, edema, vesication, desquamation, pruritus, urticaria, skin fissures. Urogenital: Mild burning sensation, lower abdominal cramps, bloating, cystitis, urethritis, mild urinary frequency, vulval erythema and itching, pain and vaginal soreness during intercourse.

Interactions

Drug: Intravaginal preparations may inactivate spermicides.

Pharmacokinetics

Absorption: Minimal systemic absorption; minimally absorbed topically. Peak: High saliva concentrations <3 h; high vaginal concentrations in 8–24 h. Metabolism: In liver. Elimination: Eliminated as metabolite in bile.

Nursing Implications

Assessment & Drug Effects

  • Evaluate effectiveness of treatment. Report any signs of skin irritation with dermal preparations.
  • Anticipate signs of clinical improvement within the first week of drug use.

Patient & Family Education

  • Use clotrimazole as directed and for the length of time prescribed by physician.
  • Generally, clinical improvement is apparent during first week of therapy. Report to physician if condition worsens or if signs of irritation or sensitivity develop, or if no improvement is noted after 4 wk of therapy.
  • If receiving the drug vaginally, your sexual partner may experience burning and irritation of penis or urethritis; refrain from sexual intercourse during therapy or have sexual partner wear a condom.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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