From the Guidelines
Boric acid vaginal suppositories are a recommended treatment option for vulvovaginal candidiasis, particularly for recurrent infections or those caused by non-albicans Candida species, with a typical dosage of 600mg inserted vaginally once daily for 14 days. The use of boric acid suppositories is supported by the 2016 clinical practice guideline for the management of candidiasis by the Infectious Diseases Society of America 1. This guideline suggests that boric acid, contained in gelatin capsules, can be an effective treatment for vulvovaginal candidiasis, especially in cases where azole therapy is not successful.
The mechanism of action of boric acid suppositories involves restoring vaginal acidity, which creates an environment hostile to pathogenic organisms. They can be purchased over-the-counter or compounded by pharmacists. When using boric acid suppositories, it is essential to insert them at bedtime to minimize leakage, wear a panty liner, and avoid sexual intercourse during treatment. Possible side effects may include mild vaginal burning or irritation. Pregnant women should avoid using boric acid suppositories due to potential risks. If symptoms persist after completing treatment or if severe irritation occurs, it is crucial to discontinue use and consult a healthcare provider. It is also important to note that boric acid should never be taken orally as it can be toxic when ingested.
Some key points to consider when using boric acid vaginal suppositories include:
- They are effective against non-albicans Candida species, which can be resistant to azole therapy 1.
- The typical recommended dosage is 600mg inserted vaginally once daily for 14 days for acute infections, or 1-2 times weekly for maintenance therapy in women with recurrent infections.
- Boric acid suppositories can be used in combination with other treatments, such as topical antifungal agents, for recalcitrant cases.
- It is essential to follow the recommended dosage and administration instructions to minimize the risk of side effects and ensure effective treatment.
Overall, boric acid vaginal suppositories are a valuable treatment option for vulvovaginal candidiasis, particularly in cases where other treatments have failed or are not suitable. As always, it is crucial to consult a healthcare provider before starting any new treatment, especially if symptoms persist or worsen over time.
From the FDA Drug Label
Warnings For external Vaginal use only. Do not use • If you never had a vaginal yeast infection diagnosed by your doctor.• If you are allergic to any of the ingredients. Uses • treats vaginal yeast infections • relieves itching and discomfort due to vaginal yeast infection
- Indications: Boric acid vaginal suppositories are used to treat vaginal yeast infections and relieve itching and discomfort due to vaginal yeast infection 2 2.
- Contraindications: Do not use if you never had a vaginal yeast infection diagnosed by your doctor or if you are allergic to any of the ingredients 2.
- Precautions: Pregnant or Breast Feeding women should ask a Health Professional before use 2.
From the Research
Boric Acid Vaginal Suppositories
- Boric acid vaginal suppositories are used to treat vulvovaginal candidiasis (VVC) and recurrent bacterial vaginosis 3
- They are included in national guidelines for the treatment of VVC or recurrent bacterial vaginosis in the United Kingdom and the United States 3
- Boric acid is not a Food and Drug Administration-approved drug, and safety data are sparse 3
Efficacy of Boric Acid Vaginal Suppositories
- A study found that diabetic women with C. glabrata VVC showed higher mycological cure with boric acid vaginal suppositories compared to single-dose oral fluconazole 4
- Another study found that boric acid is a safe, alternative, economic option for women with recurrent and chronic symptoms of vaginitis when conventional treatment fails due to non-albicans Candida spp. or azole-resistant strains 5
- The mycologic cure rates with boric acid varied from 40% to 100% in patients treated with boric acid 5
Safety of Boric Acid Vaginal Suppositories
- Available data suggest that boric acid use is safe, at least when used in doses commonly described in the literature as being prescribed by clinicians 3
- Adverse effects caused by boric acid use include vaginal burning sensation, water discharge during treatment, and vaginal erythema 5
- Information on harms in pregnancy is limited, and data remain insufficient to change current guidelines, which recommend avoiding boric acid in pregnancy 3
Comparison with Other Treatments
- Boric acid was compared with other treatments such as nystatin, terconazole, flucytosine, itraconazole, clotrimazole, ketoconazole, fluconazole, buconazole, and miconazole in various studies 5
- A systematic review found that intravaginal preparations, including boric acid, are effective in treating VVC 6, 7