What is the use of oral Clotrimazole (antifungal medication)?

From the Guidelines

Oral clotrimazole is recommended for mild oropharyngeal candidiasis at a dosage of 10 mg 5 times daily for 7-14 days. This recommendation is based on the most recent and highest quality study available, which is the 2016 update by the Infectious Diseases Society of America 1. The study suggests that clotrimazole troches, 10 mg 5 times daily, are a recommended treatment for mild disease, with a strong recommendation and high-quality evidence.

Key Points to Consider

• The dosage and duration of treatment should be individualized based on the severity of the infection and the patient's response to therapy.
• Patients should be advised to avoid eating or drinking for 30 minutes after using the medication to maximize contact time with infected tissues.
• Common side effects of oral clotrimazole include nausea, vomiting, or unpleasant taste, and the medication may not be suitable for patients with liver disease or those taking certain medications that interact with azole antifungals.
• For moderate to severe disease, oral fluconazole at a dosage of 100-200 mg daily for 7-14 days is recommended, as stated in the 2016 update 1.
• The 2016 update also recommends itraconazole solution or posaconazole suspension for fluconazole-refractory disease, with a strong recommendation and moderate-quality evidence 1.

Important Considerations

• The patient's immune status and overall health should be taken into account when selecting a treatment regimen.
• The potential for drug interactions and the patient's medical history should be carefully evaluated before initiating therapy.
• The patient should be monitored for signs of treatment failure or adverse effects, and the treatment regimen should be adjusted as needed.
• As stated in the 2009 update, chronic suppressive therapy is usually unnecessary for patients with HIV infection, but if required, fluconazole at a dosage of 100 mg 3 times weekly is recommended 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Clotrimazole is a broad-spectrum antifungal agent that inhibits the growth of pathogenic yeasts by altering the permeability of cell membranes. After oral administration of a 10 mg clotrimazole troche to healthy volunteers, concentrations sufficient to inhibit most species of Candida persist in saliva for up to three hours following the approximately 30 minutes needed for a troche to dissolve The long term persistence of drug in saliva appears to be related to the slow release of clotrimazole from the oral mucosa to which the drug is apparently bound Repetitive dosing at three hour intervals maintains salivary levels above the minimum inhibitory concentrations of most strains of Candida; In another study, the mean serum concentrations were 4.98 ± 3.7 and 3.23 ± 1. 4 nanograms/mL of clotrimazole at 30 and 60 minutes, respectively, after administration as a troche.

Oral Clotrimazole is used as an antifungal agent.

• The drug is administered orally in the form of a troche, which is a large, slowly dissolving tablet (lozenge) containing 10 mg of clotrimazole.
• Key Points:
  • Concentrations of clotrimazole sufficient to inhibit most species of Candida persist in saliva for up to three hours after administration.
  • Repetitive dosing at three hour intervals maintains salivary levels above the minimum inhibitory concentrations of most strains of Candida.
  • Mean serum concentrations of clotrimazole were measured in a study, with levels of 4.98 ± 3.7 and 3.23 ± 1.4 nanograms/mL at 30 and 60 minutes, respectively, after administration as a troche 2.

From the Research

Oral Clotrimazole

• Oral clotrimazole is used to treat oral candidiasis, also known as thrush, in patients with HIV infection 3, 4, 5, 6, 7.
• Clotrimazole troches are a common treatment for thrush in patients with HIV infection, and have been shown to be effective in treating the condition 3, 4, 5.
• However, studies have shown that fluconazole is more effective than clotrimazole in eradicating Candida from the oral flora and providing a more prolonged disease-free state 3, 4, 5.
• Clotrimazole has been found to be just as effective as fluconazole for resolution of clinical symptoms, except when patient compliance is poor 6.
• The use of clotrimazole troches has been compared to fluconazole in several studies, with fluconazole being shown to be more effective in preventing fungal infections, including cryptococcosis and esophageal candidiasis 7.
• The dosage of clotrimazole troches is typically 10 mg taken five times daily 3, 4, 5, 7.
• Side effects of clotrimazole troches are generally mild, but can include liver enzyme elevations and other adverse effects 3, 5.