Medicines to treat vaginal thrush

Vaginal thrush is treated with antifungal medicines, which kill the fungal cells and prevent them from growing and reproducing.

Antifungal medicines for vaginal thrush are available as creams or pessaries that are inserted into your vagina, or capsules that are taken by mouth. They are available on prescription and some can be bought from your pharmacy without a prescription, after discussion with your pharmacist. To ensure you get the right product, your pharmacist will ask you a few questions regarding your symptoms, and recommend a suitable product for you, or may refer you to your doctor. Read more about vaginal thrush.

Vaginal creams and pessaries

There are a variety of vaginal creams and pessaries available in New Zealand. They come in different strengths and should be used for the amount of time specified on the directions for use. A single large dose inserted into your vagina is often enough to clear a bout of thrush. Otherwise a lower dose is used for several days. Vaginal creams and pessaries can be bought from your pharmacy without a prescription, after discussion with your pharmacist.

  • Vaginal creams come as a tube of cream together with special applicators that you need to fill with the cream. The applicator is used to measure the right dose of cream and enables insertion of cream inside your vagina. 
    Examples of vaginal creams include Clomazol®, Canestan®, Micreme® and Nilstat®.
  • Vaginal pessaries are compressed and moulded into a tablet that is inserted into your vagina with a special applicator, or they can be inserted carefully by hand. 
    Examples of vaginal pessaries include Canestan®.

Vaginal creams and pessaries are best applied at night, before bed. There are directions inside the packet and your pharmacist will explain to you how to use them.

Sometimes an antifungal cream can be applied to the opening of your vagina and surrounding area (called the 'vulva'). This may ease itching and clear infection on the outside of your vagina. This may be suitable in mild cases, or for girls under the age of 16 years. Ask your doctor or pharmacist for advice about these creams. 

Capsules taken by mouth

Fluconazole capsules can be prescribed for vaginal thrush. These work just as well as the vaginal creams and pessaries but relief can be more rapid.

  • The dose is a 150 mg capsule taken once, as a single dose, with a glass of water. 
  • The capsule can be taken with or without food.
  • Fluconazole 150 mg capsule can be bought from your pharmacy without a prescription, after discussion with your pharmacist.

Combination products

There are a few combination antifungal products available. These include: 

  • Canesoral Duo: fluconazole capsule + clotrimazole cream (the capsule treats the infection and the cream relieves discomfort).
  • Canesten: clotrimazole pessary + clotrimazole cream (the pessary treats the infection and the cream relieves discomfort).

Antifungal medicines – how to choose

The choice of antifungal medicines depends on a number of things. Your doctor or pharmacist will discuss the best option for you. The following are examples of the sorts of things to consider.

  • Whether you are pregnant: Fluconzaole is not recommended for use in pregnancy or if you are planning a pregnancy. Pregnant woman can use the vaginal cream but take care when inserting the vaginal cream using an applicator so that there is no contact with the cervix. Some women may prefer to use vaginal pessaries (without applicator) to avoid any risk.
  • How often you get vaginal thrush: Over-the-counter products may not be adequate if the infection occurs frequently.  
  • Whether you use latex condoms or diaphragms: Creams and pessaries can damage them and make them less reliable, increasing the risk of pregnancy. 
  • Whether you are taking other medicines: Some medicines may interact with some antifungal products.  
  • Your age: Girls under the age of 16 and women over 60 should ask their doctor for advice.
  • Your preference: Some women may find using the cream or pessary messy and uncomfortable.
  • Side effects: The cream and pessaries can cause irritation of your vagina, such as redness, itch and swelling. Fluconazole can cause nausea (feeling sick) and headache.

Recurrent vaginal thrush

For women with recurrent thrush (more than twice in 6 months) it is best to see your doctor for further advice. Your doctor may prescribe antifungal medication that needs to be used for a longer time.  

Probiotics

There is no evidence that taking or using Lactobacillus acidophilus (or other probiotics) will help treat vaginal thrush. There is, however, no evidence of harm with their use. Using a probiotic alongside antifungal treatment for thrush may help control the condition in the short term, but not necessarily for recurrent thrush. Read more about probiotics

References

  1. Vulvovaginal health in premenopausal women BPAC, NZ, 2011
  2. Fungal infections New Zealand Formulary
  3. Thrush – detection and management in community pharmacy The Pharmaceutical Journal, 2018
Credits: Sandra Ponen, pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 17 Apr 2019