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 the 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 the 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 the vagina. Examples of vaginal creams include Clomazol®, Canestan®, Micreme® and Nilstat®.
  • Vaginal pessaries are compressed and moulded into a tablet that is inserted into the 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 give you directions on how to use them.    

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

Capsules taken by mouth

There are two types of antifungal capsules that can be prescribed for vaginal thrush. These have similar effectiveness to the vaginal treatments but relief can be more rapid.

Medicine  Description
Fluconazole
  • 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.
Itraconazole
  • The dose is two capsules, twice daily for one day OR two capsules, once daily for 3 days.
  • This is available on prescription only. 

Combination products

There are a few combination antifungal products available. For example: 

  • fluconazole capsule + cream
  • pessary + cream.

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.

  • Are your pregnant: fluconzaole and itraconazole are 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.  
  • Are you using latex condoms or diaphragms: creams and pessaries can damage them and make them less reliable, increasing the risk of pregnancy. 
  • Are you taking other medicines: some medicines may interact with some antifungal products.  
  • Your age: women under the age of 16 or 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 the vagina such as redness, itch and swelling. Fluconazole and itraconazole 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, 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