Candidiasis:
Oropharyngeal, mild disease, treatment: Oral: 10 mg dissolved slowly 5 times daily for 7 to 14 days (AST-IDCOP [Aslam 2019]; HHS [OI adult 2021]; IDSA [Pappas 2016]).
Oropharyngeal, chronic suppression for recurrent infection:
Note: Suppressive therapy is usually unnecessary; however, if given, some experts prefer a systemic azole (eg, fluconazole) (IDSA [Pappas 2016]; Kauffman 2021).
Oral: 10 mg dissolved slowly 3 times daily for the duration of immunosuppression (eg, chemotherapy or high-dose steroids).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Clotrimazole (oral): Pediatric drug information")
Candidiasis, oropharyngeal; treatment: Children ≥3 years and Adolescents: Oral: 10 mg troche dissolved slowly 5 times daily for 14 consecutive days. Note: When used for initial treatment in patients with HIV, duration of therapy is 7 to 14 days (HHS [OI adult 2016]; HHS [OI pediatric 2016]).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Troche, Mouth/Throat:
Generic: 10 mg
Yes
Oral: Allow troche to dissolve slowly in the mouth. Dissolution is complete in approximately 30 minutes.
Oral: Allow lozenge (troche) to slowly dissolve in mouth. Dissolution is complete in approximately 30 minutes.
Oropharyngeal candidiasis, mild disease, treatment: Local treatment of oropharyngeal candidiasis.
Oropharyngeal candidiasis, chronic suppression for recurrent infection: To reduce the incidence of oropharyngeal candidiasis in immunocompromised patients undergoing chemotherapy, radiotherapy, or steroid therapy utilized in the treatment of leukemia, solid tumors, or renal transplantation.
Clotrimazole may be confused with co-trimoxazole
Mycelex may be confused with Myoflex
Cloderm: Brand name for clotrimazole [Germany], but also brand name for alclomethasone [Indonesia]; clobetasol [China, India, Malaysia, Singapore, Thailand]; clocortolone [U.S., Canada]
Canesten [multiple international markets] may be confused with Canesten Bifonazol Comp brand name for bifonazole/urea [Austria]; Canesten Extra brand name for bifonazole [China, Germany]; Canesten Extra Nagelset brand name for bifonazole/urea [Denmark]; Canesten Fluconazole brand name for fluconazole [New Zealand]; Canesten Oasis brand name for sodium citrate [Great Britain]; Canesten Once Daily brand name for bifonazole [Australia]; Canesten Oral brand name for fluconazole [United Kingdom]; Cenestin brand name for estrogens (conjugated A/synthetic) [U.S., Canada]
Mycelex: Brand name for clotrimazole [U.S.] may be confused with Mucolex brand name for bromhexine [Malaysia]; carbocisteine [Thailand]
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Hepatic: Abnormal liver function tests
Frequency not defined:
Dermatologic: Pruritus
Gastrointestinal: Nausea, vomiting
Hypersensitivity to clotrimazole or any component of the formulation
Documentation of allergenic cross-reactivity for antifungals is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity can not be ruled out with certainty.
Concerns related to adverse effects:
• Hepatic effects: Abnormal LFTs have been reported, including abnormal aspartate aminotransferase (AST). Elevations are usually minimal. Monitor LFTs periodically, especially in patients with preexisting hepatic impairment.
Disease-related concerns:
• Hepatic impairment: Use with caution; abnormal LFTs have been reported. Elevations are usually minimal. Monitor LFTs periodically.
• Systemic fungal infection: Clotrimazole should not be used for treatment of systemic fungal infection.
Other warnings/precautions:
• Administration: Clotrimazole must be slowly dissolved in the mouth for maximum efficacy.
Inhibits CYP3A4 (weak)
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
ALPRAZolam: CYP3A4 Inhibitors (Weak) may increase the serum concentration of ALPRAZolam. Risk C: Monitor therapy
CarBAMazepine: CYP3A4 Inhibitors (Weak) may increase the serum concentration of CarBAMazepine. Risk C: Monitor therapy
CycloSPORINE (Systemic): CYP3A4 Inhibitors (Weak) may increase the serum concentration of CycloSPORINE (Systemic). Risk C: Monitor therapy
Dofetilide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Dofetilide. Risk C: Monitor therapy
Everolimus: Clotrimazole (Oral) may increase the serum concentration of Everolimus. Risk C: Monitor therapy
Finerenone: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Finerenone. Risk C: Monitor therapy
Flibanserin: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Flibanserin. Risk C: Monitor therapy
Ixabepilone: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Ixabepilone. Risk C: Monitor therapy
Lemborexant: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Lemborexant. Management: The maximum recommended dosage of lemborexant is 5 mg, no more than once per night, when coadministered with weak CYP3A4 inhibitors. Risk D: Consider therapy modification
Lomitapide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Lomitapide. Management: Patients on lomitapide 5 mg/day may continue that dose. Patients taking lomitapide 10 mg/day or more should decrease the lomitapide dose by half. The lomitapide dose may then be titrated up to a max adult dose of 30 mg/day. Risk D: Consider therapy modification
Lonafarnib: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Lonafarnib. Management: Avoid concurrent use of lonafarnib with weak CYP3A4 inhibitors. If concurrent use is unavoidable, reduce the lonafarnib dose to or continue at a dose of 115 mg/square meter. Monitor for evidence of arrhythmia, syncope, palpitations, or similar effects. Risk D: Consider therapy modification
Methysergide: Clotrimazole (Oral) may increase the serum concentration of Methysergide. Risk X: Avoid combination
Midazolam: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Midazolam. Risk C: Monitor therapy
NiMODipine: CYP3A4 Inhibitors (Weak) may increase the serum concentration of NiMODipine. Risk C: Monitor therapy
Pimozide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Pimozide. Risk X: Avoid combination
Simvastatin: CYP3A4 Inhibitors (Weak) may increase serum concentrations of the active metabolite(s) of Simvastatin. CYP3A4 Inhibitors (Weak) may increase the serum concentration of Simvastatin. Risk C: Monitor therapy
Sirolimus (Conventional): Clotrimazole (Oral) may increase the serum concentration of Sirolimus (Conventional). Risk C: Monitor therapy
Sirolimus (Protein Bound): CYP3A4 Inhibitors (Weak) may increase the serum concentration of Sirolimus (Protein Bound). Management: Reduce the dose of protein bound sirolimus to 56 mg/m2 when used concomitantly with a weak CYP3A4 inhibitor. Risk D: Consider therapy modification
Tacrolimus (Systemic): Clotrimazole (Oral) may increase the serum concentration of Tacrolimus (Systemic). Risk C: Monitor therapy
Triazolam: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Triazolam. Risk C: Monitor therapy
Ubrogepant: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Ubrogepant. Management: In patients taking weak CYP3A4 inhibitors, the initial and second dose (given at least 2 hours later if needed) of ubrogepant should be limited to 50 mg. Risk D: Consider therapy modification
Clotrimazole troches are an alternative treatment for oropharyngeal candidiasis in non-pregnant patients. However, local topical treatment of oropharyngeal candidiasis is preferred during pregnancy (HHS [OI adult] 2020).
It is not known if clotrimazole is present in breast milk following oral (troche) administration.
Consider KOH test or culture prior to treatment to confirm oropharyngeal candidiasis; periodic liver function tests during therapy.
Binds to phospholipids in the fungal cell membrane altering cell wall permeability resulting in loss of essential intracellular elements
Distribution: Oral: Inhibitory concentrations remain in the saliva for up to 3 hours after dissolution of the troche
Troche (Clotrimazole Mouth/Throat)
10 mg (per each): $1.43 - $3.44
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