5 OTC treatments
Azoles are synthetic antimycotic agents that act by inhibiting replication of yeast cells through interfering with the synthesis of ergosterol, the main sterol in the yeast cell membrane. Azoles available without prescription for treatment of vaginal thrush are fluconazole and clotrimazole.
Fluconazole is presented as a single-dose 150mg oral capsule. It is well absorbed when taken by mouth, and symptoms usually improve 12–24 hours after administration. Adverse effects are generally mild and mainly gastrointestinal. Fluconazole interacts with a number of drugs, including those metabolised by cytochrome P450 enzymes, but interactions are unlikely to be clinically significant with a single dose of fluconazole.
Clotrimazole is only used topically because of adverse effects when given orally and varying absorption rates, and because it is metabolised in the liver to inactive compounds. It is available for intravaginal use as a single 500mg pessary, a 5g prefilled single application of 10% cream, and 2% cream available for twice or three times daily application to the external genitalia. Symptoms usually begin to improve more quickly than with oral fluconazole. Night-time use is recommended for intravaginal preparations.