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Thrush or BV?Understanding the difference
10-minute module
Many women across the UK face obstacles to receiving the healthcare they need.1 Almost 30% of women feel uncomfortable speaking to healthcare professionals (HCPs) about their gynaecological issues, and more than 5 in 6 (84%) say there have been instances where HCPs have not listened to their concerns.2 A lack of good communication and awareness can lead to common conditions such as thrush and bacterial vaginosis (BV) going untreated or being misdiagnosed, which can lead to potential health complications.
Pharmacy teams play a key role in supporting women’s health by encouraging meaningful conversations to help reduce the stigma and shame that many women feel when addressing their vaginal health.3
Learning objectives
Understand the impact of the vaginal microbiome in thrush and BV
Recognise the key differences between these conditions
Identify appropriate products to recommend for thrush and BV
Be able to empower women to confidently discuss their vaginal health
The vaginal microbiome
Watch this video to learn about the vaginal microbiome and the conditions that can occur when its balance is affected.
Test your knowledge - Thrush vs BV
How much do you know about these common conditions?
Select the condition that each statement applies to.
1. This condition is the most common cause of abnormal discharge in women aged 15-44 years
Thrush
BV
2. A symptom of this condition is a white, thick (like cottage cheese) vaginal discharge
Thrush
BV
3. This condition has a strong, fishy odour
Thrush
BV
4. This condition is classed as a fungal infection
Thrush
BV
5. Approximately 50% of women show no symptoms of this condition
Thrush
BV
You scored:
4 of 5
Thrush vs BV
Thrush and BV are two common but different vaginal infections. Understanding the differences between the two is important to ensure correct treatment and management.
Definition & prevalence
THRUSH
A fungal yeast infection that is most often caused by an overgrowth of Candida albicans4,5
Around 75% of women experience at least one infection during their lifetime.4 Thrush can also affect other parts of the body, including the mouth5
BV
A bacterial infection caused by an imbalance in the vaginal microbiome and an overgrowth of harmful bacteria6,7
It is the most common cause of abnormal vaginal discharge in women of childbearing age (15-44 years).6 It has been suggested that 1 in 3 women experience BV at least once in their lives8
Symptoms & pH level
THRUSH
Symptoms can cause some discomfort and include:5,9,10
White, thick vaginal discharge (like cottage cheese)
Vaginal itching, burning and irritation
Soreness and stinging during intercourse or urination
Swelling and redness of the outer skin
Vaginal pH level typically stays normal (between 3.8-4.5)8,9
BV
Approximately 50% of women with BV do not experience any symptoms.6,11 Others may experience:8,11
Thin, watery, white or grey coloured discharge
Strong, fishy odour
BV is not usually associated with soreness or itching
Vaginal pH level is increased (> 4.5)8,9
Causes
THRUSH
Tends to grow in warm, moist conditions and can happen if the customer:10
Has irritated or damaged skin
Is taking antibiotics
Has poorly controlled diabetes
Has a weakened immune system eg due to chemotherapy
Is pregnant*
Is on hormone replacement therapy (HRT)
BV
Caused by a change in the natural balance of bacteria in the vagina. Its cause is not fully known but customers are more likely to experience it if they:11
Are sexually active
Have had a change in sexual partner
Have an IUD (contraception device)
Use perfumed products in or around the vagina
Treatment
THRUSH
Antifungal medicines are recommended.9
Capsules, vaginal tablets, pessaries and creams are available.
Thrush usually clears up within 7 to 14 days of treatment.10
Partners usually do not need to be treated unless they have symptoms9,10
BV
Can go away on it its own; however, it is sometimes treated with antibiotic tablets, gels or creams.7,11
Products that balance pH levels are also available for symptomatic relief.
A woman can pass BV on to another woman during sex, so same-sex partners may also require treatment11
Prevention & symptom relief
THRUSH
Do9,10
Wash the affected area with water and an emollient
Dry the area properly after washing
Wear cotton underwear
Avoid intercourse until thrush has cleared, particularly if sex is uncomfortable
Don’t
Use strong soaps and shower gels
Use vaginal deodorants or douches
Wear tight-fitting jeans or nylon underwear
BV
Do8,11
Use water or gentle soaps to wash the genital area
Have showers instead of baths
Don’t
Use strong soaps or shower gels
Use vaginal deodorants or douches
Use strong detergents to wash underwear
Smoke
Use antiseptics in the bath
Excessively wash the vaginal area – once a day is enough
The Government’s ‘Women’s Health Strategy for England’ prioritises normalising conversations on taboo topics, including tackling stigmas about gynaecological conditions.1 These stigmas have been found to contribute to poor mental health in some women, including feelings of anxiety and low self-esteem.3
Common myths around vaginal infections can contribute to the taboo around discussing them. You can reassure customers by understanding the facts about thrush and BV.
Click on the flashcards to discover whether these statements are true or false.
Thrush and BV
are caused by
poor hygiene
FALSE!
Thrush and BV are not due to poor hygiene. In fact, excessive washing, using deodorants, douches and perfumed soaps can worsen these conditions and alter the normal, healthy conditions of the vagina.8,9
Thrush and BV are sexually transmitted infections (STIs)
FALSE!
Neither thrush nor BV are classed as STIs. However, thrush and BV can be triggered by sex and the customer may be more likely to get an STI if they have BV (this may be due to the reduced acidity in the vagina making other infections more likely to occur).8,10,11
Thrush and BV
normally only affect
women at certain ages
FALSE!
Thrush and BV can affect women of all ages. Non-vaginal types of thrush can also affect men and babies. Hormonal changes such as puberty and menopause can trigger BV, and thrush is more common in the ‘reproductive years’ ie the years between the start of menstruation and the start of menopause.8,9
Which Canesten product?
Canesten products have been helping women with their intimate health for over 40 years. It is important to understand the different options of treatment for thrush and BV to correctly manage each condition.
Click on the products below to find out more.
(BV)
(THRUSH)
Canestest® Self-Test for Vaginal Infections
An easy-to-use test to help diagnose between BV and thrush by linking vaginal pH and symptoms to a probable condition.
Canesbalance® Bacterial Vaginosis Vaginal Gel
Canesbalance® Bacterial Vaginosis Vaginal Pessaries
Available in a gel applicator and a pessary format, Canesbalance:12
Contains lactic acid that helps to restore the normal pH of the vagina and therefore effectively neutralises the unpleasant odour
Contains glycogen, which provides nutrients to the lactic acid bacteria and supports their growth
Restricts the growth of bad bacteria and actively supports good bacteria
Provides effective relief from symptoms of bacterial infections such as unpleasant odour, abnormal discharge and discomfort and regulates the vaginal pH level.
7 single use applicators/pessaries to be used daily for 7 days.
Canesten® Thrush Combi Pessary & External Cream18
Canesten® Thrush Pessary19
Canesten® Thrush Combi Soft Gel Pessary & External Cream20
Canesten® Thrush Soft Gel Pessary21
Canesten Pessary is an effective single dose pessary with applicator which goes straight to the site of the infection for treatment of vaginal thrush. Used with the double-strength external cream,* it helps to relieve the six main symptoms of thrush.
Adults (16-60 years):
One 500mg pessary should be inserted at night using the applicator provided as high as possible into the vagina. This is best achieved when lying back with legs bent up
The new Canesten thrush pessary applicator has a round and smooth shape designed to be more comfortable to insert. This applicator will be available in Canesten Thrush Combi Pessary & External Cream and Canesten Thrush Pessary
The external cream should be applied thinly two or three times a day to the vulva and surrounding area and rubbed in gently
Customers who are ages under 16 or over 60 should be referred to their GP.
*Compared to Canesten 1% w/w cream
Canesten® Thrush Combi Internal & External Creams15
Canesten® Thrush Internal Cream16
Canesten® Thrush External Cream17
The internal cream uses a no mess, pre-filled applicator which may be preferred by women who experience vaginal dryness. Used with the double-strength external cream,* it helps to relieve the six main symptoms of thrush include itching, burning, unusual discharge, swelling, redness and soreness.
Adults (16-60 years):
The internal cream should be administered intravaginally using the applicator supplied, preferably at night
Internal creams may be more suitable for those who are uncomfortable with pessaries
The external cream should be applied thinly two or three times a day to the vulva and surrounding area and rubbed in gently
Customers who are ages under 16 or over 60 should be referred to their GP.
*Compared to Canesten 1% w/w cream
Canesten® Thrush Duo Oral Capsule & External Cream13
Canesten® Thrush Oral Capsule14
A single-dose oral, capsule and double-strength* external cream that work as antifungal medicines to clear both the cause and symptoms of thrush.
Adults (16-60 years):
One capsule should be swallowed whole with a glass of water, anytime during the day
The external cream should be applied thinly two or three times a day to the vulva and surrounding area and rubbed in gently
Products are available individually and as combi packs
Products containing fluconazole are not suitable for pregnant or breastfeeding women. Medicines can affect the unborn baby. Care should be taken when recommending medicines for use in pregnancy as medicines can cross the placenta and may effect the fetus.
*Compared to Canesten 1% w/w cream
Canescool® Soothing Cream Gel
Canescool® Soothing Cream Gel is enriched with oatmeal extract and glycine, with a specially developed gel-in-oil formulation that provides a soothing sensation and moisturises the sensitive intimate area.
For external use only.
CanesBiotics®
CanesBiotics® is an oral food supplement* for intimate care† with 4 billion live cultures of 4 strains of lactobacilli and bifidobacterium.
*Food Supplements are intended to supplement the diet and should not be substituted for a varied diet or healthy lifestyle
†CanesBiotics® contains vitamin B2, which supports the maintenance of mucous membranes and normal skin such as vaginal mucosa and vulvar skin
Canesfresh® Soothing Wash Gel
Canesfresh® Soothing Gel Wash gently cleanses and helps soothe the sensitive intimate area during times of discomfort. It can be used alongside thrush treatment for gentle cleansing and soothing care.
Red flags
Some customers may not be able to use certain products or may require referral to the pharmacist or GP.
These include customers who are:10-16
Experiencing thrush symptoms for the first time
Suffering from thrush more than twice in 6 months or 4 times in 12 months
Suffering with symptoms that have not improved/worsened with thrush treatment
Males suffering from thrush that is not associated with a sexual partner
Suffering with BV and their symptoms worsen, they experience pain, or if the discomfort does not cease
Suffering with BV and they have discharge that is blood-stained or if discharge is occurring during menopause
Suffering with BV more than four times in 12 months
Pregnant or breastfeeding*
Taking certain medications or who have certain medical conditions, eg diabetes
Under 16 years of age or those over 60 years of age
*Products containing fluconazole are not suitable for pregnant or breastfeeding women. Medicines can affect the unborn baby. Care should be taken when recommending medicines for use in pregnancy as medicines can cross the placenta and may effect the fetus.
Confident conversations
Dealing with vaginal infections can be challenging both physically and emotionally for customers. It is important to remember to respect the customer’s privacy and confidentiality when having these conversations.
Click through the carousel for some examples of suitable responses to things customers might say during discussions around their vaginal health.
Customer: I’ve got thrush and it’s really itchy. I’ve had it before and I tried a pessary but didn’t like using it. Is there anything else you can recommend that I can start using immediately?
PA: An oral combination treatment like Canesten Thrush Duo may be a suitable option, as the oral capsule can be taken right away and will help to clear the infection internally, whilst the cream can help to treat it externally and help with symptom relief
Customer: This is a bit embarrassing but I’ve noticed a greyish vaginal discharge that smells unpleasant and fishy. I’ve tried washing a few times a day with a strongly scented bodywash but it seems to be getting worse.
PA: It sounds like you may have BV, which is a very common condition. In fact, it affects 1 out of 3 women at some point in their lives. Canesbalance can help to relieve symptoms of BV such as unpleasant odour, abnormal discharge and discomfort, and should be used for 7 days as directed. It’s important to only wash the vaginal area once a day with water or a gentle soap as over washing can worsen the condition
Customer: This is my third time having thrush in the past six months! Is there anything stronger you can give me?
PA: As you have had thrush more than twice in six months, this needs further investigation. You should see your GP so they can assess your condition further
You can access the online symptom checker here to aid your conversations.
Summary
Meaningful conversations about women’s health should be normalised and encouraged by pharmacy teams
Understanding the differences between thrush and BV is key to their effective management and prevention
Recognising the differences between over-the-counter (OTC) products available for thrush and BV will ensure that customers receive the most effective care.
1. GOV.uk. Women’s Health Strategy for England. 2022.
Available at: https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england
2. GOV.uk. Results of the ‘Women’s Health – Let’s talk about it ’ suvery. 2022.
Available at: https://www.gov.uk/government/calls-for-evidence/womens-health-strategy-call-for-evidence/outcome/results-of-the-womens-health-lets-talk-about-it-survey
3. Royal College of Obstetricians and Gynaecologists. RCOG and women’s health organisations joint statement on stigma and shame in w omen’s health services. 2023.
Available at: https://www.rcog.org.uk/news/rcog-and-women-s-health-organisations-joint-statement-on-stigma-and-shame-in-women-s-health-services/
4. NICE. Candida – female genital. 2023. Available at: https://cks.nice.org.uk/topics/candida-female-genital/
5. Jacobson. J. MedlinePlus. Vaginal yeast infection. 2023. Available at: https://medlineplus.gov/ency/article/001511.htm
6. NICE. Bacterial vaginosis. 2023. Available at: https://cks.nice.org.uk/topics/bacterial-vaginosis/
7. MedlinePlus. Bacterial Vaginosis Test. 2023. Available at: https://medlineplus.gov/lab-tests/bacterial-vaginosis-test/
8. McKechnie. D. Bacterial Vaginosis. Patient. 2023. Available at: https://patient.info/sexual-health/vaginal-discharge-female-discharge/bacterial-vaginosis
9. McKechnie.D. Vaginal Thrush. Patient. 2023. Available at: https://patient.info/sexual-health/vaginal-discharge-female-discharge/vaginal-thrush-yeast-infection
10. NHS. Thrush in men and women. 2023. Available at: https://www.nhs.uk/conditions/thrush-in-men-and-women/
11. NHS. Bacterial vaginosis. 2022. Available at: https://www.nhs.uk/conditions/bacterial-vaginosis/
12. Patient information leaflet. Canesbalance. 2021.
Available at: https://www.boots.com/wcsstore/ExtendedSitesCatalogAssetStore/Attachment%2FProduct_PatientLeaflets%2F10308215_PIL.pdf
13. SmPC. Canesten Thrush Duo Oral Capsule & External Cream 150mg / 2% w/w capsule and cream. 2024. Available at: https://www.medicines.org.uk/emc/product/9076/smpc/print
14. SmPC. Canesten Thrush Duo Oral Capsule 150mg capsule. 2024. https://www.medicines.org.uk/emc/product/40/smpc/print
15. SmPC. Canesten Thrush Combi Internal & External Creams 10% w/w / 2% w/w vaginal cream & cream. 2022. Available at: https://www.medicines.org.uk/emc/product/134/smpc/print
16. SmPC. Canesten Thrush Internal Cream 10% w/w vaginal cream. 2022. Available at: https://www.medicines.org.uk/emc/product/8223/smpc/print
17. SmPC. Canesten Thrush External Cream 2% w/w cream. 2022. Avaialable at: https://www.medicines.org.uk/emc/product/2206/smpc/print
18. SmPC. Canesten Thrush Combi Pessary & External Cream 500mg / 2% w/w pessary & cream. 2023. Available at: https://www.medicines.org.uk/emc/product/5532/smpc/print
19. SmPC. Canesten Thrush Pessary 500mg pessary. 2023. Available at: https://www.medicines.org.uk/emc/product/2042/smpc/print
20. SmpC. Canesten Combi Soft Gel Pessary & External Cream 500mg / 2% w/w vaginal capsule & cream. 2022. Available at: https://www.medicines.org.uk/emc/product/4129/smpc/print
21. SmPC. Canesten Thrush Soft Gel Pessary 500mg vaginal capsule. 2022. Available at: https://www.medicines.org.uk/emc/product/8395/smpc/print
Online references last accessed September 2024
Canesten Thrush Products
Canesten® Thrush Combi Soft Gel Pessary & External Cream 500mg/ 2% w/w vaginal capsule & cream (clotrimazole 500mg soft gel pessary and clotrimazole 2% w/w cream).
Legal Cat: GSL. RRP: £19.79 (Excl. VAT). MA Number: PL 00010/0635.
Canesten® Thrush Combi Pessary & External Cream 500mg/ 2% w/w vaginal capsule & cream (clotrimazole 500mg pessary and clotrimazole 2% w/w cream).
Legal Cat: GSL. RRP: £19.79 (Excl. VAT). MA Number: PL 00010/0300.
Canesten® Thrush Combi Internal & External Creams 10% w/w / 2% w/w vaginal cream & cream (clotrimazole 10% w/w 5g pre-filled applicator of internal cream, plus a 10g tube of clotrimazole 2% w/w external cream).
Legal Cat: GSL. RRP: £19.79 (Excl. VAT). MA Number: PL 00010/0301.
Canesten® Thrush Soft Gel Pessary 500mg vaginal capsule (clotrimazole) Legal Cat: P. RRP: £14.79 (Excl. VAT). MA Number: PL 00010/0633.
Canesten® Thrush Pessary 500mg (clotrimazole) Legal Cat: P. RRP: £12.19 (Excl. VAT). MA Number: PL 00010/0083.
Canesten® Thrush Internal Cream 10% w/w vaginal cream (clotrimazole) Legal Cat: P. RRP: £12.99 (Excl. VAT). MA Number: PL 00010/0654.
Canesten® Thrush External Cream 2% w/w vaginal cream (clotrimazole) Legal Cat: P. RRP: £10.59 (Excl. VAT). MA Number: PL 00010/0077.
Indications: The internal treatments (pessary, soft gel pessary, internal cream) are indicated for the treatment of candidal vaginitis. The external cream is indicated for the treatment of candidal vulvitis. It should be used as an adjunct to treatment of candidal vaginitis. Dosage and Administration: Adults: One internal treatment should be inserted into the vagina at night using the applicator provided. The external cream should be applied to the vulva and surrounding area two or three times daily and rubbed in gently. Children: Paediatric usage is not recommended (under 16 years). Contraindications: Hypersensitivity to clotrimazole or any other ingredients. Do not use to treat nail or scalp infections. Warnings and Precautions: Medical advice must be sought if this is the first time the patient has experienced symptoms of candidal vulvovaginitis or if any of the following are applicable: more than two infections of candidal vaginitis in the last six months; previous history of, or exposure to, partner with a sexually transmitted disease; pregnancy or suspected pregnancy; aged under 16 or over 60 years; known hypersensitivity to imidazoles or other vaginal antifungal products. Medical advice should be sought if the patient has any of the following symptoms: irregular vaginal bleeding; abnormal vaginal bleeding or a blood-stained discharge; vulval or vaginal ulcers, blisters or sores; lower abdominal pain or dysuria; any adverse events such as redness, irritation or swelling associated with the treatment; fever or chills; nausea or vomiting; diarrhoea; foul smelling vaginal discharge. If no improvement in symptoms is seen within seven days, the patient should consult their doctor. This product contains cetostearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis). The product also contains benzyl alcohol which may cause allergic reaction and mild local irritation. The treatment should be finished before the onset of menstruation. Do not use tampons, intravaginal douches, spermicides or other vaginal products while using this product. Vaginal intercourse should be avoided in case of vaginal infection and while using this product because the partner could become infected. Vaginal intercourse should be avoided in case of vaginal infection and while using this product because the partner could become infected. Interactions: Oral tacrolimus/sirolimus. This product may damage latex contraceptives therefore patients should use alternative precautions for at least five days after using the product. Side-effects: Frequency not known: anaphylactic reaction, angioedema, hypersensitivity; internal treatments: syncope, hypotension, dyspnea, abdominal pain, nausea, rash, urticaria, pruritus, vaginal (exfoliation, discharge, haemorrhage), vulvovaginal (discomfort, erythema, burning sensation, pruritus, pain), application site irritation; oedema, pain; external cream: syncope, hypotension, dyspnea, blister, dermatitis contact, erythema, paraesthesia, skin exfoliation, pruritus, rash, urticaria, stinging skin/burning sensation skin. application site irritation, application site reaction, oedema, pain. Use in pregnancy: There are limited amount of data on the use of clotrimazole in pregnant women. Only when under supervision of a physician or midwife. During pregnancy internal treatments should be inserted without using an applicator. Internal Cream: During pregnancy, the treatment should be carried out with clotrimazole pessary since these can be inserted without using an applicator. MA Holder: Bayer plc, 400 South Oak Way, Reading, RG2 6AD, UK. Date of Prep: August 2023.
Canesten® Thrush Duo Oral Capsule and External Cream 150mg / 2% w/w capsule & cream (fluconazole 150mg capsule, plus 10g tube of clotrimazole 2% w/w cream). Indications: The capsule is indicated for treatment of candidal vaginitis, acute or recurrent. Also for treatment of partners with associated candidal balanitis. The cream is indicated for the treatment of candidal vulvitis. It can also be used for treatment of the sexual partner’s penis to prevent re-infection. Dosage and Administration: Adults (16 – 60 years): Swallow one capsule whole. Apply cream to vulva and surrounding area two or three times daily and rub in gently. If after concomitant treatment of vaginitis, symptoms do not improve within seven days, the patient should consult a physician. For treatment of sexual partner’s penis, cream should be applied two or three times daily for up to two weeks. Children: Paediatric usage is not recommended (under 16 years). Contraindications: Hypersensitivity to fluconazole, clotrimazole, related azole substances or any of the excipients e.g. cetostearyl alcohol; co-administration with terfenadine, cisapride, astemizole, pimozide, quinidine and erythromycin. Warnings and Precautions: The cream may cause damage to latex contraceptives. Patients should use alternative precautions for at least five days after using this product. A physician should be consulted if the patient is experiencing symptoms of candidal vaginitis for the first time; is taking any medication other than the pill; is taking terfenadine or cisapride; has had more than two infections of thrush in the last six months; has any disease or illness affecting the liver or kidneys or has had unexplained jaundice; suffers from any other chronic disease or illness; the patient or partner have had exposure to sexually transmitted disease; is uncertain of the cause of symptoms. Women only –patient is suffering from irregular vaginal bleeding or a blood-stained discharge; vulval or vaginal sores, ulcers or blisters; lower abdominal pain or dysuria; adverse events such as redness, irritation or swelling associated with the treatment; is experiencing fever or chills; nausea or vomiting; diarrhoea; foul smelling vaginal discharge. Men only – patient is suffering from penile sores, ulcers or blisters, there is abnormal penile discharge, the penis has started to smell, they have dysuria, or their sexual partner does not have thrush. Patients should consult their doctor if symptoms have not been relieved within one week of treatment. The prevalence of resistance to fluconazole should be taken into account. Administer with caution in renal dysfunction, adrenal insufficiency and liver dysfunction, patients with congenital or acquired QT prolongation, known cardiomyopathy, sinus bradycardia, cardiac arrhythmia, or history of torsades de pointes or other proarrhythmic conditions. Patients have rarely developed exfoliative cutaneous reactions such as Stevens Johnson syndrome and toxic epidermal necrolysis during treatment. Drug reaction with eosinophilia and systemic symptoms (DRESS) has been reported. The patient should consult the doctor if rash develops. If rash or anaphylaxis develops patient should never use the product again. Administer with caution in patients taking products with narrow therapeutic window metabolised through CYP2C9, CYP2C19 and CYP3A4. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take the capsule. The cream contains cetostearyl alcohol, which may cause local skin reactions (e.g., contact dermatitis). The cream also contains benzyl alcohol which may cause allergic reactions and mild local irritation. Side-effects: Oral capsule may cause headache, abdominal pain, diarrhoea, nausea, vomiting, alanine aminotransferase increased, aspartate aminotransferase increased, blood alkaline phosphatase increased, rash, anaemia, agranulocytosis, leukopenia, thrombocytopenia, neutropenia, anaphylaxis, hypersensitivity, decreased appetite, hypercholesterolaemia, hypertriglyceridaemia, hypokalaemia, somnolence, insomnia, headache, seizures, paraesthesia, dizziness, dysgeusia, tremor, vertigo, torsades de pointes, QT prolongation, abdominal pain, constipation, dyspepsia, flatulence, dry mouth. alanine aminotransferase increased, aspartate aminotransferase increased, blood alkaline phosphatase increased, jaundice, cholestasis, bilirubin increased, hepatic failure, hepatocellular necrosis, hepatitis, hepatocellular damage, rash, drug eruption including fixed drug eruption, urticaria, pruritus, hyperhidrosis, toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalised exanthematous-pustulosis, dermatitis exfoliative, angioedema, face oedema, alopecia, myalgia, fatigue, malaise, asthenia, pyrexia. Cream may cause anaphylactic reaction, angioedema, hypersensitivity, blister, contact dermatitis, erythema, paraesthesia, skin exfoliation, pruritus, rash, urticaria, stinging skin/burning sensation skin, application site irritation, application site reaction, oedema, pain. Use in pregnancy: Do not use during pregnancy or in women of childbearing potential unless clearly necessary or as recommended by a doctor. Fluconazole should not be used whilst breast-feeding. Cost (Excl. VAT): £18.19. MA Number: PL 00010/0652. MA Holder: Bayer plc, 400 South Oak Way, Reading, RG2 6AD, UK. Legal Category: P. Date of Preparation: April 2024.
Canesten® Thrush Oral Capsule 150mg capsule (fluconazole). Indications: For the treatment of candidal vaginitis, acute or recurrent. For the treatment of partners with associated candidal balanitis. Dosage and Administration: Adults (16 – 60 years): Swallow one capsule whole. Not recommended in children (under 16) or Elderly (over 60). Contraindications: Hypersensitivity to the active substance, related azole substances or any of the excipients; co-administration with terfenadine, cisapride, astemizole, pimozide, quinidine and erythromycin. Warnings and Precautions: A physician should be consulted if the patient is: taking any medication other than the pill; is taking terfenadine or cisapride; has had more than two infections of thrush in the last six months; has any disease or illness affecting the liver or kidneys or has had unexplained jaundice; suffers from any other chronic disease or illness; the patient or partner have had exposure to sexually transmitted disease; is uncertain of the cause of symptoms. Women only –patient is suffering from abnormal or irregular vaginal bleeding or a blood-stained discharge; vulval or vaginal sores, ulcers or blisters; lower abdominal pain or dysuria. In men - medical advice should be sought if they have penile sores, ulcers or blisters, there is abnormal penile discharge, the penis has started to smell, they have dysuria, or their sexual partner does not have thrush. Patients should consult their doctor if symptoms have not been relieved within one week of treatment. Prescriber should consider the prevalence of resistance to various Candida species to fluconazole. Administer with caution in renal dysfunction, adrenal insufficiency and liver dysfunction, patients with congenital or acquired QT prolongation, known cardiomyopathy, sinus bradycardia, cardiac arrhythmia, or history of torsades de pointes or other proarrhythmic conditions. Patients have rarely developed exfoliative cutaneous reactions such as Stevens Johnson syndrome and toxic epidermal necrolysis during treatment, therefore patient should consult doctor if rash develops. Drug reaction with eosinophilia and systemic symptoms (DRESS) have been reported in association with fluconazole treatment. If rash or anaphylaxis develops patient should never use the product again. Administer with caution in patients taking products with narrow therapeutic window metabolised through CYP2C9, CYP2C19 and CYP3A4. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take the capsule. Side-effects: May cause nausea, diarrhoea, vomiting, abdominal pain, constipation, dyspepsia, dry mouth, flatulence. Anaemia, leukopenia, neutropenia, agranulocytosis and thrombocytopenia. Torsades de pointes/QT prolongation. Increased alanine aminotransferase, increased aspartate aminotransferase, increased blood alkaline phosphatase, hepatitis, jaundice, cholestasis, increased bilirubin, hepatic failure, hepatocellular damage and necrosis. Anaphylaxis and hypersensitivity. Decreased appetite, hypercholesterolaemia, hypertriglyceridaemia and hypokalaemia. Somnolence, insomnia. Seizures, paraesthesia, dizziness, headache, dysgeusia, tremor. Vertigo. Rash, drug eruption, pruritus, urticaria, hyperhidrosis, alopecia, Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous-pustulosis, dermatitis exfoliative, angioedema, face oedema, DRESS. Myalgia, fatigue, malaise, asthenia, pyrexia. Use in pregnancy: Do not use during pregnancy, suspected pregnancy unless clearly necessary or as recommended by a doctor. Fluconazole should not be used whilst breast-feeding. Cost (Excl. VAT): £13.39 MA Number: PL 00010/0282. MA Holder: Bayer plc, 400 South Oak Way, Reading, RG2 6AD, UK. Legal Category: P. Date of Preparation: April 2024.
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September 2024