Thrush (also known as Candidiasis) is a common condition affecting mainly women; however, men can also get it, and also children might get affected by Thrush.
Thrush infection may affect the vagina (or penis in men) or mouth (oral thrush). The focus of this post is the treatment of vaginal Thrush with creams and combination products, which are available from pharmacies (including online chemists), supermarkets, and other online retailers.
Fortunately, creams for Thrush are available in pharmacies, and most patients can buy them without seeing a GP.
Combination products and creams for Thrush are reviewed in this post according to their availability. Firstly pharmacy-only products (P) are discussed, and then a General Sale List (GSL) products. Products and drugs can only be purchased from registered pharmacies (‘behind the counter” products), whereas GSL products are available off the shelf from stores, supermarkets, pharmacies, and online.
Symptoms Of Thrush
Thrush is a fungal infection caused mostly by Candida (a type of yeast). Thrush infection usually affects the mouth or the vagina.
In women, common symptoms of Vaginal Thrush are:
- Burning and itchiness of the vagina
- Discharge from vagina described commonly as “cottage cheese-like”
- The discharge does not smell usually
Although less common, Thrush infection can affect men characterized by:
- A rash present on the penis
- Discharge present on the penis – “cottage cheese-like”
- Unpleasant odor
Thrush: When To See GP
Products, which are sold over the counter or from pharmacies for the treatment of thrush have specific licensed use, including exclusions on the use by certain people, for example, due to age.
A patient who falls into the exclusion category for over-the-counter treatment of thrush is usually referred to GP and consequently refused the sale of the product. The following patients should see their GP if they experience symptoms of thrush:
- Anyone who had more than two episodes of thrush in the last six months
- Aged below 16 or over 60
- History of a sexually transmitted disease (STD) or partner with STD
- Anyone who is hypersensitive to ‘Imidazole’ antifungal group of drugs
Thrush: Treatment Recommendations
Vaginal Thrush is treated with antifungal drugs called Imidazoles with two drugs available over the counter – Clotrimazole and Fluconazole. Antifungal drugs for Thrush come in various formulations with products most commonly used:
- Pessaries (a vaginal tablet)
- Internal creams
- Combination products, for example, external and internal thrush cream
Summary of product availability for the treatment of Thrush:
|Clotrimazole 1% cream||
Various, including Canesten
|Clotrimazole 2% cream||
Canesten Thrush cream
|Clotrimazole 10% internal cream||
|Canesten Thrush Internal Cream 10%||
|Clotrimazole 2% cream and fluconazole 150mg capsule||
|Canesten Thrush Duo Oral Capsule & External Cream||
|Clotrimazole 200mg pessary||
|Canesten 200mg Pessary||
|Clotrimazole 500mg of gel pessary||
|Canesten Thrush Soft Gel Pessary 500mg||
|Clotrimazole 2% cream and 500mg pessary||
|Canesten Thrush Combi Pessary & External Cream
Canesten Thrush Combi Soft Gel Pessary & External Cream
|Clotrimazole 10% internal cream and 2% external cream||
|Canesten Thrush Combi Internal & External Creams 10% and 2% vaginal creams||
P: Pharmacy-only product available in pharmacies and online chemists
GSL: General sale license product, available in stores and supermarkets
*Can be used under the supervision of a midwife or a doctor
**Fluconazole capsule (one of the drugs in this combination product) is not recommended in the pregnancy
Clotrimazole for the treatment of Thrush comes in different forms, including:
- Creams: Internal and external creams for Thrush
- Pessaries (a vaginal tablet) and
- Combination products containing cream and pessary or cream and Fluconazole capsule or a combination product containing internal and external Clotrimazole creams.
Clotrimazole creams for thrush (pharmacy-only products)
Creams for thrush: Clotrimazole 1% and 2%
Clotrimazole cream for thrush is available as 1% and 2% creams.
Both clotrimazole 1% and 2% creams are sold as pharmacy-only medication when used for the treatment of vaginal thrush (licensed use for this condition).
Clotrimazole 1% cream for thrush
Clotrimazole 1% cream for the treatment of thrush is available under many brands, for example:
- Boots Thrush 1% Cream
- Tesco 1% Thrush cream
- Morrisons Thrush Relief 1% Cream
- Canesten 1% cream
- And many others
As I mentioned before, Clotrimazole 1% cream, which is used according to its license for the treatment of Thrush, can only be purchased from the pharmacy.
However, Clotrimazole 1% cream (same drug) can be bought off the shelf from most supermarkets for treatment of other fungal skin infections such as athlete’s foot or jock itch (e.g., Canesten Dual Action 1%).
In addition to the treatment of thrush Clotrimazole 1%, the cream can also be used by sexual partners who have symptoms of Candidal balanitis.
Age restrictions for Clotrimazole 1% creams
When used for the treatment of Vaginal Thrush, Clotrimazole 1% cream is indicated for adolescents and adults over 16 and below 60 years of age. Patients who do not fall in the 16-60 age group will be refused the sale of the cream and referred to see their GP.
Furthermore, to referral criteria found in one of the previous paragraphs (when to see GP), Clotrimazole 1% cream has several special warnings and precautions for use, for example:
- Suspected pregnancy
- Abnormal or irregular vaginal bleeding
- No improvement in 7 days
- Presence of symptoms that suggest another condition, for example, painful and difficult urination or lower abdominal pain.
How is clotrimazole 1% cream for thrush used?
Clotrimazole cream should be applied 2-3 times. If not, improvement is seen after seven days; patients are advised to see their GP. When prescribed, follow the direction of your GP.
Can you use clotrimazole 1% cream for the treatment of thrush in the pregnancy?
Clotrimazole 1% cream can be used in pregnancy for the treatment of thrush, as long as a midwife or a doctor supervises the treatment.
Clotrimazole 2% cream for thrush (Canesten Thrush)
Clotrimazole 2% cream is sold under the brand name of Canesten Thrush External Cream 2%.
Canesten Thrush is a pharmacy-only medication, available to buy from pharmacies only.
Canesten Thrush cream: restrictions
The same restriction on sale applies to Canesten Thrush cream as to previously discussed clotrimazole 1% cream, for example, a limit on the age (patients 16-60 years of age) or patients with regular episodes of thrush (more than two episodes in last six months).
How is Canesten Thrush cream used?
For the treatment of thrush, Clotrimazole 2% should be applied 2-3 times a day until symptoms go away.
If no improvement is seen after seven days (treatment alongside another antifungal preparation, for example, an antifungal capsule), patients should seek advice from their doctor.
For the treatment of Thrush in men (sexual partners), Canesten Thrush cream should be applied 2-3 times a day for up to two weeks.
Canesten Thrush Internal Cream for thrush
Canesten Thrush Internal Cream 10% (contains Clotrimazole 10%) is a pharmacy-only medication for the treatment of vaginal thrush. Clotrimazole 10% internal cream comes as a single dose inside an applicator.
The cream is inserted into the vagina with a preferred night-time administration. Similar sale restrictions apply to Canesten Internal Cream as with previously discussed creams, for example, age restrictions.
Patients are advised that the second dose of Canesten Internal Cream may be necessary to treat vaginal thrush.
Can you use Canesten Internal cream for thrush in pregnancy?
Clotrimazole can be used in the pregnancy, however, under the supervision of a midwife or a doctor.
Combination products for the treatment of vaginal thrush (pharmacy only)
Canesten Thrush Duo Oral Capsule & External Cream
The last combination product available from pharmacies only is Canesten Thrush Duo.
Canesten Thrush Duo contains Clotrimazole 2% external cream and a single dose of Fluconazole antifungal drug.
A combination of external cream with capsules ensures that the cause of thrush is treaded as well as patients get relief from the main ‘external’ symptoms such as itchiness and soreness of the vulva.
How to use Canesten Thrush Duo?
A single capsule should be taken at the start of the treatment.
Canesten, 2% cream, should be applied 2-3 times a day until symptoms resolve; however, if no improvement is seen in 7 days, patients should speak to their GP.
Symptoms usually improve within two days of starting the treatment.
Can you use Canesten Thrush Duo (capsule & cream) in the pregnancy?
Canesten Thrush Duo should not be used in the pregnancy. Fluconazole (capsule) is not recommended for thrush in the pregnancy.
Combination products for the treatment of Vaginal Thrush (GSL)
GSL items can be purchased in most supermarkets, smaller stores, pharmacies, and online websites, off the shelf without the supervision of a pharmacist.
Canesten Thrush Combi Internal & External Creams
Canesten Thrush Combi Internal & External Creams contains Clotrimazole 2% cream for external application (treatment of Candidal vulvitis) and clotrimazole 10% for the internal use and treatment of Candidal vaginitis.
How to use Canesten Thrush Combi Internal & External Creams?
The internal cream comes as a single dose in a prefilled applicator. Clotrimazole 10% internal cream should be applied at night.
External 2% clotrimazole cream should be applied 2-3 times a day. If both products are used, and symptoms do not improve within seven days, patients should seek advice from their doctor.
Can you use the Canesten combination cream product in pregnancy?
Clotrimazole can be used in the pregnancy, however under the supervision of a midwife or a doctor.
Canesten Thrush Combi Pessary & External Cream
Canesten Thrush Combi Pessary & External Cream is the last combination product available on sale from supermarkets, pharmacies, and online vendors. This product contains two different formulations of antifungal drugs. Firstly a 2% Clotrimazole (external) cream and a single pessary (a vaginal tablet) containing 500mg of clotrimazole.
A similar combination of a pessary and external cream, Canesten Thrush Combi Soft Gel Pessary & External Cream, can also be purchased.
A pessary is used for the treatment of candidal vaginitis, whereas a cream is used for candidal vulvitis. This product can be used for the treatment of thrush (previously diagnosed by a doctor). The combination of both products ensures that the cause of the Thrush is treated, and patients get relief from external symptoms of Thrush, such as itchiness and rashes.
Canesten Thrush Combi Pessary & External Cream restrictions
The same restriction on the use applies to Canesten Thrush Combi Pessary & External Cream as with all previously discussed Canesten preparations, even though this product can be purchased off the shelf.
How to use Canesten Thrush Combi Pessary & External Cream
A pessary is inserted at night with the applicator provided unless the patient is pregnant. The cream should be applied 2-3 times a day until symptoms resolve.
Symptoms should improve within two days. If, however, no improvement is seen within seven days of combination treatment (pessary and cream), patients should contact their GP to get advice.
Can you use Canesten Thrush Pessary & External Cream in the pregnancy?
Clotrimazole can be used in the pregnancy, however, under the supervision of a midwife or a doctor. When pregnant, patients should insert the pessary without an applicator.
What Is The Most Effective Cream For Thrush Or A Combination Product?
There is no evidence to suggest one formulation is superior to all other clotrimazole formulations. Generally, it can be assumed a combination of products (for example, cream and pessary) provide for dual ‘effect’ by treating the fungal infection and helping with the symptoms of thrush such as itching.
This may be a preferred choice of treatment for some customers. Clotrimazole 2% and 1% creams are generally used for the treatment of external symptoms of thrush.
Is It Thrush Or Bacterial Vaginosis?
Bacterial vaginosis (BV) is another infection that affects the vagina. The most common side effect is vaginal discharge, which smells fishy/unpleasant; however, sometimes Thrush and BV may be mistaken as the same condition.
Canesten offers a self-test to distinguish between bots conditions. You can buy Canesten self-test from the shops, pharmacies, and online.
Alternative Treatment Of Vaginal Thrush
Other option for treatment of thrush available from the pharmacy includes:
- Use of Fluconazole antifungal drug which comes in the form of a single dose capsule (150mg of Fluconazole) or as discussed in this post in combination with creams or pessaries
- Clotrimazole 100mg pessaries (Canesten 100mg Pessary), which provides a three-day course for the treatment of thrush
- Clotrimazole 200mg pessaries (Canesten 200mg Pessary), which provides for a three-day course
- Clotrimazole 500mg pessary (Canesten Thrush Pessary 500mg or other brands), treatment with a single pessary
Self-care Measures To Prevent Thrush
The following should be avoided to reduce the chances of getting a Thrush (NICE, 2017):
- Wearing tight clothing
- Wearing non-absorbent underwear
- Cleaning vulval more than once a day
- Use of soap or shower products to clean the vulval area
- Vaginal douching
Combination Products: Paying NHS Prescription Charges
Non-exempt patients who usually pay for NHS prescriptions need to pay two prescription charges when a combination product containing two different formulations is prescribed. For example, a patient would need to pay two prescription charges when Canesten Thrush Duo Oral Capsule & External Cream is prescribed.
This is because two different drugs are included inside the box of the product. It is cheaper to buy a combination product without a prescription from the pharmacy; therefore, patients may prefer to use this option rather than paying two prescription charges.