Clotrimazole: Difference between revisions

(Restore original dosing content alongside dynamic SMW tables)
(Fix corrupted content: restore correct Clotrimazole (antifungal) content, was incorrectly showing Clozapine)
 
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==General==
==Administration==
*Type: Atypical [[antipsychotic]]
*Type: [[Antifungal]], azole
*Dosage Forms:  
*Dosage Forms
**12.5, 25, 50, 100, 200
**Topical:1% cream
**12.5, 25, 50, 100, 150, 200 ODT
**Vaginal: 100mg supp, 200mg supp; 1% cream, 2% cream
*Common Trade Names: Clozaril, FezaClo, Versacloz
**Oropharyngeal: 10mg troche
*Routes of Administration: topical, oropharyngeal, vaginal
*Common Trade Names
**Topical: Anti-Fungal Liquid, Desenex AF Prescription Strength, FungiCURE Pump Spray, Lotrimin AF Cream, Lotrimin AF For Her, Lotrimin AF Jock Itch, Lotrimin AF Solution, Lotrimin Jock Itch Powder, MPM Anti-Fungal, Prescription Strength Cruex
**Vulvovaginal: Clotrimazole-3, Clotrimazole-7, Femcare, Gyne-Lotrimin, Gyne-Lotrimin 3 Day, Gyne-Lotrimin Combo Pack
**Oropharyngeal: Mycelex Troche


==Adult Dosing==
==Adult Dosing==
===[[Schizophrenia]], resistant===
*Topical
*150-300mg PO BID
**Candidiasis, cutaneous
*start: 12.5mg PO QD-bid, increase by 25-50mg/day to target 300-450mg/day in divided doses by day 14; then may increase by up to 100mg/day q3-7days;
***Apply bid
*max 900mg/day
**Tinea
*retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d
***Apply bid
*taper dose over 1-2 weeks to DC
***2-4 weeks for best results with corporis, cruris, pedis, versicolor
 
*Vulvovaginal
===Suicide prevention, schizophrenia-associated===
**candidiasis, vulvovaginal
*150-300mg PO BID
***200mg PV qhs x3 days
*start, increase, retitrate, and DC as above
***Alt: 100mg PV qhs x7 days
 
***Alt: 1 applicatorful 2% PV qhs x3 days
***Alt: 1 applicatorful 1% PV qhs x7-14 days
*Oropharyngeal
**candidiasis treatment, oropharyngeal
***10mg PO 5x/day x14 days
****slowly dissolve in mouth; do not chew or swallow whole
**candidiasis prophylaxis, oropharyngeal
***10mg PO tid
****continue for duration of chemo or high-dose steroid; slowly dissolve in mouth; do not chew or swallow whole


===Indications by Disease===
===Indications by Disease===
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==Pediatric Dosing==
==Pediatric Dosing==
*Schizophrenia (limited data - adjusted dose based on tolerability, clinical response)
Same as adult
** Children >6 years PO 6.25 or 12.5mg qd
** Adolescents 12.5mg 1-2x daily
 


===Indications by Disease===
===Indications by Disease===
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==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B (no evidence of risk)
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B (topical, vulvovaginal), C (oropharyngeal)
*Lactation: possibly unsafe
*[[Lactation risk categories|Lactation risk]]: Probably safe (topical, vulvovaginal), Safety unknown (oropharyngeal)
*Renal Dosing
===Renal Dosing===
**Adult
*Adult:
***not defined, consider decreasing dose for significant impairment
*Pediatric:
**Pediatric
===Hepatic Dosing===
***not available
*Adult: Precaution with troches. Monitor LFTs.
*Hepatic Dosing
*Pediatric:
**Adult
***not defined, consider decreasing dose for significant impairment
**Pediatric
***not available


==Indications==
*Controls positive and negative symptoms of psychotic disorders
*Used for schizophrenia
*Off label use:
**Bipolar disorder
**Borderline personality disorder
==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*history of clozapine-associated myocarditis
*history of agranulocytosis or granulocytopenia
*uncorrected electrolyte abnormalities
*caution in elderly, stroke, dementia, CAD, prolonged QT
*caution if history of torsades de pointes, ventricular arrhythmias
*caution if bradycardic, recent MI, CHF
*caution if eosinophila
*caution if pulmonary disease, hepatic impairment, seizure risk
*caution if BPH, angle-closure glaucoma, DM
*caution if PKU


==Adverse Reactions==
==Adverse Reactions==
*[[QT prolongation]]
===Serious===
*[[Myocarditis]]
may occur but none reported
*[[Agranulocytosis]] in 1%–2% of patients during initial treatment 3 months
===Common===
**Highest ~3 months into treatment and then decreases
*Topical
*Other potential side effects:
**irritation
**Dyslipidemia
**burning/stinging
**Diabetes
**pruritus
**Decreased seizure threshold
**erythema
*"Other adverse cardiovascular and respiratory effects" <ref name="FDA">"Clozaril (Clozapine) drug description - FDA approved labeling for prescription drugs and medications at RxList". Rxlist.com. Retrieved 2008-10-09.</ref>
**localized edema
*"Increased mortality in elderly patients with dementia-related psychosis"<ref name="FDA" />
**urticaria
**peeling
**blistering
*Vulvovaginal
**vulvovaginal burning
**vulvovaginal pruritus
**vulvovaginal soreness
**vulvovaginal swelling
**pelvic pain
**pelvic cramps
**abdominal pain
*Oropharyngeal
**vomiting
**nausea
**abdominal cramps
**abnormal LFTs


==Pharmacology==
==Pharmacology==
*Half-life: 4-66h
*Half-life: Unknown
*Metabolism: liver extensively
*Metabolism: liver; CYP450: unknown; Info: minimal systemic absorption
*Excretion: urine 50%, feces 30%
*Excretion: bile/feces primarily, urine
*Mechanism of Action: exact mechanism of action unknown, antagonizes dopamine D2, serotonin 5-HT2, α adrenergic, cholinergic muscarinic receptors, others
 
==Mechanism of Action==
*Exact mechanism of action unknown
*Azole antifungal
**Inhibits 14-alpha demethylase, reducing fungal cell membrane ergosterol synthesis and increasing cellular permeability
 
==Comments==


==See Also==
==See Also==
*[[Schizophrenia]]
*[[Antifungals]]
*[[Bipolar disorder]]
*[[Fungal infections]]
*[[Borderline personality disorder]]
*[[Antipsychotics]]


==References==
==References==
*[https://online.epocrates.com/drugs/1660/clotrimazole-oropharyngeal Epocrates: clotrimazole-oropharyngeal]
*[https://online.epocrates.com/drugs/12/clotrimazole-topical Epocrates:clotrimazole-topical]
*[https://online.epocrates.com/drugs/3416/clotrimazole-vaginal Epocrates: clotrimazole-vaginal]
<references/>
<references/>


[[Category:Pharmacology]]
[[Category:Pharmacology]]
[[Category:Psychiatry]]
[[Category:ID]]

Latest revision as of 12:11, 20 March 2026

Administration

  • Type: Antifungal, azole
  • Dosage Forms
    • Topical:1% cream
    • Vaginal: 100mg supp, 200mg supp; 1% cream, 2% cream
    • Oropharyngeal: 10mg troche
  • Routes of Administration: topical, oropharyngeal, vaginal
  • Common Trade Names
    • Topical: Anti-Fungal Liquid, Desenex AF Prescription Strength, FungiCURE Pump Spray, Lotrimin AF Cream, Lotrimin AF For Her, Lotrimin AF Jock Itch, Lotrimin AF Solution, Lotrimin Jock Itch Powder, MPM Anti-Fungal, Prescription Strength Cruex
    • Vulvovaginal: Clotrimazole-3, Clotrimazole-7, Femcare, Gyne-Lotrimin, Gyne-Lotrimin 3 Day, Gyne-Lotrimin Combo Pack
    • Oropharyngeal: Mycelex Troche

Adult Dosing

  • Topical
    • Candidiasis, cutaneous
      • Apply bid
    • Tinea
      • Apply bid
      • 2-4 weeks for best results with corporis, cruris, pedis, versicolor
  • Vulvovaginal
    • candidiasis, vulvovaginal
      • 200mg PV qhs x3 days
      • Alt: 100mg PV qhs x7 days
      • Alt: 1 applicatorful 2% PV qhs x3 days
      • Alt: 1 applicatorful 1% PV qhs x7-14 days
  • Oropharyngeal
    • candidiasis treatment, oropharyngeal
      • 10mg PO 5x/day x14 days
        • slowly dissolve in mouth; do not chew or swallow whole
    • candidiasis prophylaxis, oropharyngeal
      • 10mg PO tid
        • continue for duration of chemo or high-dose steroid; slowly dissolve in mouth; do not chew or swallow whole

Indications by Disease

DiseaseDoseContext
Balanoposthitis1% applied topically to glans q12hrs until resolutionAntifungal
Candida vulvovaginitis1% cream applied vaginally for 7 days OR 2% applied vaginally for 3 daysIntravaginal therapy
Oropharyngeal candidiasis10 mg troches 5 times/day for 14 consecutive daysAdult

Pediatric Dosing

Same as adult

Indications by Disease

DiseaseDoseContext
Oropharyngeal candidiasis10mg PO five times daily for 14 daysPediatric (>3 years)

Special Populations

Renal Dosing

  • Adult:
  • Pediatric:

Hepatic Dosing

  • Adult: Precaution with troches. Monitor LFTs.
  • Pediatric:

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

may occur but none reported

Common

  • Topical
    • irritation
    • burning/stinging
    • pruritus
    • erythema
    • localized edema
    • urticaria
    • peeling
    • blistering
  • Vulvovaginal
    • vulvovaginal burning
    • vulvovaginal pruritus
    • vulvovaginal soreness
    • vulvovaginal swelling
    • pelvic pain
    • pelvic cramps
    • abdominal pain
  • Oropharyngeal
    • vomiting
    • nausea
    • abdominal cramps
    • abnormal LFTs

Pharmacology

  • Half-life: Unknown
  • Metabolism: liver; CYP450: unknown; Info: minimal systemic absorption
  • Excretion: bile/feces primarily, urine

Mechanism of Action

  • Exact mechanism of action unknown
  • Azole antifungal
    • Inhibits 14-alpha demethylase, reducing fungal cell membrane ergosterol synthesis and increasing cellular permeability

Comments

See Also

References

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