Clotrimazole: Difference between revisions

(Replace manual dosing with dynamic SMW tables)
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==Administration==
==General==
*Type: [[Antifungal]], azole
*Type: Atypical [[antipsychotic]]
*Dosage Forms
*Dosage Forms:  
**Topical:1% cream
**12.5, 25, 50, 100, 200
**Vaginal: 100mg supp, 200mg supp; 1% cream, 2% cream
**12.5, 25, 50, 100, 150, 200 ODT
**Oropharyngeal: 10mg troche
*Common Trade Names: Clozaril, FezaClo, Versacloz
*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===
*150-300mg PO BID
*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;
*max 900mg/day
*retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d
*taper dose over 1-2 weeks to DC
===Suicide prevention, schizophrenia-associated===
*150-300mg PO BID
*start, increase, retitrate, and DC as above
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Clotrimazole]] [[Has Population::Adult]]
{{#ask: [[Has DrugName::Clotrimazole]] [[Has Population::Adult]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
|format=table
|format=table
|limit=50
|limit=50
|mainlabel=-
|mainlabel=-
|headers=show
|headers=show
|sort=Treats disease
|sort=Treats disease
}}
}}


==Pediatric Dosing==
==Pediatric Dosing==
*Schizophrenia (limited data - adjusted dose based on tolerability, clinical response)
** Children >6 years PO 6.25 or 12.5mg qd
** Adolescents 12.5mg 1-2x daily
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Clotrimazole]] [[Has Population::Pediatric]]
{{#ask: [[Has DrugName::Clotrimazole]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
|format=table
|format=table
|limit=50
|limit=50
|mainlabel=-
|mainlabel=-
|headers=show
|headers=show
|sort=Treats disease
|sort=Treats disease
}}
}}


==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B (topical, vulvovaginal), C (oropharyngeal)
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B (no evidence of risk)
*[[Lactation risk categories|Lactation risk]]: Probably safe (topical, vulvovaginal), Safety unknown (oropharyngeal)
*Lactation: possibly unsafe
===Renal Dosing===
*Renal Dosing
*Adult:
**Adult
*Pediatric:
***not defined, consider decreasing dose for significant impairment
===Hepatic Dosing===
**Pediatric
*Adult: Precaution with troches. Monitor LFTs.
***not available
*Pediatric:
*Hepatic Dosing
**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==
===Serious===
*[[QT prolongation]]
may occur but none reported
*[[Myocarditis]]
===Common===
*[[Agranulocytosis]] in 1%–2% of patients during initial treatment 3 months
*Topical
**Highest ~3 months into treatment and then decreases
**irritation
*Other potential side effects:
**burning/stinging
**Dyslipidemia
**pruritus
**Diabetes
**erythema
**Decreased seizure threshold
**localized edema
*"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>
**urticaria
*"Increased mortality in elderly patients with dementia-related psychosis"<ref name="FDA" />
**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: Unknown
*Half-life: 4-66h
*Metabolism: liver; CYP450: unknown; Info: minimal systemic absorption
*Metabolism: liver extensively
*Excretion: bile/feces primarily, urine
*Excretion: urine 50%, feces 30%
 
*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==
*[[Antifungals]]
*[[Schizophrenia]]
*[[Fungal infections]]
*[[Bipolar disorder]]
*[[Borderline personality disorder]]
*[[Antipsychotics]]


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


<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]]
[[Category:ID]]
[[Category:Psychiatry]]

Revision as of 02:39, 20 March 2026

General

  • Type: Atypical antipsychotic
  • Dosage Forms:
    • 12.5, 25, 50, 100, 200
    • 12.5, 25, 50, 100, 150, 200 ODT
  • Common Trade Names: Clozaril, FezaClo, Versacloz

Adult Dosing

Schizophrenia, resistant

  • 150-300mg PO BID
  • 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;
  • max 900mg/day
  • retitrate from 12.5mg PO QD-bid if treatment interrupted > 2 d
  • taper dose over 1-2 weeks to DC

Suicide prevention, schizophrenia-associated

  • 150-300mg PO BID
  • start, increase, retitrate, and DC as above


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

  • Schizophrenia (limited data - adjusted dose based on tolerability, clinical response)
    • Children >6 years PO 6.25 or 12.5mg qd
    • Adolescents 12.5mg 1-2x daily


Indications by Disease

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

Special Populations

  • Pregnancy Rating: B (no evidence of risk)
  • Lactation: possibly unsafe
  • Renal Dosing
    • Adult
      • not defined, consider decreasing dose for significant impairment
    • Pediatric
      • not available
  • Hepatic Dosing
    • 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

  • 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

  • QT prolongation
  • Myocarditis
  • Agranulocytosis in 1%–2% of patients during initial treatment 3 months
    • Highest ~3 months into treatment and then decreases
  • Other potential side effects:
    • Dyslipidemia
    • Diabetes
    • Decreased seizure threshold
  • "Other adverse cardiovascular and respiratory effects" [1]
  • "Increased mortality in elderly patients with dementia-related psychosis"[1]

Pharmacology

  • Half-life: 4-66h
  • Metabolism: liver extensively
  • Excretion: urine 50%, feces 30%
  • Mechanism of Action: exact mechanism of action unknown, antagonizes dopamine D2, serotonin 5-HT2, α adrenergic, cholinergic muscarinic receptors, others

See Also

References

  1. ↑ 1.0 1.1 "Clozaril (Clozapine) drug description - FDA approved labeling for prescription drugs and medications at RxList". Rxlist.com. Retrieved 2008-10-09.
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