Creams for thrush - treatment of vaginal thrush
Women's health

Best creams for thrush | Vaginal thrush treatment

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Thrush (also known as candidiasis) is a common condition affecting mainly women; however, men can also get it. 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 the 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. The following will be discussed:

  • Thrush definition and symptoms
  • When to see GP
  • Treatment recommendations
  • Creams for thrush
  • Combination products for the treatment of vaginal thrush
  • Alternative treatments for vaginal thrush
  • Self-care measures to prevent thrush
  • Note on paying for NHS prescriptions when a combination product for the treatment of thrush is prescribed

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. P 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 a mouth or the vagina. In women, common symptoms of vaginal thrush are:

  • Burning and itchiness of the vagina
  • Soreness
  • Discharge from vagina described commonly as “cottage cheese-like”
  • The discharge does not smell usually


Although less common, thrush infection can affect men characterised by:

  • a rash present on the penis
  • discharge present on the penis – “cottage cheese-like”
  • unpleasant odour

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 the 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:

  • Capsules
  • Pessaries (a vaginal tablet)
  • Internal creams
  • Combination products, for example, external and internal thrush cream

Summary of product availability for the treatment of thrush

ProductAvailability

Brand

Pregnancy
Clotrimazole 1% cream

P

Various, including Canesten

Yes*

Clotrimazole 2% cream

P

Canesten Thrush cream

Yes*

Clotrimazole 10% internal cream

P

Canesten Thrush Internal Cream 10%

Yes*

Clotrimazole 2% cream and fluconazole 150mg capsule

P

Canesten Thrush Duo Oral Capsule & External Cream

No**

Clotrimazole 200mg pessary

P

Canesten 200mg Pessary

Yes*

Clotrimazole 500mg of gel pessary

P

Canesten Thrush Soft Gel Pessary 500mg

Yes*

Clotrimazole 2% cream and 500mg pessary

GSL

Canesten Thrush Combi Pessary & External Cream

 

Canesten Thrush Combi Soft Gel Pessary & External Cream

Yes*

Clotrimazole 10% internal cream and 2% external cream

GSL

Canesten Thrush Combi Internal & External Creams 10% and 2%  vaginal creams

Yes*

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 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  

Creams for thrush - Canesten 1% cream

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% cream can also be used by sexual partners who have symptoms 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 the previous paragraphs (when to see GP) clotrimazole 1% cream have several special warnings and precaution for use, for example:

  • Suspected pregnancy
  • Abnormal or irregular vaginal bleeding
  • No improvement in 7 days
  • Presence of symptoms which 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)

Creams for thrush - Canesten Thrush Cream contains 2% clotrimazole

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 midwife or a doctor.  

Combination products for the treatment of vaginal thrush (pharmacy only)

Canesten Thrush Duo Oral Capsule & External Cream

Canesten Thrush Duo for treatment of thrush - contains clotrimazole external cream and fluconazole capsule

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. 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.

Sale
Canesten Thrush Combi Internal & External Creams contains internal clotimazole 10e% an external clotrimazole 2% cream
5,029 Reviews
Canesten Thrush Combi Internal & External Creams | Clotrimazole | Thrush Treatment | Complete Two-Step Thrush Treatment
  • A 2-step solution to calm the itch and clear the infection for a complete relief
  • This soothing combination treatment targets both the internal cause and external symptoms of vaginal thrush for a complete relief
  • With an easy to use applicator prefilled with a single dose of internal cream to clear the internal infection, this pack also comes with double strength* thrush external cream to treat your uncomfortable external symptoms. *Compared with Canesten 1% Cream.
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 Canesten combination cream product in pregnancy?

Clotrimazole can be used in the pregnancy, however under the supervision of 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. 

Sale
Canesten Thrush Combi Pessary & External Cream for thrust
2,982 Reviews
Canesten Thrush Combi Pessary & External Cream | Clotrimazole | Thrush Treatment | Complete Two-Step Thrush Treatment
  • A 2-step solution to calm the itch and clear the infection for a complete relief
  • Our original combination treatment targets both the internal cause and external symptoms of vaginal thrush for a complete relief
  • With a single pessary and easy to use applicator to clear the internal infection, this pack also comes with double strength* thrush cream to treat your uncomfortable external symptoms. *Compared with Canesten 1% Cream.

A similar combination of a pessary and external cream, Canesten Thrush Combi Soft Gel Pessary & External Cream can also be purchased.

Sale
Canesten Thrush Combi Soft Gel Pessary & External Cream or treatment of vaginal thrush
2,485 Reviews
Canesten Thrush Combi Soft Gel Pessary & External Cream | Clotrimazole | Thrush Treatment | Complete Two-Step Thrush Treatment
  • A 2-step solution to calm the itch and clear the infection for a complete relief
  • Designed for comfort, this combination treatment targets both the internal cause and external symptoms of vaginal thrush for a complete relief
  • With a single soft gel pessary and easy to use applicator to clear the internal infection, this pack also comes with double strength* thrush cream to treat your uncomfortable external symptoms. *Compared with Canesten 1% cream

A pessary is used for the treatment of candidal vaginitis, whereas cream for candidal vulvitis. This product can be used for the treatment of thrush (previously diagnosed by a doctor). Combination of both products ensures that cause of the thrush is treated and patients get relief from external symptoms of thrush such as itchiness and

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, not 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 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-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?

Sale
Canesten self-test for bacterial vaginosis or thrush
1,859 Reviews
Canestest Self Test for Common Vaginal Infections; Helps To Diagnose Bacterial Vaginosis. From the makers of Canesten.
  • Unique self-test for Bacterial Vaginosis
  • Allows you to self test in the comfort of your own home
  • Canestest links vaginal pH and symptoms to a probable condition

Bacterial vaginosis (BV) is another infection which 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 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. 

Creams for thrush: FAQ

How do I get rid of thrush fast?

Use a combination product containing antifungal drugs such as clotrimazole and fluconazole (e.g. cream and capsule) to get rid of thrush fast.

Where do you apply thrush cream?

External thrush cream (1% or 2%) is applied to the vulva and surrounding area, whereas internal cream (10% cream) is applied inside the vagina with the applicator provided.

What antifungal cream is best for thrush?

In the UK clotrimazole cream (1% and 2%) is the only cream available for the treatment of thrush. 2% cream is double the strength of 1% cream, however, combination products containing cream and another antifungal product are the best for thrush.

Can I buy fluconazole over the counter?

Fluconazole can be purchased from pharmacies only as single capsule containing 150mg of fluconazole.

References:

NICE (2017). Candida – female genital. Available at: https://cks.nice.org.uk/topics/candida-female-genital/management/during-pregnancy/ Accessed on 22/08/2020

The Electronic Medicines Compendium (emc). Available at: https://www.medicines.org.uk/ Accessed on 21/08/2020

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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