Clotrimazole


Thông tin thuốc gốc
Chỉ định và Liều dùng
Oral
Oropharyngeal candidiasis
Adult: As 10 mg loz: Treatment: Dissolve 1 loz slowly in the mouth 5 times daily for 14 days. As prophylaxis for immunocompromised patients undergoing chemotherapy, radiotherapy, or steroid therapy: 1 loz tid for the duration of chemotherapy or until steroids are reduced to maintenance levels.
Child: ≥3 years As 10 mg loz: Treatment: Same as adult dose.

Otic/Aural
Fungal otitis externa
Adult: As 1% solution: Instill 2-3 drops onto affected ear(s) bid or tid for at least 2 weeks to prevent relapse.

Topical/Cutaneous
Candidal balanitis
Adult: As 1% or 2% cream: Apply bid or tid onto male sexual partner’s genital organ, for up to 2 weeks.

Topical/Cutaneous
Skin fungal infections
Adult: As 1% cream, lotion, solution: Apply thinly onto the affected area(s) bid or tid. Continue treatment for at least 4 weeks (dermatophyte infections) or at least 2 weeks (candida infections).

Vaginal
Vulvovaginal candidiasis
Adult: As pessary: Insert 100 mg daily for 6 days, or 200 mg daily for 3 days, or 500 mg as a single dose. As 10% cream: Insert 5 g (1 applicator-full) intravaginally as a single dose. All doses are inserted as high as possible intravaginally, preferably at night, using the applicator provided. Treatment may be repeated once if necessary and should be finished before onset of menstruation. As 1% or 2% cream: Apply thinly bid or tid, onto the external anogenital area, for at least 2 weeks (candida infections).
Child: >16 years As pessary: Insert 100 mg daily for 6 days or 200 mg daily for 3 days. As 10% cream: Same as adult dose. All doses are inserted as high as possible intravaginally, preferably at night, using the applicator provided. Treatment may be repeated once if necessary and should be finished before onset of menstruation.
Chống chỉ định
Hypersensitivity.
Thận trọng
Vaginal: Patient who have had >2 infections of candidal vaginitis for the past 6 months, history of STD or exposure to partner with STD, irregular or abnormal bleeding, vaginal ulcers, diarrhoea, dysuria or lower abdominal pain, fever or chills. Not indicated for systemic fungal infection (oral). Hepatic impairment. Children. Pregnancy and lactation.
Phản ứng phụ
Significant: Abnormal LFTs, including elevated AST levels; increased skin irritation (e.g. redness, itching, burning, blistering, swelling, oozing).
Gastrointestinal disorders: Nausea, vomiting, unpleasant mouth sensation, abdominal pain.
General disorders and administration site conditions: Application site reactions (e.g. peeling/exfoliation, stinging sensation, pain, discomfort).
Immune system disorders: Allergic reaction.
Nervous system disorders: Paraesthesia.
Reproductive system and breast disorders: Vulvovaginal burning, vaginal discharge, pruritus vulvae, vulvar pain and swelling, genital peeling, pelvic pain, vaginal haemorrhage.
Skin and subcutaneous tissue disorders: Rash, urticaria, pruritus.
Vascular disorders: Syncope, hypotension.
Topical/Vag: B; Mouth/Throat: C
Thông tin tư vấn bệnh nhân
Vaginal: May damage and decrease the effectiveness of latex contraceptives (e.g. condoms, diaphragms); use alternative contraceptive measures. Avoid use of tampons, intravaginal douches, spermicides, or other vaginal products. Topical: Avoid use of occlusive wrappings or dressings; contact with eyes and mucous membranes.
MonitoringParameters
Monitor LFTs periodically during therapy; consider KOH test or culture prior to treatment to confirm oropharyngeal candidiasis. Monitor for severe skin irritation (e.g. redness, itching, burning, blistering, swelling, oozing).
Quá liều
Symptoms: Dizziness, nausea or vomiting. Management: Perform gastric lavage only if life-threatening amount has been ingested, symptoms become apparent and if the airway can be adequately protected.
Tương tác
May diminish therapeutic effects of progesterone. May increase the serum concentrations of sirolimus, tacrolimus, aripiprazole, dofetilide, lomitapide, neratinib, nimodipine, pimozide.
Tác dụng
Description: Clotrimazole is an imidazole antifungal that exerts its antimicrobial activity by binding to phospholipids in the cell membrane and altering cell wall permeability, thereby causing a loss in essential intracellular elements.
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract. Minimally absorbed from the skin and vagina. Time to peak plasma concentration: Approx 24 hours (vaginal cream).
Distribution: Inhibitory concentration in saliva for up to 3 hours (loz); penetrates the epidermis (topical).
Metabolism: Metabolised in the liver to inactive compounds.
Excretion: Via faeces and urine.
Đặc tính

Chemical Structure Image
Clotrimazole

Source: National Center for Biotechnology Information. PubChem Database. Clotrimazole, CID=2812, https://pubchem.ncbi.nlm.nih.gov/compound/Clotrimazole (accessed on Jan. 21, 2020)

Bảo quản
Store between 20-25°C.
Phân loại ATC
G01AF02 - clotrimazole ; Belongs to the class of imidazole derivative antiinfectives. Used in the treatment of gynecological infections.
A01AB18 - clotrimazole ; Belongs to the class of local antiinfective and antiseptic preparations. Used in the treatment of diseases of the mouth.
D01AC01 - clotrimazole ; Belongs to the class of imidazole and triazole derivatives. Used in the topical treatment of fungal infection.
References
Anon. Clotrimazole (Oral). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/11/2019.

Anon. Clotrimazole (Topical). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/11/2019.

Anon. Clotrimazole. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 05/11/2019.

Buckingham R (ed). Clotrimazole. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/11/2019.

Candazole Lotion (HOE Pharmaceuticals Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my/. Accessed 28/01/2020.

Clotrimazole Cream 1% (Glenmark Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/11/2019.

Clotrimazole Lozenge (Paddock Laboratories, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/11/2019.

Clotrimazole Topical Solution (Novitium Pharma LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 05/11/2019.

Joint Formulary Committee. Clotrimazole. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/11/2019.

Mycelex Troche (ALZA Pharmaceuticals). U.S. FDA. https://www.fda.gov/. Accessed 28/01/2020.

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