First-lineCanesten
Clotrimazole
Imidazole antifungal (topical)
First-line for vulvovaginal candidiasis in pregnancy.
Topical pessaryTopical cream
First-line for
- Vulvovaginal candidiasis (pregnancy)
- Recurrent VVC maintenance
Mechanism
Disrupts fungal cell membrane by inhibiting ergosterol synthesis (CYP51).
“7-day cream in pregnancy, NOT oral fluconazole”
- Topical safe T1–T3
- Oral fluconazole = cardiac defects T1
Dosing
- Pregnancy
- 100 mg pessary nightly x 7 nights
- Cream
- 1% topical BD x 7 d
Contraindications
- AbsoluteHypersensitivity to imidazoles
Side effects
- Local burning
- Vulval irritation
Fetal & maternal notes
- • Topical clotrimazole compatible across pregnancy
- • Avoid oral fluconazole in T1
Key interactions
Latex condoms
CautionCream degrades latex
Clinical pearls
- 💡 Use 7-day course in pregnancy (vs 1-day non-pregnant)
- 💡 Counsel: avoid oral azoles unless severe
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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