Clotrimazole (Canesten)

1. Health Canada Product Monograph — Clotrimazole

• Clotrimazole 1% cream is used to treat athlete's foot, jock itch, and ringworm caused by susceptible dermatophyte fungi.
• Clotrimazole 1% cream is used to treat skin candidiasis caused by Candida albicans.
• Clotrimazole 1% cream is used to treat tinea versicolor caused by Malassezia furfur.
• Clotrimazole 1% cream is used to treat diaper rash infected with Candida albicans, when diagnosed by a physician.
• Clotrimazole 1% cream is not suitable for treating fungal infections of the nails or scalp.

• There are limited data on clotrimazole use in pregnant women, though animal studies have not shown harmful reproductive effects.
• Use during pregnancy, especially the first trimester or while trying to conceive, is not recommended unless a physician considers it essential.

• Clotrimazole and its breakdown products have been shown to pass into milk in animal studies.
• Breastfeeding should be discontinued during treatment, or use should only be on the advice of a physician, since topical application does still result in some systemic absorption.

• No specific dosing differences have been identified for older adults using topical clotrimazole cream.

• For diaper rash caused by Candida albicans and diagnosed by a physician, the cream may be used in children as directed by a doctor.
• Clotrimazole cream is not recommended for children under 2 years of age unless a doctor advises otherwise.

• For diaper rash in children, a thin layer of cream is applied and gently massaged into the affected and surrounding skin twice daily, morning and evening, at diaper changes, for no more than 14 days.
• For jock itch, athlete's foot, and ringworm in adults, a thin layer of cream is applied and gently massaged into the affected and surrounding skin twice daily, morning and evening.
• Athlete's foot typically requires at least 4 weeks of treatment; jock itch, ringworm, and diaper rash usually resolve within 2-4 weeks; candidiasis is generally treated for 2 weeks.
• Treatment should continue for about 2 weeks after symptoms clear to help prevent relapse, even if improvement occurs sooner.
• If there is no improvement after 4 weeks in adults, or after 14 days for diaper rash, a physician should be consulted.
• If a dose is missed, apply the next dose as scheduled; do not apply extra cream to make up for a missed application.

If overdose is suspected, seek emergency medical attention immediately or contact your regional Poison Control Centre without delay.

• Specific data on overdose with topical clotrimazole cream are not described in the product monograph.
• If clotrimazole cream is accidentally swallowed, contact a poison control centre or seek emergency medical help right away, even if there are no symptoms.

• Stinging or a burning sensation at the application site may occur.
• Redness at the application site may occur.
• Itching may occur.
• Skin peeling may occur.
• Rash may occur.
• Hives may occur.
• Blistering may occur.
• Application site irritation or reaction may occur.
• Swelling at the application site may occur.
• Pain at the application site may occur.
• A tingling sensation may occur.
• Contact dermatitis may occur.

Serious side effects require immediate discussion with the prescriber or emergency care.

• Severe allergic reactions, including anaphylaxis and angioedema with swelling of the face, mouth, hands, or feet, can occur rarely.
• A drop in blood pressure and fainting have been reported rarely.
• Difficulty breathing has been reported rarely as part of an allergic reaction.
• Seek urgent medical attention for facial or throat swelling, difficulty breathing, fainting, or signs of a severe allergic reaction.

• Use with caution around the eyes, since clotrimazole cream is not intended for ophthalmic use; rinse thoroughly with water if accidental eye contact occurs.
• Do not cover the treated area with an occlusive dressing unless directed by a physician, since this can increase irritation; regular diaper use is not considered occlusive.
• Discontinue use and consult a physician if skin sensitization, worsening irritation, or a spreading rash develops.
• Use with caution in pregnancy and breastfeeding, only on a physician's advice.
• Consult a physician before use on children under 2 years of age.
• No human fertility studies have been conducted, though animal studies have not shown any effect of clotrimazole on fertility.

• Contraindicated in patients with known hypersensitivity to clotrimazole or to any ingredient in the formulation.

• Clotrimazole cream may reduce the effectiveness of latex-based contraceptive products, including condoms, diaphragms, and vaginal spermicides; this effect is temporary and limited to the treatment period.

• Food interactions do not apply, since clotrimazole cream is applied to the skin rather than taken by mouth.

• Clotrimazole cream is applied twice daily, morning and evening, rather than timed around meals, since it is a topical product.

• Store clotrimazole cream at room temperature, between 15°C and 30°C.

• Clotrimazole (Canesten) cream treats fungal and yeast skin infections such as athlete's foot, jock itch, ringworm, tinea versicolor, and infected diaper rash.
• Apply a thin layer to the affected and surrounding skin twice daily and continue for the full recommended treatment period, even if symptoms improve sooner.
• Avoid contact with the eyes, and do not use an airtight bandage over the treated area unless your doctor tells you to.
• See a doctor if there is no improvement within the expected treatment time, or sooner if irritation worsens.