Generic Name

Clotrimazole

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Classification

FDA Approved Indications

• Oral candidiasis
• Vaginal candidiasis
• Cutaneous candidiasis

Mechanism of Action

Clotrimazole inhibits fungal cytochrome P450-dependent 14α-demethylase, resulting in decreased ergosterol synthesis and disruption of fungal cell membrane formation, leading to leakage of cell contents and fungal cell death.

Dosage and Administration

Adult: For vaginal candidiasis, one applicatorful (100 mg) intravaginally once daily for 7 days; for cutaneous infections, apply a thin layer to affected area twice daily for 2-4 weeks.

Pediatric: Use as directed by a healthcare provider; typically similar dosing for vaginal candidiasis, but consult specific guidelines.

Geriatric: No dose adjustment generally required; monitor for skin integrity and use in conjunction with renal or hepatic impairment as needed.

Renal Impairment: No specific adjustment needed, but caution advised.

Hepatic Impairment: No specific adjustment needed, but caution advised.

Pharmacokinetics

Absorption: Minimal systemic absorption when used topically; significant absorption when administered via oral or vaginal routes.

Distribution: Widely distributed in body tissues, especially skin and mucous membranes.

Metabolism: Metabolized in the liver via cytochrome P450 enzymes.

Excretion: Excreted mainly in urine, primarily as inactive metabolites.

Half Life: Approximately 3-4 hours when absorbed systemically.

Contraindications

• Hypersensitivity to clotrimazole or imidazoles.

Precautions

• Use with caution in patients with liver disease; monitor for signs of systemic absorption if used extensively or on large areas.

Adverse Reactions - Common

• Application site burning or itching (Common)
• Skin irritation (Common)

Adverse Reactions - Serious

• Hypersensitivity reactions (rare) (Serious)
• Systemic toxicity (very rare, with oral use) (Rare)

Drug-Drug Interactions

• Warfarin (may increase bleeding risk)
• Other CYP450 substrates or inhibitors

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Use medication exactly as prescribed.
• Keep the area clean and dry before application.
• Report any severe or allergic reactions.
• Complete the full course of therapy even if symptoms improve.

Special Considerations

Black Box Warnings: N/A

Genetic Factors: No known genetic factors affecting use.

Lab Test Interference: None reported.

Overdose Management

Signs/Symptoms: Nausea, vomiting, or gastrointestinal discomfort if swallowed in excess; local irritation if topical overdose.

Treatment: Supportive care; no specific antidote. Remove unabsorbed drug/application and provide symptomatic relief.

Storage and Handling

Storage: Store at room temperature, protected from light and moisture.

Stability: Stable until expiration date when stored properly.