- Approval Id
- e6006951b13740b0
- Drug Approval Emc Name
- Canesten Thrush Combi Soft Gel Pessary & External Cream 500mg / 2% w/w vaginal capsule & cream
- Drug Name
- Canesten Thrush Combi Soft Gel Pessary & External Cream 500mg / 2% w/w vaginal capsule & cream
- Company Name
- Bayer plc
- Company Address
- 400 South Oak Way, Reading, Berkshire, RG2 6AD
- Company Website
- http://www.bayer.co.uk
- Company Telephone
- +44 (0)118 206 3000
- Company Medical Info Email
- medical.information@bayer.co.uk
- Atc Code
- G01AF02
- Legal Category
- General Sales List
- Authorisation Holder
- Bayer plc
400 South
Oak Way
Reading
RG2 6AD
- Authorisation Number
- PL 00010/0635
- Authorisation Date
- 05 September 2011
- Instruction Authorisation Holder
- Bayer plc
400 South
Oak Way
Reading
RG2 6AD
- Instruction Authorisation Number
- PL 00010/0635
- Instruction Authorisation Date
- 05 September 2011
- Instruction Composition
- Canesten Thrush Soft Gel Pessary contains Clotrimazole 500mg.
Canesten Thrush External Cream contains Clotrimazole 2% w/w.
\*\*Excipients with known effect\*\*:
Cream: Cetostearyl alcohol 100mg in each gram of cream
Benzyl alcohol 20mg in each gram of cream
For the full list of excipients, see section 6.1.
- Instruction Dosage Form
- Vaginal capsule, soft
Yellow teardrop-shaped soft capsule
Cream White cream
- Instruction Clinical Particulars
- 4.1 Therapeutic indications
The soft gel pessary is indicated for the treatment of candidal vaginitis.
The cream is indicated for the treatment of candidal vulvitis. It should be used as an adjunct to treatment of candidal vaginitis.
These products should only be used if candidal vulvovaginitis (thrush) was previously diagnosed by a doctor.4.2 Posology and method of administration
\*\*Adults\*\*
One soft gel pessary should be inserted into the vagina at night. Using the applicator provided, the soft gel pessary should be inserted as high as possible into the vagina. This is best achieved when lying back with legs bent up.
The cream should be thinly applied to the vulva and surrounding area, two or three times daily and rubbed in gently.
Treatment with the cream should be continued until symptoms of the infection disappear. However, if after concomitant treatment of the vaginitis, the symptoms do not improve within seven days, the patient should consult a physician.
\*\*Children\*\*
Not for use in children under 16.4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. Do not use to treat nail or scalp infections.4.4 Special warnings and precautions for use
This product contains cetostearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis). The product also contains benzyl alcohol which may cause allergic reactions and mild local irritation.
Before using Canesten Thrush Combi Soft Gel Pessary & External Cream, medical advice must be sought if any of the following are applicable:
- more than two infections of candidal vaginitis in the last 6 months.
- previous history of sexually transmitted disease or exposure to partner with sexually transmitted disease.
- pregnancy or suspected pregnancy.
- aged under 16 or over 60 years.
- known hypersensitivity to imidazoles or other vaginal antifungal products.
The soft gel pessary and cream should not be used if the patient has any of the following symptoms whereupon medical advice should be sought:
- irregular vaginal bleeding.
- abnormal vaginal bleeding or a blood-stained discharge.
- vulval or vaginal ulcers, blisters or sores.
- lower abdominal pain or dysuria.
- any adverse events such as redness, irritation or swelling associated with the treatment.
- fever or chills.
- nausea or vomiting.
- diarrhoea.
- foul smelling vaginal discharge.
Treatment during the menstrual period should be avoided due to the risk of the soft gel pessary being washed out by the menstrual flow. The treatment should be finished before the onset of menstruation.
Do not use tampons, intravaginal douches, spermicides or other vaginal products while using this product.
Vaginal intercourse should be avoided in case of vaginal infection and while using this product because the partner could become infected.
When used in pregnancy, the soft gel pessary should be inserted without using an applicator (see “Pregnancy”).
If no improvement in symptoms is seen after 7 days the patient should consult their doctor.4.5 Interaction with other medicinal products and other forms of interaction
Laboratory tests have suggested that, when used together, this product may cause damage to latex contraceptives. Consequently the effectiveness of such contraceptives may be reduced. Patients should be advised to use alternative precautions for at least five days after using this product.
Concomitant treatment with vaginal clotrimazole and oral tacrolimus (FK-506; immunosuppressant) might lead to increased tacrolimus plasma levels and similarly with sirolimus. Patients should thus be closely monitored for signs and symptoms of tacrolimus or sirolimus overdosage, if necessary by determination of the respective plasma levels.4.6 Fertility, pregnancy and lactation
Pregnancy:
There are limited amount of data from the use of clotrimazole in pregnant women. Animal studies with clotrimazole have shown reproductive toxicity at high oral doses (see section 5.3). At the low systemic exposures of clotrimazole following vaginal treatment, harmful effects with respect to reproductive toxicity are not predicted.
Clotrimazole can be used during pregnancy, but only under the supervision of a physician or midwife. During pregnancy the soft gel pessary should be inserted without using an applicator.
Lactation:
There are no data on the excretion of clotrimazole into human milk. However, systemic absorption is minimal after administration and is unlikely to lead to systemic effects. Clotrimazole may be used during lactation.
Fertility:
No human studies of the effects of clotrimazole on fertility have been performed, however, animal studies have not demonstrated any effects of the drug on fertility.4.7 Effects on ability to drive and use machines
The medication has no or negligible influence on the ability to drive or use machinery.4.8 Undesirable effects
Frequency not known. As the listed undesirable effects are based on spontaneous reports, assigning accurate frequency of occurrence for each is not possible.
Immune system disorders: anaphylactic reaction, angioedema, hypersensitivity.
\*\*Canesten Soft Gel Pessary\*\*
Vascular disorder: syncope, hypotension
Respiratory, thoracic and mediastinal disorders: dyspnea
Gastrointestinal disorders: abdominal pain, nausea.
Skin and Subcutaneous Tissue Disorders: rash, urticaria, pruritus
Reproductive system and breast disorders: vaginal exfoliation, vaginal discharge, vaginal haemorrhage, vulvovaginal discomfort, vulvovaginal erythema, vulvovaginal burning sensation, vulvovaginal pruritus, vulvovaginal pain.
General disorders and administration site conditions: application site irritation, oedema, pain.
\*\*Canesten Cream\*\*
Vascular disorder: syncope, hypotension
Respiratory, thoracic and mediastinal disorders: dyspnea
Skin and subcutaneous tissue disorders: blister, dermatitis contact, erythema, paraesthesia, skin exfoliation, pruritus, rash, urticaria, stinging skin/burning sensation skin.
General disorders and administration site conditions: application site irritation, application site reaction, oedema, pain.
\*\*Reporting of suspected adverse reactions\*\*
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.4.9 Overdose
No risk of acute intoxication is seen as it is unlikely to occur following a single vaginal or dermal application of an overdose (application over a large area under conditions favourable to absorption) or inadvertent oral ingestion. There is no specific antidote.
However, in the event of accidental oral ingestion, routine measures such as gastric lavage should be performed only if clinical symptoms of overdose become apparent (e.g. dizziness, nausea or vomiting). Gastric lavage should be carried out only if the airway can be protected adequately.
- Instruction Pharmacology
- 5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Gynaecological antiinfectives and antiseptics – imidazole derivatives ATC Code: G01A F02
Mechanism of Action
Azoles (e.g. clotrimazole) are usually recommended for the local treatment of vulvovaginal candidosis that is characterized by vulvovaginal symptoms such as itching, burning, discharge, redness, swelling and soreness.
Clotrimazole acts against fungi by inhibiting ergosterol synthesis. Inhibition of ergosterol synthesis leads to structural and functional impairment of the fungal cytoplasmic membrane.
Clotrimazole has a broad antimycotic spectrum of action in vitro and in vivo, which includes dermatophytes, yeasts, moulds, etc.
Under appropriate test conditions, the MIC values for these types of fungi are in the region of less than 0.062 – 8 microgram/ml substrate. The mode of action of clotrimazole is fungistatic or fungicidal depending on the concentration of clotrimazole at the site of infection. In-vitro activity is limited to proliferating fungal elements; fungal spores are only slightly sensitive.
Primarily resistant variants of sensitive fungal species are very rare; the development of secondary resistance by sensitive fungi has so far only been observed in very isolated cases under therapeutic conditions.5.2 Pharmacokinetic properties
Pharmacokinetic investigations after vaginal application have shown that only a small amount of clotrimazole (3 – 10%) is absorbed. Due to the rapid hepatic metabolism of absorbed clotrimazole into pharmacologically inactive metabolites the resulting peak plasma concentrations of clotrimazole after vaginal application of a 500mg dose were less than 10 ng/ml, reflecting that clotrimazole applied intravaginally does not lead to measurable systemic effects or side effects.
Pharmacokinetic investigations after dermal application have shown that clotrimazole is practically not absorbed from the intact or inflamed skin into the human blood circulation. The resulting peak serum concentrations of clotrimazole were below the detection limit of 0.001 μg/ml, reflecting that clotrimazole applied topically does not lead to measurable systemic effects or side effects.5.3 Preclinical safety data
Non-clinical data reveal no special hazard for humans based on studies of repeated dose toxicity, genotoxicity and carcinogenicity.
Clotrimazole was not teratogenic in reproductive toxicity studies in mice, rats and rabbits. In rats high oral doses were associated with maternal toxicity, embryotoxicity, reduced fetal weights and decreased pup survival.
In rats clotrimazole and/or its metabolites were secreted into milk at levels higher than in plasma by a factor of 10 to 20 at 4 hrs after administration, followed by a decline to a factor of 0.4 by 24 hrs.
- Instruction Pharmaceutical Particulars
- 6.1 List of excipients
The soft gel pessary contains:
White soft paraffin
Liquid paraffin
Gelatin
Glycerol
Water
Titanium dioxide (E171)
Quinoline yellow (E104)
Sunset yellow (E110)
Lecithin
Medium-chain triglycerides.
The cream contains:
Sorbitan stearate
Polysorbate 60
Cetyl palmitate
Cetostearyl alcohol
Octyldodecanol
Benzyl alcohol
Purified Water6.2 Incompatibilities
Not applicable6.3 Shelf life
2 years6.4 Special precautions for storage
This product should be stored in the original carton in a dry place in order to protect it from moisture. Do not store above 30°C.6.5 Nature and contents of container
The soft gel pessary is packed into a blister consisting of formed clear triplex laminate film PVC/PVdC/PVC (Total PVC 250μm; PVdC 120g/m2) sealed with 20 μm hard tempered aluminium lidding foil) and is supplied with an applicator.
The cream is filled into Aluminium tubes (10g) with internal lacquer coating, latex stopper and HDPE screw top.6.6 Special precautions for disposal and other handling
No special requirements.
- Instruction Content
- ## Composition
Canesten Thrush Soft Gel Pessary contains Clotrimazole 500mg.
Canesten Thrush External Cream contains Clotrimazole 2% w/w.
\*\*Excipients with known effect\*\*:
Cream: Cetostearyl alcohol 100mg in each gram of cream
Benzyl alcohol 20mg in each gram of cream
For the full list of excipients, see section 6.1.
## Pharmaceutical Form
Vaginal capsule, soft
Yellow teardrop-shaped soft capsule
Cream White cream
## Clinical Particulars
4.1 Therapeutic indications
The soft gel pessary is indicated for the treatment of candidal vaginitis.
The cream is indicated for the treatment of candidal vulvitis. It should be used as an adjunct to treatment of candidal vaginitis.
These products should only be used if candidal vulvovaginitis (thrush) was previously diagnosed by a doctor.4.2 Posology and method of administration
\*\*Adults\*\*
One soft gel pessary should be inserted into the vagina at night. Using the applicator provided, the soft gel pessary should be inserted as high as possible into the vagina. This is best achieved when lying back with legs bent up.
The cream should be thinly applied to the vulva and surrounding area, two or three times daily and rubbed in gently.
Treatment with the cream should be continued until symptoms of the infection disappear. However, if after concomitant treatment of the vaginitis, the symptoms do not improve within seven days, the patient should consult a physician.
\*\*Children\*\*
Not for use in children under 16.4.3 Contraindications
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. Do not use to treat nail or scalp infections.4.4 Special warnings and precautions for use
This product contains cetostearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis). The product also contains benzyl alcohol which may cause allergic reactions and mild local irritation.
Before using Canesten Thrush Combi Soft Gel Pessary & External Cream, medical advice must be sought if any of the following are applicable:
- more than two infections of candidal vaginitis in the last 6 months.
- previous history of sexually transmitted disease or exposure to partner with sexually transmitted disease.
- pregnancy or suspected pregnancy.
- aged under 16 or over 60 years.
- known hypersensitivity to imidazoles or other vaginal antifungal products.
The soft gel pessary and cream should not be used if the patient has any of the following symptoms whereupon medical advice should be sought:
- irregular vaginal bleeding.
- abnormal vaginal bleeding or a blood-stained discharge.
- vulval or vaginal ulcers, blisters or sores.
- lower abdominal pain or dysuria.
- any adverse events such as redness, irritation or swelling associated with the treatment.
- fever or chills.
- nausea or vomiting.
- diarrhoea.
- foul smelling vaginal discharge.
Treatment during the menstrual period should be avoided due to the risk of the soft gel pessary being washed out by the menstrual flow. The treatment should be finished before the onset of menstruation.
Do not use tampons, intravaginal douches, spermicides or other vaginal products while using this product.
Vaginal intercourse should be avoided in case of vaginal infection and while using this product because the partner could become infected.
When used in pregnancy, the soft gel pessary should be inserted without using an applicator (see “Pregnancy”).
If no improvement in symptoms is seen after 7 days the patient should consult their doctor.4.5 Interaction with other medicinal products and other forms of interaction
Laboratory tests have suggested that, when used together, this product may cause damage to latex contraceptives. Consequently the effectiveness of such contraceptives may be reduced. Patients should be advised to use alternative precautions for at least five days after using this product.
Concomitant treatment with vaginal clotrimazole and oral tacrolimus (FK-506; immunosuppressant) might lead to increased tacrolimus plasma levels and similarly with sirolimus. Patients should thus be closely monitored for signs and symptoms of tacrolimus or sirolimus overdosage, if necessary by determination of the respective plasma levels.4.6 Fertility, pregnancy and lactation
Pregnancy:
There are limited amount of data from the use of clotrimazole in pregnant women. Animal studies with clotrimazole have shown reproductive toxicity at high oral doses (see section 5.3). At the low systemic exposures of clotrimazole following vaginal treatment, harmful effects with respect to reproductive toxicity are not predicted.
Clotrimazole can be used during pregnancy, but only under the supervision of a physician or midwife. During pregnancy the soft gel pessary should be inserted without using an applicator.
Lactation:
There are no data on the excretion of clotrimazole into human milk. However, systemic absorption is minimal after administration and is unlikely to lead to systemic effects. Clotrimazole may be used during lactation.
Fertility:
No human studies of the effects of clotrimazole on fertility have been performed, however, animal studies have not demonstrated any effects of the drug on fertility.4.7 Effects on ability to drive and use machines
The medication has no or negligible influence on the ability to drive or use machinery.4.8 Undesirable effects
Frequency not known. As the listed undesirable effects are based on spontaneous reports, assigning accurate frequency of occurrence for each is not possible.
Immune system disorders: anaphylactic reaction, angioedema, hypersensitivity.
\*\*Canesten Soft Gel Pessary\*\*
Vascular disorder: syncope, hypotension
Respiratory, thoracic and mediastinal disorders: dyspnea
Gastrointestinal disorders: abdominal pain, nausea.
Skin and Subcutaneous Tissue Disorders: rash, urticaria, pruritus
Reproductive system and breast disorders: vaginal exfoliation, vaginal discharge, vaginal haemorrhage, vulvovaginal discomfort, vulvovaginal erythema, vulvovaginal burning sensation, vulvovaginal pruritus, vulvovaginal pain.
General disorders and administration site conditions: application site irritation, oedema, pain.
\*\*Canesten Cream\*\*
Vascular disorder: syncope, hypotension
Respiratory, thoracic and mediastinal disorders: dyspnea
Skin and subcutaneous tissue disorders: blister, dermatitis contact, erythema, paraesthesia, skin exfoliation, pruritus, rash, urticaria, stinging skin/burning sensation skin.
General disorders and administration site conditions: application site irritation, application site reaction, oedema, pain.
\*\*Reporting of suspected adverse reactions\*\*
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.4.9 Overdose
No risk of acute intoxication is seen as it is unlikely to occur following a single vaginal or dermal application of an overdose (application over a large area under conditions favourable to absorption) or inadvertent oral ingestion. There is no specific antidote.
However, in the event of accidental oral ingestion, routine measures such as gastric lavage should be performed only if clinical symptoms of overdose become apparent (e.g. dizziness, nausea or vomiting). Gastric lavage should be carried out only if the airway can be protected adequately.
## Pharmacological Properties
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Gynaecological antiinfectives and antiseptics – imidazole derivatives ATC Code: G01A F02
Mechanism of Action
Azoles (e.g. clotrimazole) are usually recommended for the local treatment of vulvovaginal candidosis that is characterized by vulvovaginal symptoms such as itching, burning, discharge, redness, swelling and soreness.
Clotrimazole acts against fungi by inhibiting ergosterol synthesis. Inhibition of ergosterol synthesis leads to structural and functional impairment of the fungal cytoplasmic membrane.
Clotrimazole has a broad antimycotic spectrum of action in vitro and in vivo, which includes dermatophytes, yeasts, moulds, etc.
Under appropriate test conditions, the MIC values for these types of fungi are in the region of less than 0.062 – 8 microgram/ml substrate. The mode of action of clotrimazole is fungistatic or fungicidal depending on the concentration of clotrimazole at the site of infection. In-vitro activity is limited to proliferating fungal elements; fungal spores are only slightly sensitive.
Primarily resistant variants of sensitive fungal species are very rare; the development of secondary resistance by sensitive fungi has so far only been observed in very isolated cases under therapeutic conditions.5.2 Pharmacokinetic properties
Pharmacokinetic investigations after vaginal application have shown that only a small amount of clotrimazole (3 – 10%) is absorbed. Due to the rapid hepatic metabolism of absorbed clotrimazole into pharmacologically inactive metabolites the resulting peak plasma concentrations of clotrimazole after vaginal application of a 500mg dose were less than 10 ng/ml, reflecting that clotrimazole applied intravaginally does not lead to measurable systemic effects or side effects.
Pharmacokinetic investigations after dermal application have shown that clotrimazole is practically not absorbed from the intact or inflamed skin into the human blood circulation. The resulting peak serum concentrations of clotrimazole were below the detection limit of 0.001 μg/ml, reflecting that clotrimazole applied topically does not lead to measurable systemic effects or side effects.5.3 Preclinical safety data
Non-clinical data reveal no special hazard for humans based on studies of repeated dose toxicity, genotoxicity and carcinogenicity.
Clotrimazole was not teratogenic in reproductive toxicity studies in mice, rats and rabbits. In rats high oral doses were associated with maternal toxicity, embryotoxicity, reduced fetal weights and decreased pup survival.
In rats clotrimazole and/or its metabolites were secreted into milk at levels higher than in plasma by a factor of 10 to 20 at 4 hrs after administration, followed by a decline to a factor of 0.4 by 24 hrs.
## Pharmaceutical Particulars
6.1 List of excipients
The soft gel pessary contains:
White soft paraffin
Liquid paraffin
Gelatin
Glycerol
Water
Titanium dioxide (E171)
Quinoline yellow (E104)
Sunset yellow (E110)
Lecithin
Medium-chain triglycerides.
The cream contains:
Sorbitan stearate
Polysorbate 60
Cetyl palmitate
Cetostearyl alcohol
Octyldodecanol
Benzyl alcohol
Purified Water6.2 Incompatibilities
Not applicable6.3 Shelf life
2 years6.4 Special precautions for storage
This product should be stored in the original carton in a dry place in order to protect it from moisture. Do not store above 30°C.6.5 Nature and contents of container
The soft gel pessary is packed into a blister consisting of formed clear triplex laminate film PVC/PVdC/PVC (Total PVC 250μm; PVdC 120g/m2) sealed with 20 μm hard tempered aluminium lidding foil) and is supplied with an applicator.
The cream is filled into Aluminium tubes (10g) with internal lacquer coating, latex stopper and HDPE screw top.6.6 Special precautions for disposal and other handling
No special requirements.
