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CANESTEN THRUSH DUO ORAL CAPSULE & EXTERNAL CREAM 150MG/2% W/W CAPSULE & CREAM

Active substance(s): CLOTRIMAZOLE / FLUCONAZOLE / CLOTRIMAZOLE / FLUCONAZOLE / CLOTRIMAZOLE / FLUCONAZOLE

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SUMMARY OF PRODUCT CHARACTERISTICS
1

NAME OF THE MEDICINAL PRODUCT
Canesten Thrush Duo Oral Capsule & External Cream 150mg / 2% w/w capsule &
cream

2

QUALITATIVE AND QUANTITATIVE COMPOSITION
Canesten Thrush Oral Capsule contains Fluconazole 150mg
Canesten Thrush External Cream contains Clotrimazole 2% w/w
Excipients with known effect:
Capsule: lactose
Cream: cetostearyl alcohol
For the full list of excipients, see section 6.1

3

PHARMACEUTICAL FORM
Hard capsule.
Opaque light blue capsule (size 1) with “Canesten®” printed in black between two
black lines.
Cream.
White cream.

4

CLINICAL PARTICULARS

4.1

Therapeutic indications
Canesten Thrush Oral Capsule is indicated for the treatment of candidal vaginitis,
acute or recurrent. It should also be used for the treatment of partners with associated
candidal balanitis.

Canesten Thrush External Cream is indicated for the treatment of candida vulvitis.
It should be used as an adjunct to treatment of candidal vaginitis.
It can also be used for treatment of the sexual partner’s penis to prevent re-infection.

4.2

Posology and method of administration
Adults (16 to 60):
One capsule should be swallowed whole.
The cream should be applied thinly two or three times daily to the vulva and
surrounding area 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 doctor.
If the cream is being used for treatment of the sexual partner’s penis it should be
applied two or three times daily for up to two weeks.
Children (under 16):
Paediatric use is not recommended.

Elderly:
Not recommended in patients over 60.

Renal Impairment:
There is no separate dosage schedule in patients with renal impairment for single dose
therapy.

4.3

Contraindications
Known hypersensitivity to fluconazole, clotrimazole, related azole compounds or any
of the excipients listed in section 6.1 .
Fluconazole should not be administered concomitantly with terfenadine, cisapride or
ergot-derivatives (see section 4.5).

4.4

Special warnings and precautions for use
Medical advice should be sought if this is the first time the patient has experienced
symptoms of candidal vaginitis.
The product is available from pharmacies without prescription and includes a leaflet
that advises the patient - Do not use Canesten Thrush Duo Oral Capsule & External
Cream without first consulting your doctor:
If you are under 16 or over 60 years of age
If you are allergic to any of the ingredients in Canesten Thrush Duo Oral Capsule &
External Cream or other antifungals and other thrush treatments
If you are taking any other medicine other than the Pill.
If you are taking the antihistamine terfenadine or the prescription medicine cisapride
If you have had thrush more than twice in the last six months
If you have any disease or illness affecting your liver or kidneys or have had
unexplained jaundice.
If you suffer from any other chronic disease or illness.
If you or your partner have had exposure to a sexually transmitted disease.
If you are unsure of the cause of your symptoms.
Women only:
If you are pregnant, suspect you might be pregnant or are breast-feeding.
If you have any abnormal or irregular vaginal bleeding or a blood stained discharge
If you have vulval or vaginal sores, ulcers or blisters.
If you are experiencing lower abdominal pain or burning sensation on passing water.
If you are experiencing any adverse events such as redness, irritation or swelling
associated with the treatment.
If you are experiencing fever or chills, nausea, vomiting or diarrhoea.
If you have foul smelling vaginal discharge.
Men only:
If your sexual partner does not have thrush.
If you have penile sores, ulcers or blisters.
If you have an abnormal penile discharge (leakage).
If your penis has started to smell.
If you have pain on passing urine.
The product should never be used again if the patient experiences a rash or
anaphylaxis following the use of the drug.

Recurrent use (men and women): patients should be advised to consult their physician
if the symptoms have not been relieved within one week of taking Canesten Oral
Capsule. Canesten Oral Capsule can be used if the candidal infection returns after 7
days. However, if the candidal infection recurs more than twice within six months,
patients should be advised to consult their physician.
Fluconazole has been associated with rare cases of serious hepatic toxicity, including
fatalities primarily in patients with serious underlying medical conditions.
Fluconazole must be taken with particular care in patients with congenital or acquired
QT prolongation and torsades de pointes or a history thereof, known cardiomyopathy,
sinus bradycardia, cardiac arrhythmia, or are treated with a co-medication potentially
leading to QT prolongation (see section 4.5).
Patients with rare hereditary problems of galactose intolerance, the Lapp lactase
deficiency or glucose-galactose malabsorption should not take this medicine.
The cream contains cetostearyl alcohol, which may cause local skin reactions (e.g.
contact dermatitis).

4.5

Interaction with other medicinal products and other forms of interaction
Fluconazole, like other azoles, may interfere with the metabolism of some drugs if
given concomitantly, mainly through inhibition of the cytochrome P450 isoenzymes
CYP3A4 and CYP2C9. The vast majority of formal interaction studies and case
reports are related to multiple dose fluconazole use, therefore, the magnitude of the
effect of this inhibition on an individual patient after a single dose of fluconazole is
hard to predict, particularly in light of the individual variability in the activity of the
isoenzymes. Nonetheless, single dose pharmacokinetic studies have demonstrated that
the inhibitory action of fluconazole is immediate and leads, dose-dependently, to
increased plasma concentrations of the interacting agents. Given fluconazole’s long
plasma elimination half-life of approximately 30 hours and substantially longer tissue
bioavailability (see section 5.2 Pharmacokinetic Properties), these interactions may be
clinically relevant following coadministration with drugs that have both a narrow
therapeutic window and also act on vital organ systems like the heart and brain or are
involved with glucose metabolism.
Anticoagulants:
Fluconazole increased the prothrombin time after warfarin administration in healthy
males during an interaction study. The change was small (12%) but bleeding events
such as bruising, epistaxis, gastrointestinal bleeding, hematuria and melena have been
reported in association with increases in prothrombin time in patients receiving
fluconazole and warfarin concomitantly. Careful monitoring of prothrombin time in
patients receiving coumarin type anticoagulants is recommended.
Sulphonylureas:

In healthy volunteers, fluconazole prolonged the serum half-life of oral
sulphonylureas such as chlorpropamide, glibenclamide, glipizide and tolbutamide,
when co-administered. Fluconazole and oral sulphonylureas may be concomitantly
administered to diabetics but the possibility of an hypoglycaemic episode should be
considered.
Hydrochlorothiazide:
Co-administration of fluconazole and multiple dose hydrochlorothiazide to healthy
volunteers during a kinetic interaction study, increased plasma concentrations of
fluconazole by 40%. However, although the prescriber should bear this in mind, the
fluconazole dose in patients receiving concomitant diuretics should not need to be
altered.
Anti-arrhythmic drugs:
Cases of QTc prolongation and/or torsades de pointes may occur after concomitant
use of fluconazole with Class I, Class Ia, and all Class III anti-arrhythmic agents.
Even though no formal drug interaction studies have been done, concomitant use of
these anti-arrhythmic agents and drugs known to prolong the QT interval is not
recommended.
Pharmacodynamic interactions:
Medicinal products that prolong QT interval: Case reports indicate that fluconazole
might have the potential to induce QT prolongation leading to serious cardiac
arrhythmia. Patients treated concomitantly with fluconazole and other drugs that
prolong QT interval should be carefully monitored, since an additive effect cannot be
excluded.
Benzodiazepines:
Substantial increases in midazolam concentrations and psychomotor effects are
observed when oral midazolam and fluconazole (oral or intravenous) are coadministered. The effect on midazolam appears to be greater when fluconazole is
administered orally than when fluconazole is administered intravenously. If
concomitant administration of benzodiazepines and fluconazole is required then the
prescriber should consider reducing the benzodiazepine dose and appropriate
monitoring of the patient should be undertaken.
Phenytoin:
Levels of phenytoin may increase to a clinically significant degree during coadministration with fluconazole. Phenytoin levels should be monitored and the
phenytoin dose adjusted to maintain therapeutic levels if co-administration is
necessary.
Carbamazepine, Phenobarbital, Phenytoin, Rifapentine:

Concurrent administration of fluconazole and carbamazepine, phenobarbital,
phenytoin or rifapentine results in enhanced metabolism of fluconazole, potentially
reducing fluconazole effective inhibitory serum concentrations. An increase in the
fluconazole dose should be considered in patients receiving concomitant
carbamazepine, phenobarbital, phenytoin or rifapentine.
Oral Contraceptives:
Studies on the use of combined oral contraceptives with multiple doses of fluconazole
have been performed. No relevant effects on hormone levels occurred during a study
with fluconazole 50mg, whilst the AUCs of ethinylestradiol and levonorgestrel were
increased by 40% and 24% respectively during a study with fluconazole 200mg. It is
therefore considered that multiple dose fluconazole is unlikely to affect the efficacy
of the combined oral contraceptive.
Rifampicin:
A 25% decrease in the AUC and 20% shorter half-life of fluconazole occurred when
fluconazole and rifampicin were administered concomitantly. An increase in the
fluconazole dose should be considered in patients receiving concomitant rifampicin.
Endogenous Steroid:
No effect on endogenous steroid levels was observed in females when treated with
fluconazole 50mg daily. No significant effect on endogenous steroid levels or on
ACTH stimulated response was observed in healthy male volunteers when treated
with fluconazole 200 to 400mg daily.
Ergot derivatives:
Because of the potential for serious toxicity including vasospasm that can occur with
increased plasma concentrations of ergot derivatives (dihydroergotamine, ergoloid
mesylates, ergonovine, ergotamine, methylergonovine, methysergide) the concurrent
use of fluconazole and ergot derivatives is contraindicated (see Contraindications).
Fluconazole and ergot derivatives are both metabolized by cytochrome P450 3A4
enzymes, and the competition for metabolism could result in a rapid onset of
increased plasma concentration of the ergot derivative.
Losartan:
CYP2C9 and CYP3A4 are involved in the metabolism of losartan to its active
carboxylic acid metabolite E-3174 that is responsible for most of the angiotensin II
receptor antagonism that occurs with losartan therapy. Fluconazole was shown to
significantly inhibit the conversion of losartan to this metabolite. Monitoring of
patients for continued control of their hypertension is recommended.
Ciclosporin:
In a kinetic study it was found that fluconazole 200mg daily slowly increases
ciclosporin concentrations in renal transplant patients, but a multiple dose study with
fluconazole 100mg daily showed no effect on ciclosporin levels in patients with bone

marrow transplants. It is therefore recommended that ciclosporin plasma
concentration is monitored in patients receiving fluconazole.
Fentanyl, Methadone:
Coadministration of fluconazole may cause decreased clearance of fentanyl or
methadone and subsequent increased or prolonged opioid effects (CNS depression,
respiratory depression). Dosage adjustment of the opioid may be necessary.
Theophylline:
Use of fluconazole 200mg for 14 days showed an 18% decrease in the mean plasma
clearance of theophylline. Patients who require high doses of theophylline or who
may be at increased risk of theophylline toxicity should be monitored for signs of
theophylline toxicity when fluconazole is co-administered. The therapy should be
modified if signs of toxicity occur.
Terfenadine:
Fluconazole 200mg daily did not show a prolongation in the QTc interval. Use of
fluconazole (taken in multiple doses of 400mg and 800mg per day) and terfenadine
concomitantly, significantly increased plasma levels of terfenadine. Spontaneous
reports of palpitations, tachycardia, dizziness and chest pains have occurred in
patients taking fluconazole and terfenadine concomitantly where the relationship of
the reported adverse events to drug therapy or underlying medical condition is
uncertain. It is recommended that terfenadine and fluconazole should not be
administered concomitantly due to the potential seriousness of such an interaction.
(See 4.3).
Cisapride:
Cardiac events including torsades de pointes have been reported in patients receiving
fluconazole and cisapride concomitantly. Most of these patients appear to have been
predisposed to arrhythmias or had serious underlying medical conditions, and the
relationship of the reported events to a possible drug interaction is uncertain. Coadministration of cisapride is contra-indicated in patients receiving fluconazole. (See
4.3).
Zidovudine:
Zidovudine levels in AIDS or ARC patients were determined before and after daily
treatment with fluconazole 200mg for 15 days. A significant increase in zidovudine
AUC was observed (20%). A second study in HIV infected patients also showed a
significant increase in zidovudine AUC (74%) when fluconazole was administered
concomitantly. Patients received zidovudine 200mg every eight hours either with or
without fluconazole 400mg for seven days on two occasions, 21 days apart. The
increased zidovudine levels are most likely caused by a decrease in the conversion of
zidovudine to its major metabolite. It is recommended that patients receiving
fluconazole and zidovudine be monitored for zidovudine related adverse reactions.
Rifabutin:

Increased serum levels of rifabutin have been reported in patients receiving
fluconazole and rifabutin concomitantly, suggesting a possible interaction. Uveitis
has also been reported in patients receiving this combination. It is therefore
recommended that patients are carefully monitored.
Tacrolimus, Sirolimus:
Increased serum levels of tacrolimus have been reported in patients receiving
fluconazole and tacrolimus concomitantly, suggesting a possible interaction. There
have also been reports of nephrotoxicity in patients receiving this combination.
Patients receiving tacrolimus or sirolimus and fluconazole concomitantly should be
carefully monitored.
Astemizole or other drugs metabolised by the cytochrome P450 system taken
concomitantly with fluconazole may be associated with elevations in serum levels of
these drugs in patients. Fluconazole should be co-administered with caution in these
circumstances and careful monitoring of patients should be undertaken.
Studies show that when fluconazole is taken orally with food, cimetidine, antacids or
following total body irradiation for bone marrow transplantation, the absorption of
fluconazole is not significantly impaired.
Drug – drug interaction studies with other medications have not been conducted but
prescribers should be aware that such interactions may occur.
Laboratory tests have suggested that, when used together, the cream 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.

4.6

Fertility, pregnancy and lactation
Canesten Thrush Duo Oral Capsule and External Cream should not be used during
pregnancy or in women of childbearing potential unless adequate contraception is
being used. Fluconazole is found in breast milk so it should not be used whilst breastfeeding.

4.7

Effects on ability to drive and use machines
No studies on the effect on the ability to drive and use machines have been
performed. However, undesirable effects such as dizziness have been observed. If
dizziness occurs, patients should not drive or operate machines.

4.8

Undesirable effects
The listed undesirable effects are based on spontaneous reports, thus assigning
accurate frequency of occurrence for each is not possible.

Canesten Thrush Oral Capsule
Blood and lymphatic system disorders
Leukopenia, neutropenia, agranulocytosis, thrombocytopenia.

Cardiac disorders
Torsades de pointes/QT prolongation.

Gastrointestinal disorders
Nausea, diarrhea, vomiting, gastrointestinal and abdominal pains, abdominal
distension, flatulence.

Hepatobiliary disorders
Most events were observed when a multiple treatment was used: mild transient
elevations in transaminases, hepatitis (non infective), jaundice, cholestasis and acute
hepatic failure, including fatalities.

Immune System Disorders
Allergic reaction, anaphylactic reaction, anaphylactic shock.
Hypersensitivity reactions including symptoms such as rash, urticaria, oedema,
pruritus, cardio-respiratory distress.

Investigations
Electrocardiogram QT prolonged, electrocardiogram QT corrected interval
prolonged, hypercholesterolemia, hypertriglyceridemia, hypokalemia.
Nervous system disorders
Seizures, dizziness, headache, dysgeusia.

Skin and subcutaneous tissue disorders
Rash, pruritus, alopecia, exfoliative skin reactions including Stevens-Johnson
syndrome, toxic epidermal necrolysis.

Canesten Thrush External Cream
Immune System Disorders
Allergic reaction (syncope, hypotension, dyspnea, urticaria).

Skin and subcutaneous tissue disorders
Blisters, discomfort/pain, oedema, erythema, irritation, peeling/exfoliation, pruritus,
rash, stinging/burning.

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

4.9

Overdose
Canesten Thrush Oral Capsule
Supportive measures and symptomatic treatment, with gastric lavage if necessary,
may be adequate.
Fluconazole is largely excreted in the urine and therefore, forced volume diuresis
would probably increase the elimination rate. Plasma levels are decreased by
approximately 50% during a 3-hour haemodialysis session.

Canesten Thrush External Cream
No risk of acute intoxication is seen as it is unlikely to occur following a single
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.

5

PHARMACOLOGICAL PROPERTIES

5.1

Pharmacodynamic properties
Canesten Thrush Oral Capsule
Pharmacotherapeutic group: Fluconazole is a triazole antifungal
ATC-Code: J02AC01

Fluconazole is a triazole antifungal. It is a potent and selective inhibitor of fungal
enzymes necessary for the synthesis of ergosterol.
Fluconazole shows little pharmacological activity in a wide range of animal studies.
Some prolongation of pentabarbitone sleeping times in mice (p.o.), increased mean
arterial and left ventricular blood pressure and increased heart rate in anaesthetised
cats (i.v.) occurred. Inhibition of rat ovarian aromatase was observed at high
concentrations.
Fluconazole was active in a variety of animal fungal infection models. Activity has
been demonstrated against opportunistic mycoses, such as infections with Candida
spp. including systemic candidiasis in immuno-compromised animals; with
Cryptococcus neoformans, including intracranial infections; with Microsporum spp.
and with Trichophyton spp. Fluconazole has also been shown to be active in animal
models of endemic mycoses, including infections with Blastomyces dermatitides;
with Coccidoides immitis, including intracranial infection and with Histoplasma
capsulatum in normal and immuno-compromised animals.
There have been reports of cases of superinfection with Candida species other than C.
albicans, which are often inherently not susceptible to fluconazole (e.g. Candida
krusei). Such cases may require alternative antifungal therapy.
Fluconazole is highly specific for fungal cytochrome P-450 dependent enzymes.
Fluconazole has been shown not to affect testosterone plasma concentrations in males
or steroid concentrations in females of childbearing age when given 50mg daily for
up to 28 days. No clinically significant effect has been seen on endogenous steroid
levels or on ACTH stimulated response in healthy male volunteers taking fluconazole
200 – 400mg daily. Interaction studies with antipyrine indicate that single or multiple
doses of fluconazole 50mg do not affect its metabolism.

Canesten Thrush External Cream
Pharmacotherapeutic group: Antifungals for topical use – imidazole and triazole
derivatives
ATC Code: D01A C01
Mechanism of Action
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 0.062-8.0 µg/ml substrate. The mode of action of clotrimazole is
primarily 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.
In addition to its antimycotic action, clotrimazole also acts on gram-positive
microorganisms (Streptococci / Staphylococci / Gardnerella vaginalis), and gramnegative microorganisms (Bacteroides).
In vitro clotrimazole inhibits the multiplication of Corynebacteria and gram-positive
cocci - with the exception of Enterococci - in concentrations of 0.5-10 µg/ml
substrate.
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
Canesten Thrush Oral Capsule
The pharmacokinetic properties of fluconazole are similar whether administered
orally or by the intravenous route. After oral administration, fluconazole is well
absorbed and plasma levels (and systemic bioavailability) are over 90% of the levels
achieved after intravenous administration. Concomitant food intake does not affect
oral absorption. In the fasting state peak plasma concentrations occur between 0.5 and
1.5 hours post-dose with a plasma elimination half-life of approximately 30 hours.
Plasma concentrations are proportional to dose. Ninety- percent steady state levels are
reached by day 4 to 5 with multiple once daily dosing.
Administration of a loading dose (on day 1) of twice the usual daily dose enables
plasma levels to approximate to 90% steady state levels by day 2. The apparent
volume of distribution approximates to total body water. Plasma protein binding is
low (11-12%).
Fluconazole achieves good penetration in all body fluids studied. The levels of
fluconazole in saliva and sputum are similar to plasma levels. In patients with fungal
meningitis, fluconazole levels in the CSF are approximately 80% of the
corresponding plasma levels.
High skin concentrations of fluconazole, above serum concentrations, are achieved in
the stratum corneum, epidermis-dermis and eccrine sweat. Fluconazole accumulates
in the stratum corneum. At a dose of 50mg once daily, the concentration of
fluconazole after 12 days was 73 mg/g and 7 days after cessation of treatment the
concentration was still 5.8 mg/g.

Excretion is mainly renal, with approximately 80% of the administered dose
appearing in the urine as unchanged drug. Fluconazole clearance is proportional to
creatinine clearance. There is no evidence of circulating metabolites.
The long plasma elimination half-life provides the basis for single dose therapy for
genital candidiasis.
A study compared the saliva and plasma concentrations of a single fluconazole
100mg dose administration in a capsule or in an oral suspension by rinsing and
retaining in the mouth for 2 minutes and swallowing. The maximum concentration of
fluconazole in saliva after the suspension was observed five minutes after ingestion
and was 182 times higher than maximum saliva concentration after the capsule which
occurred four hours after ingestion. After about four hours, the saliva concentrations
of fluconazole were similar. The mean AUC (0-96) in saliva was significantly greater
after the suspension compared to the capsule. There was no significant difference in
the elimination rate from the saliva or the plasma pharmacokinetic parameters for the
two formulations.
Canesten Thrush External Cream
Pharmacokinetic investigations after dermal application have shown that clotrimazole
is minimally 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 mcg/ml, suggesting that clotrimazole applied topically is
unlikely to lead to measurable systemic effects or side effects.

5.3

Preclinical safety data
Canesten Thrush Oral Capsule
Reproductive Toxicity:
At 25 and 50mg/kg and higher doses, increases in foetal anatomical variants
(supernumerary ribs, renal pelvis dilation) and delays in ossification were observed.
At doses ranging from 80mg/kg to 320mg/kg embryolethality in rats was increased
and foetal abnormalities included wavy ribs, cleft palate and abnormal cranio-facial
ossification. This may be a result of known effects of lowered oestrogen on
pregnancy, organogenesis and parturition as it is consistent with the inhibition of
oestrogen synthesis in rats.
Carcinogenesis:
No evidence of carcinogenic potential was observed in mice and rats treated orally
with fluconazole for 24 months at doses of 2.5, 5 or 10mg/kg/day. The incidence of
hepatocellular adenomas was increased in male rats treated with 5 and 10mg/kg/day.
Mutagenesis:
Fluconazole, with or without metabolic activation, was negative in tests for
mutagenicity in 4 strains of S. typhimurium and in the mouse lymphoma L5178Y

system. No evidence of chromosomal mutations was observed in cytogenetic studies
in vivo (murine bone marrow cells, following oral administration of fluconazole).
Data derived from in vitro studies (human lymphocytes exposed to fluconazole) are
not consistent.
Impairment of Fertility:
The fertility of male or female rats treated orally with daily doses of fluconazole at
doses of 5, 10 or 20mg/kg or with parenteral doses of 5, 25 or 75mg/kg was not
affected, although the onset of parturition was slightly delayed at 20mg/kg p.o. In an
intravenous perinatal study in rats at 5, 20 and 40mg/kg, dystocia and prolongation of
parturition were observed in a few dams at 20mg/kg and 40mg/kg, but not at 5mg/kg.
The disturbances in parturition were reflected by a slight increase in the number of
stillborn pups and decrease of neonatal survival at these dose levels. The effects on
parturition in rats are consistent with the species specific oestrogen-lowering property
produced by high doses of fluconazole. Such a hormone change has not been
observed in women treated with fluconazole.

Canesten Thrush External Cream
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

6

PHARMACEUTICAL PARTICULARS

6.1

List of excipients
Canesten Thrush Oral Capsule
Lactose monohydrate
Maize starch
Colloidal silicon dioxide
Magnesium stearate
Sodium lauryl sulphate
Capsule shells contain:

Brilliant blue FCF (E133)
Titanium dioxide (E171)
Gelatine
Printing ink contains:
Shellac
Black iron oxide (E172)
Propylene glycol

Canesten Thrush External Cream
Sorbitan stearate
Polysorbate 60
Cetyl palmitate
Cetostearyl alcohol
Octyldodecanol
Benzyl alcohol
Purified Water

6.2

Incompatibilities
Not applicable

6.3

Shelf life
3 years

6.4

Special precautions for storage
Canesten Thrush Oral Capsule - No special precautions for storage
Canesten Thrush External Cream - Do not store above 25°C.

6.5

Nature and contents of container
Canesten Thrush Oral Capsule - Opaque, white PVC/PVdC (60g/m2) blister with
20µm aluminium foil backing containing one capsule.

Canesten Thrush External Cream - 10 g aluminium tube with internal lacquer
coating, latex stopper and HDPE screw top.

6.6

Special precautions for disposal
No special requirements

7

MARKETING AUTHORISATION HOLDER
Bayer plc
Bayer House
Strawberry Hill
Newbury
Berkshire
RG14 1JA
U.K.
Trading as Bayer plc, Consumer Care Division

8

MARKETING AUTHORISATION NUMBER(S)
PL 00010/0652

9

DATE OF FIRST AUTHORISATION/RENEWAL OF THE
AUTHORISATION
25/06/2015

10

DATE OF REVISION OF THE TEXT
25/06/2015

Expand Transcript

Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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