Oral medications for vaginal yeast infections

Examples

Generic Name	Brand Name
fluconazole	Diflucan
itraconazole	Sporanox
ketoconazole	Nizoral

Fluconazole is the first-choice oral antifungal medicine for vaginal yeast infection. Itraconazole is also commonly used.

Ketoconazole was the first medicine that was effective in eliminating acute vaginal yeast infections, but it is not widely used now because it may damage the liver.

How It Works

These antifungal medicines kill yeast organisms.

Why It Is Used

Oral medicines can be used:

• To treat the occasional vaginal yeast infection in women who have a preference for oral treatment.
• To treat a vaginal yeast infection that has not responded to vaginal medicine.
• As a weekly or monthly maintenance or suppressive treatment for 6 months to 1 year, to stop persistent, recurring vaginal yeast infection. All cases of recurring vaginal yeast infections should be confirmed by culture before preventive therapy begins.

Oral medicines are not recommended for women who are pregnant.¹

How Well It Works

Antifungal treatments cure infections 80% to 90% of the time.^{2, 1} (In some cases, the less common types of yeast infections may respond better to vaginal treatment or to boric acid suppositories.) Since oral medicines do not provide immediate relief of symptoms, vaginal medicines may also be needed in the first 48 hours of treatment.

Recurring infections (four or more in 1 year)

If you have recurring yeast infections, you may want to ask your doctor about taking antifungal medicines as maintenance or suppressive treatment. This means taking the medicine weekly or monthly for 6 months to 1 year. This long-term use of antifungal medicine has been shown to significantly reduce the number of women who have recurrent vaginal yeast infections.³ But after women stop taking the medicines, 30% to 40% of them get another vaginal infection that has symptoms.⁴

Side Effects

Side effects of oral antifungal medicine are not common after a single treatment dose. Side effects are more likely to develop when you need more than one treatment (multi-dose treatment) of the oral medicine. You most likely will need multi-dose treatment only if your infection is severe or if it comes back after the first treatment. Side effects may include:

• Headache.
• Abdominal pain.
• Nausea.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Medicine interactions

Fluconazole interacts with:¹

• Calcium channel blockers (such as diltiazem [Cardizem]).
• Cyclosporine (Sandimmune or Tacrolimus).
• Hydrochlorothiazide (Esidrix).
• Oral hypoglycemic medicines.
• Phenytoin (Dilantin).
• Rifampin (Rifadin).
• Theophylline.
• Trimetrexate (Neutrexin).
• Warfarin (such as Coumadin).
• Zidovudine (Retrovir).

Tell your doctor about all the medicines you are taking so that appropriate treatment can be recommended.

What To Think About

Oral medicines are not recommended for women who are pregnant.¹

Fluconazole is expensive, but since it is now recommended as a single-dose treatment, its use is more affordable.

Women who use several months of maintenance treatment for recurring vaginal yeast infections should have regular checkups to monitor treatment effectiveness and the occurrence of side effects.

Treatment of sex partners does not typically prevent recurrences. But sex partners with red, itchy, or painful skin in the genital area should be evaluated and treated appropriately.

Current research recommends that women with human immunodeficiency virus (HIV) follow standard medication treatments. Women with HIV appear to have an increased risk of recurring vaginal infections, but treatment recommendations are the same as for women who are not infected with HIV. Maintenance therapy helps prevent recurring vaginal yeast infections.¹

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Author:	Sandy Jocoy, RN	Last Updated: June 17, 2008
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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