Canesten Combi

What is Canesten Thrush Combi?

Canesten Combi is a combined treatment for vaginal thrush, a type of fungal infection. Each pack of Canesten Combi contains a 500mg pessary, which targets the cause of vaginal thrush, and a tube of Canesten 2% cream to treat the external symptoms, such as itching, redness, and soreness. Both the pessary and external cream contain the active ingredient, clotrimazole, an antifungal medication that kills the fungus Candida, which causes thrush infections.

One pack of Canesten Combi is a full course of treatment for vaginal thrush and comes with both the pessary and cream, as well as an applicator to insert the pessary safely.

What is Vaginal Thrush?

Thrush is a fungal infection caused by an overgrowth of naturally occurring fungi that live in the body. In the case of vaginal thrush, these organisms are known as Candida. Normally, the amount of fungi present in the vagina is regulated by the body and causes no problems.

However, changes in the vagina can cause fungi to grow rapidly and overwhelm the natural defences that regulate these organisms.

You may be more at risk of developing a yeast infection if you:

• Have a weakened immune system 
• Have diabetes
• Regularly take antibiotics

Thrush is not classed as a sexually transmitted infection (STI), but it can sometimes be passed on during sex. Avoid vaginal intercourse while you have thrush and while using this product.

How Does Canesten Combi Work?

Canesten contains clotrimazole, an antifungal. Clotrimazole inhibits fungi's ability to produce ergosterol, a crucial component of fungal cell membranes. Without ergosterol, cell membranes weaken, develop holes, and allow cellular contents to leak out, killing the fungus.

The internal pessary contains 500mg of clotrimazole and targets the main cause of vaginal thrush: Candida overgrowth. By killing Candida inside the vagina, Canesten Combi helps to get rid of the infection. However, it also contains a 2% clotrimazole cream, which is applied externally around the entrance of the vagina to kill any surface yeast and to relieve thrush symptoms, such as itching, soreness, and redness. 

How Long Does Canesten Combi Take to Work?

Canesten Combi starts working as soon as you start using it. Your thrush symptoms should disappear within 3 days of using Canesten Combi. If you do not notice an improvement in your symptoms after 7 days, speak to your doctor.

Each pack of Canesten Combi contains one pessary, which is only used once. This starts working as soon as you insert it, killing the fungus responsible for vaginal thrush. While the cream can be applied 2 to 3 times a day to treat the symptoms. So, for most people, their symptoms should disappear within 3 days because clotrimazole starts working very quickly. 

How Effective is Canesten Thrush Combi?

Clotrimazole is an effective treatment for vaginal thrush, and Canesten products are trusted by many people. One study found that 90% of people who used a Canesten product reported improvements in their symptoms and quality of life, with up to 88% reporting symptomatic relief within 1 day. The study also found that 95% of people who were given dual-action products, such as Canesten Combi, to treat their thrush started working from the first application, compared with 90% of those given a single-action product. 

How to Use Canesten Combi Pessary and Cream

The Canesten Thrush Combi is a two-step treatment that uses a vaginal pessary that is inserted deep into the vagina to treat the root cause of vaginal thrush infections and an external cream that can relieve soreness and itchiness around the vulva.

Seek medical advice before using Canesten Combi/Canesten Thrush Combi if this is your first episode or:

• You are unsure whether it is thrush
• You have had more than two thrush infections in 6 months
• You or your partner has had or may have been exposed to an STI
• You are under 16 or over 60
• You have had an allergic reaction to Canesten/imidazoles/vaginal antifungals
• You have irregular or abnormal vaginal bleeding, blood-stained discharge, ulcers/blisters/sores, lower abdominal pain, pain or difficulty passing urine, fever/chills, nausea/vomiting, diarrhoea, or foul-smelling discharge

How to Use the Internal Pessary

The internal pessary is a small device, similar to a tablet, which is inserted into the vagina using the provided applicator. It dissolves inside the vagina, releasing clotrimazole to fight the infection directly. It’s recommended that you insert the Canesten pessary at bedtime.

To insert the pessary, follow these instructions:

1. Wash your hands thoroughly with soap and warm water, and then dry them, before handling the applicator and the foil blister pack.
2. Remove the applicator from the packaging and pull out the plunger, with the red lock attached, until it stops.
3. Remove the pessary from the foil packaging and place it into the open end of the applicator, with the curved edge facing down. Push the plunger and the lock into the applicator until you feel a click. 
4. Once you have felt the click, remove the lock from the plunger.
5. Carefully insert the applicator into your vagina as deeply as is comfortable. You may find it easier to do this while lying on your back with your knees bent up. Hold the applicator at the patterned grip zone.
6. Slowly press the plunger all the way until it stops to dispense the pessary into the vagina.
7. Carefully remove the applicator and dispose of it safely. Do not flush the applicator down the toilet.
8. Wash and dry your hands thoroughly when you have finished.

As the pessary dissolves inside the vagina, you may find it useful to wear a panty liner because it may leave a white chalky residue. If this happens, it does not mean the treatment has not worked. However, if you notice any undissolved pessary pieces, speak to a doctor or pharmacist, as the treatment may not have worked properly.

How to Use the External Cream

The cream inside the Canesten Combi pack is for use on the vulva (the area around the opening of the vagina). Apply the cream 2 or 3 times daily until the symptoms subside, following these steps:

1. Before you use the cream, pierce the tube’s seal by inverting the cap over the end of the tube and pressing firmly.
2. Apply a thin and even layer of cream around the entrance of the vagina and smooth it in gently. 
3. Only use the external cream on the outside of your vagina 2 to 3 times a day.
4. Wash your hands after applying the cream.

Detailed instructions for using Canesten Combi and Canesten Thrush Combi are available in the Patient Information Leaflets.

How Often Can You Use Canesten Thrush Combi?

If you experience a recurrence of the infection after a week, you can use one further treatment; however, you will need to see your doctor if you've had more than two infections in the past six months.

Can I Use Canesten Combi When On My Period?

Do not use Canesten Combi during your period, as the pessary may be less effective or may be washed out. The treatment should be finished before your period starts or after it has ended.

It is also advisable to avoid using tampons, douches, or spermicides while using Canesten Combi. Tampons can absorb the medication released by the pessary, making it less effective

What If I Forget to Use Canesten Combi?

If you forget to use the pessary, use it at night if you remember. If you only remember the next day, wait until bedtime to take your dose. Pessaries work best at night, so it is advisable to wait until you go to bed to use them.

If you forget to apply the external cream, use it as soon as you remember, and continue applying it 2 to 3 times a day as usual.

If you have forgotten for more than one day, your infection may not be fully treated. If you still have vaginal thrush symptoms after you finish your treatment, speak to your clinician.

What If I Use Too Much Canesten Combi?

If you apply too much external 2% clotrimazole cream or use it more often than you need to, it can irritate your skin. Use less cream next time if this happens. Each pack of Canesten Thrush Combi contains only one pessary, so you cannot insert more than one.

However, if you apply multiple pessaries at the same time, you may experience discomfort or irritation. If this persists, stop using the pessaries and see a doctor.

Canesten Combi Side Effects and Cautions

Before using Canesten Combi for vaginal thrush, it is important that you understand the potential side effects and cautions associated with using it, so you know what signs to look out for.

Canesten Combi Pessary and Cream Side Effects

Like all medications, Canesten Combi can cause side effects, but not everyone will get them. The pessary and external cream can cause different side effects. You may experience side effects inside your vagina from the pessary or around the outside of the vaginal opening if you get side effects from the external cream.

If you experience any of these side effects while using Canesten Thrush Combi, contact your doctor straight away. You should also report any side effects, even those not listed here or in the Patient Information Leaflet, to a doctor, nurse, or pharmacist, or the Yellow Card Scheme. By reporting side effects, you’ll be providing valuable information about the safety of this medication. 

Allergic Reaction

Some people may be allergic to the pessary or the cream and may get an allergic reaction shortly after using the medicine. If you experience an allergic reaction, or if the redness, burning, itching, or swelling gets worse, stop using the medication and tell your doctor straight away, or go to your nearest A&E.

Signs of an allergic reaction include:

• Rash
• Swallowing or breathing difficulties
• Swelling of your lips, face, throat, or tongue
• Weakness, dizziness, or fainting
• Feeling sick (nausea)

Canesten Combi Warnings and Interactions

The active ingredient in Canesten Combi, clotrimazole, may not be suitable for everyone. There are some health conditions, circumstances, or medications that may make Canesten Combi less effective or potentially unsafe. It is important to tell the clinician about any medical conditions you have or any medications you take before using Canesten Combi for vaginal thrush.

Do not use Canesten Combi if:

• You are allergic to clotrimazole or any other ingredients, including cetostearyl alcohol or benzyl alcohol, of the pessary or cream
• You are currently on your period

Important Ingredient Information

The external 2% clotrimazole cream contains cetostearyl alcohol, which may cause local skin reactions. It also contains 20 mg of benzyl alcohol in each gram of cream, which can also cause allergic reactions and mild local irritation.

If you are allergic to either of these ingredients, do not use Canesten Thrush Combi and discuss an alternative thrush treatment with your clinician.

Special Precautions

Canesten Thrush Combi can reduce the effectiveness of rubber contraceptives, such as condoms and diaphragms. So, you must use alternative contraception for at least 5 days after using this medication.

You should also avoid vaginal intercourse while you have thrush and during the use of this medication because your partner could become infected. However, thrush is not an STI.

Do not use tampons, douches, spermicides, or other vaginal products while using Canesten Thrush Combi.

Canesten Combi Interactions

Some medications can interact with Canesten Combi and make it less effective or potentially unsafe. You must tell the clinician during your consultation if you are taking any prescribed or over-the-counter medications or herbal remedies, especially tacrolimus or sirolimus, which are used to reduce the immune response to prevent organ rejection after a transplant.

Pregnancy and Breastfeeding

Canesten Thrush Combi can be used during pregnancy and while breastfeeding.

If you are pregnant, breastfeeding, or trying for a baby, tell your doctor or midwife before using Canesten Combi Pessary or External Cream. If they approve its use for you, follow their instructions carefully.

To treat internal thrush, a clinician may recommend using the pessary without an applicator.

Frequently Asked Questions About Canesten Combi