A Pharmacist's Guide to OTC Therapy: Vaginal Antifungal Products

It is estimated that 3 of every 4 women will experience the discomfort associated with having a vaginal yeast infection at least once in their lifetime. Fortunately, several products are available over the counter for treating mild-to-moderate vulvovaginal candidiasis (yeast infection), which ranks second among the most common forms of vaginal infections.

Signs and Symptoms of Yeast Infections

The most common signs and symptoms of yeast infections may include intense pruritis; thick, whitish vaginal discharge with no offensive odor; erythema around the vulva or vaginal area; and dysuria.¹

Risk Factors for Developing a Yeast Infection

Some of the risk factors that may increase a woman's susceptibility to candidal infections are as follows:

• Use of certain medications, such as recent antibiotic therapy, oral contraceptives, hormone replacement therapy agents, and steroids
• Uncontrolled diabetes
• Pregnancy
• Immune system disorders
• Thyroid or endocrine disorders

Available Therapies

Imidazole products?such as butoconazole, clotrimazole, miconazole, and tioconazole?currently are available over the counter (Table). These products designed for vaginal use, are available in various dosage forms, such as creams, suppositories, and tablets. They are approved for the treatment of mild-to-moderate vaginal yeast infections and for the relief of external vulvar itching and irritation associated with yeast infections. These products are designed for women who have had a previous yeast infection and not for those who have never had a yeast infection.

Conclusion

Pharmacists can play a fundamental role in determining whether the use of these OTC antifungal products may be appropriate for a patient or whether the patient should immediately seek medical care from a physician. Pharmacists also should make sure that the patient clearly understands how to use these products correctly and how important it is to seek medical care if the infection worsens. Although the symptoms of mild-to-moderate vaginal yeast infections typically improve within a few days after initial therapy is started, patients should be reminded to complete a full course of therapy.

Patients with frequently recurring yeast infections or more severe infections always should be encouraged to consult their physician for further assessment. Patients who have never experienced a vaginal yeast infection should be encouraged to seek the advice of a physician to determine whether the use of these nonprescription products is an appropriate choice.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Va.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Stahl, Pharmacy Times, 241 Forsgate Drive, Jamesburg, NJ 08831; or send an e-mail request to: astahl@ascendmedia.com.