Canesten Duopak *

Canesten 100mg pessaries are recommended for the treatment of candidal vaginitis.

The cream is recommended for associated vulvitis and treatment of the sexual partner to prevent re-infection.

Canesten 100mg Pessaries should be inserted intravaginally, as high as possible, using the applicator supplied.

The cream is for topical application to the vulva and surrounding area.

Adults and children of 12 years of age and older:

Insert one pessary daily, preferably at night, before going to bed, for six consecutive days. Alternatively, two pessaries can be inserted for three consecutive days. The cream should be applied two or three times daily.

If symptoms persist for more than 7 days the patient may have a medical condition that requires treatment by a doctor.

The treatment can be repeated if necessary, however, recurrent infections may indicate an underlying medical cause. Patient should seek medical advice if symptoms return within 2 months.

Canesten pessaries need moisture in the vagina in order to dissolve completely, otherwise undissolved pieces of the pessary might crumble out of the vagina. Pieces of undissolved pessary may be noticed by women who experience vaginal dryness. To help prevent this it is important that the pessary is inserted as deeply as possible into the vagina at bedtime.

Treatment during the menstrual period should not be performed due to the risk of the 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.

Avoidance of vaginal intercourse is recommended in case of vaginal infection while using this product because your partner could become infected.

Children under 12 years of age:

As the pessaries are used with an applicator, paediatric usage is not recommended.

1. Pull out plunger until it stops. Place a pessary into the applicator.

2. Insert applicator containing the pessary carefully as deeply as is comfortable into the vagina. (This is best done with the patient lying on her back with the knees bent up.)

3. Push plunger until it stops, thereby depositing the pessary into the vagina. Remove the applicator.

4. After use, remove plunger completely by pulling it out of the applicator. Then wash it in warm (not boiling) soapy water, rinse and dry carefully.

Hypersensitivity to the active substance clotrimazole or to any of the excipients listed in section 6.1

Medical advice should be sought if this is the first time the patient has experienced symptoms of candidal vaginitis.

Before using Canesten 100mg Pessaries, 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 a sexually transmitted disease or exposure to partner with a sexually transmitted disease.

- Pregnancy or suspected pregnancy.

- Aged under 12 or over 60 years.

- Known hypersensitivity to imidazoles or other vaginal antifungal products.

Canesten 100mg Pessaries 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 (vaginal haemorrhage) 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 (temperature of 38°C or above) or chills

- Nausea or vomiting.

- Diarrhoea.

- Foul smelling vaginal discharge.

- Back pain.

- Associated shoulder pain.

Avoid contact with eyes and do not swallow

All possible infected areas should be treated at the same time.

The cream contains cetostearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis).

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 medication with vaginal clotrimazole and oral tacrolimus (FK-506; immunosuppressant) might lead to increased tacrolimus plasma levels and similarly with sirolimus. Patients should thus be thoroughly monitored for symptoms of tacromilus or sirolimus overdosage, if necessary by determination of the respective plasma levels.

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.

Pregnancy:

There are limited amount of data from the use of clotrimazole in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity (see section 5.3). As a precautionary measure, it is preferable to avoid the use of clotrimazole during the first trimester of pregnancy.

During pregnancy the treatment should be carried out with clotrimazole vaginal tablets, since these can be inserted without using an applicator.

Lactation:

Available pharmacodynamic/toxicological data in animals have shown excretion of clotrimazole/metabolites in milk (see section 5.3). Breast-feeding should be discontinued during treatment with clotrimazole.

The medication has no or negligible influence on the ability to drive or use machinery.

The following adverse reactions have been identified during post-approval use of Clotrimazole. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency.

Immune system disorders

Allergic reaction (ME) with symptoms such as dyspnea (PT), hypotension (PT), syncope (PT), and urticaria (ME),

Reproductive system and breast disorders

Vulvovaginal discomfort (PT), edema (PT), burning (PT), genital peeling, irritation, pruritus (ME), pelvic pain (PT), rash (ME), vaginal haemorrhage (PT), erythema (PT).

Gastrointestinal disorders

Abdominal pain (ME)

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 HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie.

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).

Pharmacotherapeutic group: Gynaecological antiinfectives and antiseptics – imidazole derivatives.

ATC Code: G01AF02

Mechanism of Action

Clotrimazole acts against fungi by inhibiting ergosterol synthesis. Inhibition of ergosterol synthesis leads to structural and functional impairment of the cytoplasmic membrane.

Pharmacodynamic Effects

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 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 vagiinalis) and gram-negative microorganisms (Bacteroides/). It has no effect on lactobacilli.

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.

Pharmacokinetic investigations after vaginal application have shown that only a small amount of clotrimazole (3 – 10% of the dose) 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 micrograms/ml, reflecting that clotrimazole applied topically does not lead to measurable systemic effects or side effects.

Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential and toxicity to reproduction and development.

Pessaries:

Calcium lactate pentahydrate

Maize starch

Crospovidone

Colloidal anhydrous silica

Lactic acid

Lactose monohydrate

Magnesium stearate

Hypromellose

Microcrystalline cellulose

Cream:

Sorbitan stearate

Polysorbate 60

Cetyl palmitate

Cetostearyl alcohol

Octyldodecanol

Benzyl alcohol

Purified water

Not applicable.

3 years.

Do not store above 25°C.

Six pessaries are packed into a blister consisting of 25μm PA / 45μm soft aluminium / 60μm PVC and 20μm hard aluminium / 7 g/m² heat seal lacquer. An applicator is also provided.

20g of a smooth, white, oil-in-water type cream is packed in an aluminium tube with internal lacquer coating, tamper evident seal and HDPE screw on cap.

The pessaries, cream and applicator are enclosed in a cardboard carton.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.