Mycelex


clotrimazole (oral)

(kloe-trim-a-zole) clotrimazoleoral,

Mycelex

(trade name)

Classification

Therapeutic: antifungals
Pregnancy Category: C

Indications

Treatment of oropharyngeal candidiasis.Prevention of oropharyngeal candidiasis in immunocompromised patients (receiving chemotherapy or radiation for cancer or corticosteroids for cancer or transplant).

Action

Affects the permeability of the fungal cell wall, allowing leakage of cellular contents.

Therapeutic effects

Decrease in or prevention of symptoms of oropharyngeal candidiasis.

Pharmacokinetics

Absorption: Minimal systemic absorption.Distribution: Inhibitory concentrations remain in saliva for up to 3 hr after troche dissolves.Metabolism and Excretion: Metabolized by liver; <1% excreted unchanged in urine.Half-life: 24 hr.

Time/action profile

ROUTEONSETPEAKDURATION
POunknownunknownup to 3 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to clotrimazole or other components of formulation; Systemic candidiasis.Use Cautiously in: Hepatic impairment; Obstetric: Use only if potential benefit justifies potential risk to fetus; Pediatric: Children <3 yr (safety and effectiveness not established).

Adverse Reactions/Side Effects

Gastrointestinal

  • abnormal mouth sensations
  • ↑ liver function tests
  • nausea
  • vomiting

Dermatologic

  • pruritis

Interactions

Drug-Drug interaction

May ↓ metabolism and ↑ risk of toxicity from CYP3A4 substrates, includingcyclosporine, HMG-CoA reductase inhibitors, some benzodiazepines (alprazolam, midazolam, triazolam ), calcium channel blockers, colchicine, fentanyl, tacrolimus, and warfarin..

Route/Dosage

Oral (Adults and Children ≥3 yr) Treatment—One troche 5 times daily for 14 days; Prophylaxis—One troche 3 times daily for the duration of chemotherapy or until steroid doses are reduced to maintenance levels.

Availability (generic available)

Troche: 10 mg

Nursing implications

Nursing assessment

  • Assess oropharnyngeal mucosa prior to and periodically during therapy.
  • Lab Test Considerations: Monitor hepatic function prior to and periodically during therapy. May cause ↑AST.

Potential Nursing Diagnoses

Impairedoral mucous membrane (Indications)

Implementation

  • Oral: Allow each troche to dissolve slowly in mouth to achieve maximum effect.

Patient/Family Teaching

  • Instruct patient to take clotrimazole as directed. Allow each troche to slowly dissolve in mouth.

Evaluation/Desired Outcomes

  • Decrease in or prevention of symptoms of oropharyngeal candidiasis.

Mycelex

(mī′sə-lĕks′) A trademark for the drug clotrimazole.

Mycelex®

Clotrimazole, see there.