Oral medications for vaginal yeast infections

Fluconazole is the first-choice oral antifungal medication for vaginal yeast infection; itraconazole is also commonly used.

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

These antifungal medications kill yeast organisms.

Oral medications 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 medication.
• 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 medications are not recommended during pregnancy.¹

Antifungal treatments cure infections 80% to 90% of the time.^{2, 3, 4} (In some cases, the less common types of yeast infections may respond better to vaginal treatment or to boric acid suppositories.) Since oral medications do not provide immediate relief of symptoms, vaginal medications may also be needed in the first 48 hours of treatment.

Oral fluconazole is effective as a single-dose treatment for a mild yeast infection. It remains at an effective level in the vagina for 3 to 5 days.⁵

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 shown to significantly reduce the number of women who have recurrent vaginal yeast infections.³ But once women stop taking the medicines, 30% to 40% of them get another vaginal infection that produces symptoms.⁶

Side effects of oral antifungal medication 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 only need multi-dose treatment 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.)

Medication interactions

Fluconazole interacts with:^{7, 1}

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

Tell your health professional about any medications you are taking so that appropriate treatment can be recommended.

Oral medications are not recommended during pregnancy.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. However, 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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Citations

1. U.S. Department of Health and Human Services (2002). Sexually Transmitted Diseases Treatment Guidelines 2002 (CDC Publication Vol. 51, No. RR-6), pp. 45–48. Atlanta: U.S. Department of Health and Human Services.

2. Ressel GW (2002). CDC releases 2002 guidelines for treating STDs: Part I. Diseases characterized by vaginal discharge and PID. American Family Physician, 66(9): 1777–1778.

3. Marrazzo J (2002). Vulvovaginal candidiasis. BMJ, 325(7364): 586–587.

4. Kessel KV, et al. (2003). Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: A systematic review. Obstetrical and Gynecological Survey, 58(5): 351–358.

5. Droegemuller W (2001). Infections of the lower genital tract. In MA Stenchever et al., eds., Comprehensive Gynecology, 4th ed., pp. 675–678. St. Louis: Mosby.

6. Eschenbach DA (2003). Vaginitis section of Pelvic infections and sexually transmitted diseases. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 585–589. Philadelphia: Lippincott Williams and Wilkins.

7. Ringdahl EN (2000). Treatment of recurrent vulvovaginal candidiasis. American Family Physician, 61(11): 3306–3312.