customer
care
Guides
thrush
It takes... two
The UK’s No1 brand for
treating Thrush*
Use this training to:
• Refresh your knowledge of treating thrush with
imidazoles
• Learn the importance of treating the internal infection
and relieving the external symptoms of thrush
• Increase your knowledge of the various Canesten
combination treatment options
Three out of four women will suffer from thrush at some
point in their lives, so it is likely that you will be asked for
advice and product recommendations.
When treating thrush, it is important that you recommend
a combination product to treat the internal infection as
well as relieve external symptoms.
Largest range of
Combination Thrush Treatments
You can recommend one of the following combination
products from the Canesten range:
• Canesten Combi Pessary & Cream
• Canesten Oral & Cream Duo
• Canesten Soft Gel Pessary Combi
• Canesten Cream Combi Internal & External Creams
* Based on volume sales Nielsen 02.03.2013
Symptoms of thrush
Symptoms of thrush could occur internally within the vagina or externally:
• Internal symptoms include:
• Swelling of the vaginal walls
• Pain during sexual intercourse
• External symptoms include:
• Sore and itchy vaginal area
Intense
Itching
• Odourless, creamy, white discharge
Triggers of
thrush
Burning
External
Inflammation
Internal
of the Vulva
White, creamy,
odourless discharge
(more than normal).
Inflammation of
the vagina
Soreness
Triggers of thrush could include:
• Wearing tight or synthetic clothing and underwear
• Taking certain medicines, such as antibiotics
• Stress
• Trauma caused by sexual activity or tampons
• Hormonal changes such as menstruation, pregnancy and the menopause
Letting customers know about these triggers could help them to avoid getting
thrush again in the future.
Treating thrush with imidazoles
Who is the medicine for?
Reaffirm that the medicine is definitely for her.
What are the symptoms?
Make sure that her symptoms are the same as before.
Symptoms of thrush could include:
• Swelling of the vaginal walls
• Pain during sexual intercourse
• Creamy, white discharge
• Sore and itchy vaginal area
How long has she had the symptoms?
She has had the symptoms for a few days. She has not had a thrush infection in the
last six months.
Action – has she already tried a treatment?
She has not used a treatment yet.
Medication – is she taking any other medicine?
She is not taking any other medication but is taking a multivitamin.
• Treat the internal infection and relieve external symptoms with a combination of
internal and external products.
• Treat male partners for thrush with external cream to prevent re-infection
• Customer lifestyle can indicate treatment suitability:
n Canesten Oral & Cream Duo: Good for customers who are busy.
n Canesten Combi: For customers who prefer a more traditional option.
n Canesten Soft Gel Pessary: Combi Customers who might like a comfortable
pessary format.
• Advise the customers to follow the instructions for use, found inside the packaging.
Recommending the right product
When to refer
Recommendation
Refer customers to the
pharmacist if they:
• Are under 16 or over 60 years of
age
• Have had more than two
episodes of thrush in the past six
months
• Have additional symptoms such
as pain or bleeding
• Have offensive smelling or
blood-stained discharge
• Are taking other medicines
• Are allergic to anti-fungal
treatments
• Are pregnant
• Have tried a treatment but the
symptoms are still present a week
later
NB: Always remember to ask
customers if they have been
previously diagnosed with thrush
by a GP
Canesten
Soft Gel
Pessary Combi
Soft Gel Pessary:
Clotrimazole 500mg
Double Strength* External Cream:
Clotrimazole 2% w/w
Clotrimazole
Canesten Oral
& Cream Duo
Oral Capsule:
Fluconazole 150mg
Double Strength* External Cream:
Clotrimazole 2% w/w
Clotrimazole & Fluconazole
Self help tips
for customers
You could offer customers the
following advice to help prevent
getting thrush in the future:
• Treat male partners for thrush
with an external cream to
prevent re-infection
• Wear loose clothing and cotton
underwear and avoid synthetic
underwear and nylon tights
• Shower, wash or bathe
immediately after exercising and
cool off as quickly as possible
• Use non-fragranced soaps and
shower gels
• Avoid friction in the vaginal area
as this can trigger thrush – don’t
scrub the genital area hard with
sponges or flannels and use a
lubricant during sex if necessary
Canesten
Combi Pessary
& Cream
Pessary:
Clotrimazole 500mg
Double Strength* External Cream:
Clotrimazole 2% w/w
Clotrimazole
Canesten
Cream Combi
Internal Cream in
pre-filled applicator:
Clotrimazole 10% w/w
Double Strength* External Cream:
Clotrimazole 2% w/w
Clotrimazole
*Compared with Canesten
1% Cream
Which is the right ‘Combination Treatment’
for the customer
Benefits ...
>
•Unique to
over the counter
•Comfortable to insert
•Shaped to fit the body’s natural
contours
•Gets directly to the source of the
internal infection
•External cream relieves external
itching and burning
>
•Easy to swallow
capsule treats
and clears the
internal infection
•External cream
relieves external itching
and burning
>
•Traditional
pessary treats the
internal infection
•External cream relieves
external itching and burning
>
•Internal
cream treats the
infection
•External cream
relieves external itching and
burning
Suitable for …
>
Customers who may have
used a traditional tablet
pessary in the past but
may be interested in a new
format as well as those
who have never thought of
using a pessary before
>
Women with busy
lifestyles or those who
want a discreet treatment
combined with relief from
external symptoms
>
Women who want a
traditional and convenient
preparation that treats the
internal infection as well as
relieving external symptoms
>
Less experienced customers
who may be reluctant to try
a pessary or those customers
with vaginal dryness
(e.g. menopausal women)
Assessing knowledge
Training is a key part of your role in helping to provide customers with a professional service.
If you know about thrush, you will be more confident when talking to customers and when
recommending suitable treatments.
Now that you have read this guide, use the following questions to check your understanding
of thrush and its treatment. Discuss your answers with your pharmacist.
1. A woman suffering from thrush could experience
which of the following symptoms?
4. Which of the following is true about clotrimazole?
a.Intense itching
b.White discharge
c.Soreness
d.All of the above
a.It helps to numb itchy symptoms
b.It is an example of an antiviral agent c.It is available as a cream or pessary format
d.It works by increasing the growth of the fungus
n
n
n
n
n
n
n
n
5. Which of the following is true about Canesten
Combi Pessary and Cream?
2. A customer has had thrush before and the doctor gave her a pessary. She has asked to buy it again. What would you do?
a.Sell her a pessary again n
b.Suggest she uses a cream only n
c.Sell her a combination of pessary to treat the internal infection and a cream to relieve itching n
d.Tell her to do nothing
n
a.It contains and internal and external clotrimazole creams
n
b.It helps to treat the internal infection and soothe external symtpoms
n
c.It can be used separately
n
d.It contains a 200mg clotrimazole pessary
n
3. Which of the following will help a customer
prevent thrush?
n
n
n
n
Answers to knowledge questions
1.d 2.c 3.c 4.c 5.b
a.Wear nylon underwear b.Wash or shower before exercising c.Use non-fragranced soaps and shower gels d.Avoid cotton clothing
A complete training resource for your pharmacy
E-learning modules
on thrush, athlete’s foot,
cystitis and sweat rash
This resource has not been awarded the NPA Training Seal.
Visit the Canesten Training Centre at:
www.canesten.co.uk/hcp
Customer Care Guides
available to download from
the website
Product Information for Canesten® Cream Combi Internal & External Creams. Presentation: Canesten® Cream Combi Internal & External Creams A 5g pre-filled
applicator of internal cream containing clotrimazole 10% w/w, plus a 10g tube of external cream containing clotrimazole 2% w/w. Indications: The internal cream is
recommended for the treatment of candidal vaginitis. The external cream is recommended for the treatment of candidal vulvitis. It should be used as an adjunct to
treatment of candidal vaginitis. Dosage and Administration: Adults (16 – 60 years): The internal cream should be administered intravaginally using the applicator.
Apply the external cream to the vulva and surrounding area two or three times daily and rub in gently. The treatment should be finished before the onset of menstruation.
Children: Paediatric usage is not recommended (in under 16). Contra-indications: Hypersensitivity to clotrimazole or any other ingredients e.g. cetostearyl alcohol. Not
for treatment of nail or scalp infections. Warnings and Precautions: Medical advice must be sought if this is the first time the patient has experienced symptoms of
candidal vaginitis or if any of the following are applicable: more than two infections of candidal vaginitis in the last six months; previous history of or exposure to partner
with a sexually transmitted disease; pregnancy or suspected pregnancy; aged under 16 or over 60 years; known hypersensitivity to imidazoles or other vaginal antifungal
products. Medical advice should be sought if the patient has any of the following symptoms: irregular vaginal bleeding; abnormal vaginal bleeding 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 or chills; nausea or vomiting; diarrhoea; foul smelling vaginal discharge. If no improvement in symptoms is seen after seven days, the patient should consult their
doctor. This product may damage latex contraceptives therefore patients should use alternative precautions for at least five days after using the product. The creams
contain cetostearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis). Side-effects: Allergic reaction, genital peeling/exfoliation, blisters, pruritis, rash,
oedema, discomfort/pain, stinging/burning, irritation, pelvic pain, abdominal pain. Use in pregnancy: Only when considered necessary by a physician. During pregnancy
the treatment should be carried out with clotrimazole pessary, since these can be inserted without using an applicator. RRP: £10.79 (Excl. VAT) MA Number: PL 00010/0301.
MA Holder: Bayer plc, Consumer Care Division, Newbury, Berkshire RG14 1JA, UK. Legal Category: GSL. Date of Preparation: August 2010.
® = Registered trademark of Bayer AG.
Product Information for Canesten® Oral & Cream Duo (fluconazole 150mg capsule, plus 10g tube of clotrimazole 2% w/w cream). Indications: The capsule is for
treatment of candidal vaginitis, acute or recurrent. Also for treatment of partners with associated candidal balanitis. The cream is for the treatment of candidal vulvitis.
Dosage and Administration: Adults (16 – 60 years): Swallow one capsule whole. Apply cream to vulva and surrounding area two or three times daily and rub in gently.
Treatment with the cream should be continued until symptoms of the infection disappear. If after concomitant treatment of vaginitis, symptoms do not improve within
seven days, the patient should consult a physician. For treatment of sexual partner’s penis, cream should be applied two or three times daily for two weeks. Children:
Paediatric usage is not recommended (in under 16). Contra-indications: Hypersensitivity to fluconazole, clotrimazole, related azole compounds or any of the excipients
e.g. cetostearyl alcohol; co-administration with terfenadine, cisapride or ergot-derivatives. Warnings and Precautions: Adequate contraception necessary. A physician
should be consulted if the patient or partner have had exposure to sexually transmitted disease, or if the patient: has had more than two infections of thrush in the last six
months; is experiencing thrush for the first time; has known hypersensitivity to other vaginal antifungal products; is taking any medicine other than the Pill; has any disease
or illness affecting the liver or kidneys or has had unexplained jaundice; suffers from any other chronic disease or illness; is uncertain of the cause of symptoms. Or if the
patient has any of the following symptoms: abnormal or irregular vaginal bleeding or a blood-stained discharge; vulval or vaginal sores, ulcers or blisters; lower abdominal
pain or dysuria; any adverse events such as redness, irritation or swelling associated with the treatment; fever or chills; nausea or vomiting; diarrhoea; foul smelling vaginal
discharge. In men, medical advice should be sought if they have penile sores, ulcers or blisters, there is abnormal penile discharge, the penis has started to smell, they have
dysuria, or their sexual partner does not have thrush. Patients should consult their doctor if symptoms have not been relieved within one week of treatment. Fluconazole
has been associated with rare cases of serious hepatic toxicity, including fatalities primarily in patients with serious underlying medical conditions. Fluconazole must be
taken with particular care in patients with congenital or acquired QT prolongation and torsades de pointes or a history thereof, known cardiomyopathy, sinus bradycardia,
cardiac arrhythmia, or are treated with a co-medication potentially leading to QT prolongation. Patients with rare hereditary problems of galactose intolerance, the Lapp
lactase deficiency or glucose-galactose malabsorption should not take this capsule. The cream contains cetostearyl alcohol, which may cause local skin reactions (e.g.
contact dermatitis). The cream may damage latex contraceptives so patients should be advised to use alternative precautions for at least five days after using the product.
Side-effects: Oral capsule may cause nausea, diarrhoea, vomiting, gastrointestinal and abdominal pains, abdominal distension and flatulence. Leukopenia, neutropenia,
agranulocytosis and thrombocytopenia. Torsades de pointes/QT prolongation. Mild transient elevations in transaminases, hepatitis (non infective), jaundice, cholestatis and
acute hepatic failure, including fatalities. Allergic reaction, anaphylactic reaction, anaphylactic shock. Hypersensitivity reactions including rash, urticaria, oedema, pruritus,
cardio-respiratory distress. Electrocardiogram QT prolonged, electrocardiogram QT corrected interval prolonged, hypercholesterolaemia, hypertriglyceridaemia and
hypokalaemia. Seizures, dizziness, headache, dysgeusia. Rash, pruritis, alopecia, exfoliative skin reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis.
Cream may cause allergic reactions, blisters, discomfort/pain, oedema, irritation, peeling/exfoliation, pruritus, rash, stinging/burning. Use in pregnancy: Do not use during
pregnancy, suspected pregnancy and breast-feeding. RRP: £10.95 (Excl. VAT). MA Number: PL 00010/0282 & PL 00010/0077. MA Holder: Bayer plc, Consumer Care Division,
Newbury, Berkshire RG14 1JA, UK. Legal Category: P. Date of Preparation: December 2011.
® = Registered trademark of Bayer AG
Product Information for Canesten® Combi Pessary & Cream. Presentation: Canesten® Combi Pessary & Cream A pessary containing clotrimazole 500mg, plus a
10g tube of cream containing clotrimazole 2% w/w. Indications: The pessary is recommended for the treatment of candidal vaginitis. The cream is recommended for the
treatment of candidal vulvitis. It should be used as an adjunct to treatment of candidal vaginitis. Dosage and Administration: Adults (16 – 60 years): The pessary should
be inserted into the vagina using the applicator. Apply the cream to the vulva and surrounding area two or three times daily and rub in gently. The treatment should be
finished before the onset of menstruation. Children: Paediatric usage is not recommended (in under 16). Contra-indications: Hypersensitivity to clotrimazole or any other
ingredients e.g. cetostearyl alcohol. Nail or scalp infections. Warnings and Precautions: Medical advice must be sought if this is the first time the patient has experienced
symptoms of candidal vaginitis or if any of the following are applicable: more than two infections of candidal vaginitis in the last six months; previous history of or exposure
to partner with a sexually transmitted disease; pregnancy or suspected pregnancy; aged under 16 or over 60 years; known hypersensitivity to imidazoles or other vaginal
antifungal products. Medical advice should be sought if the patient has any of the following symptoms: irregular vaginal bleeding; abnormal vaginal bleeding or a bloodstained 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 or chills; nausea or vomiting; diarrhoea; foul smelling vaginal discharge. If no improvement in symptoms is seen after seven days, the patient should consult
their doctor. This product may damage latex contraceptives therefore patients should use alternative precautions for at least five days after using the product. The cream
contains cetostearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis). Side-effects: Allergic reaction, genital peeling/exfoliation, blisters, pruritis, rash,
oedema, discomfort/pain, stinging/burning, irritation, pelvic pain, abdominal pain. Use in pregnancy: Only when considered necessary by a physician. During pregnancy
the pessary should be inserted without using an applicator. RRP: £10.79 (Excl. VAT) MA Number: PL 00010/0300. MA Holder: Bayer plc, Consumer Care Division, Newbury,
Berkshire RG14 1JA, UK. Legal Category: GSL. Date of Preparation: August 2010.
® = Registered trademark of Bayer AG.
Canesten Soft Gel Pessary Combi 500mg Soft Gel Pessary & 2% w/w Cream (clotrimazole 500mg Soft Gel Pessary and clotrimazole 2% cream).Indications: The soft
gel pessary is recommended for the treatment of candidal vaginitis. The cream is recommended for the treatment of candidal vulvitis. It should be used as an adjunct to
treatment of candidal vaginitis. Dosage and Administration: Adults (16 – 60 years): The pessary should be inserted into the vagina at night using the applicator. Apply
the cream to the vulva and surrounding area two or three times daily and rub in gently. The treatment should be finished before the onset of menstruation. Children:
Paediatric usage is not recommended (in under 16). Contra-indications: Hypersensitivity to clotrimazole or any other ingredients e.g. cetostearyl alcohol. Nail or scalp
infections. Warnings and Precautions: Medical advice must be sought if this is the first time the patient has experienced symptoms of candidal vaginitis or if any of the
following are applicable: more than two infections of candidal vaginitis in the last six months; previous history of or exposure to partner with a sexually transmitted
disease; pregnancy or suspected pregnancy; aged under 16 or over 60 years; known hypersensitivity to imidazoles or other vaginal antifungal products. Medical advice
should be sought if the patient has any of the following symptoms: irregular vaginal bleeding; abnormal vaginal bleeding 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 or chills; nausea or
vomiting; diarrhoea; foul smelling vaginal discharge. If no improvement in symptoms is seen after seven days, the patient should consult their doctor. This product may
damage latex contraceptives therefore patients should use alternative precautions for at least five days after using the product. Side-effects: Allergic reaction, genital
peeling/exfoliation, blisters, pruritis, rash, oedema, discomfort/pain, stinging/burning, irritation, pelvic pain, abdominal pain. Use in pregnancy: Only when considered
necessary by a physician. During pregnancy the soft gel pessary should be inserted without using an applicator. RRP: £12.00 (Excl. VAT) MA Number: PL 00010/0635. MA
Holder: Bayer plc, Consumer Care Division, Newbury, Berkshire RG14 1JA, UK. Legal Category: GSL. Date of Preparation: February 2012.
® = Registered trademark of Bayer AG.
For further information, visit the healthcare professional section of the Canesten website: www.canesten.co.uk/hcp
NPA Disclaimer - The training content has been approved by the NPA. The NPA in no way endorses any product(s) or product range(s) mentioned.
No part of this publication may be reproduced without the written permission of the publishers, Bayer Healthcare in
association with CIG Healthcare Partnership. © 2013 CIG Healthcare Partnership, Linen Hall, 162-168 Regent Street, London
W1B 5TB. www.cighealthcare.co.uk