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Monistat vs Diflucan

Monistat vs Diflucan – Which Is The Best Over-The-Counter Antifungal Medication?


Vulvovaginal candidiasis refers to vulval and vaginal symptoms caused by a yeast, most frequently Candida albicans.

C. albicans is responsible for over 33 percent of all cases of vulvovaginitis in reproductive-aged women.

Other Candida species like C. tropicalis, C. glabrata, C.parapsilosis, C. krusei, and Saccharomyces cerevisiae may also cause the infection.

According to statistics, about 70 percent of women report having had vulvovaginal candidiasis at some point in their lifetime.

Many women suffer recurrent episodes which can have a serious impact on their quality of life. Recurrent vulvovaginal candidiasis is defined as 4 or more episodes in a 12 month period and affects about 5% of women.

Vulvovaginal candidiasis is due to a disturbance of normal bacterial equilibrium in the vagina, usually due to an overgrowth of C. albicans. This overgrowth can result from:

  • impaired immune system;
  • taking hormone therapy or oral contraceptives, that increases estrogen levels;
  • uncontrolled diabetes;
  • pregnancy;
  • antibiotic use, which changes the pH of the vagina.

In addition, you are more at risk of developing vulvovaginal candidiasis if your immune system does not work correctly, due to chemotherapy or if you have HIV/AIDS.

Symptoms of vulvovaginal candidiasis include:

  • itching around the vagina (infectious vaginitis);
  • reddening of the vulva (the outer parts of the vagina);
  • white vaginal discharge;
  • pain during sexual intercourse;
  • white curd appearance on the skin;
  • soreness and irritation.

Women who suspect they may have a vulvovaginal candidiasis should visit their doctor. Here is a comparison of two OTC antifungals that are usually prescribed:


Its active ingredient is a medication called miconazole, which belongs to a family of medications called antifungals.

It is available in three different treatment dosage strengths, but they all cure just as effectively and in the same amount of time.

Inactive ingredients – Stearyl Alcohol, Purified Water, Propylene Glycol, Potassium Hydroxide, Polysorbate 60, Isopropyl Myristate, Cetyl Alcohol, and Benzoic Acid.


Its active ingredient is a medication called fluconazole, an antifungal medicine that belongs to a family of medicines called azole antibiotics.


Monistat is used to treat vaginal candida (yeast) infections.

Diflucan may be effective in treating peritonitis, UTIs, pneumonia, and vaginal, oral, and esophageal fungal infections caused by Candida.

Note – it can be used for treating complicated, uncomplicated, or recurrent vaginal Candida infections.

Mechanism of Action

Both medicines work by stopping the growth of yeast (fungus) which causes the infection.

Side Effects


The most common adverse events include:

  • urinating more than usual;
  • skin irritation around the vagina;
  • mild itching or burning.

Serious side effects include:

  • vaginal itching, burning, or irritation;
  • headache.


The most common adverse events include:

  • headache;
  • severe rash in women with lowered immunity;
  • changes in the way food tastes;
  • diarrhea;
  • stomach pain;
  • dizziness;
  • upset stomach;
  • nausea.

Serious side effects include:

  • severe rash;
  • yellowing of the whites of your eyes or skin;
  • seizures;
  • dark urine;
  • fainting;
  • light-colored stools;
  • dizziness;
  • severe skin itching;
  • fast, irregular heart rate;
  • feeling like your heart is skipping a beat;
  • vomiting;
  • skin peeling.


Monistat vaginal ovules, cream, or suppositories should be inserted high into the vagina once per day using the applicator(s) provided for up to 7 days, depending on the specific product being used. Relief of symptoms should begin within three days, and up to one week for the symptoms to disappear.

The usual recommended dosage of Diflucan for vulvovaginal candidiasis is 150 mg as a single oral dose. It commonly starts to work within 1 day, however, it may take 3 days for the symptoms to improve, and complete relief should occur within a week.

Warnings & Precautions

Do not use these antifungal medications if you are allergic to any of their active or inactive ingredients.

Pregnant women should avoid taking these antifungal medicines, as should patients with kidney disease, liver disease, a family history of Long QT syndrome, or heart arrhythmia.

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Drug Interactions


It may interact in a negative way with the following medications:

  • warfarin;
  • Miradon (anisindione);
  • Jantoven (warfarin);
  • dicumarol (a naturally occurring anticoagulant);
  • Coumadin (warfarin);
  • anisindione (a synthetic anticoagulant).


It may interact in a negative way with the following medications:

  • omeprazole (used to reduce the amount of acid in the stomach);
  • Bactrim (sulfamethoxazole/trimethoprim);
  • Plan B (levonorgestrel);
  • Cipro (ciprofloxacin);
  • prednisone (a man-made glucocorticoid drug which is mostly used to suppress your immune system);
  • Coumadin (warfarin);
  • Zofran (ondansetron);
  • Flagyl (metronidazole);
  • Zoloft (sertraline);
  • Flonase (fluticasone nasal);
  • Xanax (alprazolam);
  • Levaquin (levofloxacin);
  • Singulair (montelukast);
  • Lexapro (escitalopram);
  • oxycodone (a prescription opiate analgesic that works by changing the way that your brain responds to pain);
  • Nexium (esomeprazole);
  • metronidazole (an antibiotic prescribed to treat various bacterial and parasitic infections).


Using alcohol with these antifungal medicines may cause interactions to occur. Discuss with your healthcare provider the use of these antifungal medicines with alcohol.

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Pregnancy & Breastfeeding

If you are pregnant or breastfeeding, ask a health professional’s advice before use.

Monistat vs Diflucan – Which Is Better For Vulvovaginal Candidiasis?

According to a 1990 study conducted at the Maria and St Elisabeth Hospital, Tilburg, The Netherlands, Monistat is just as effective at curing vulvovaginal candidiasis as Diflucan. Clinical cure was obtained in 100 percent (short-term) and 95 percent (long-term) of the Monistat group and in 94 percent and 90 percent, respectively, of the Diflucan group.

Note – almost 50 percent of women’s healthcare professionals have reported Diflucan (fluconazole) resistance in their suferrers, however, there are few reports of Monistat (miconazole) resistant C. albicans species, even though this antifungal has been widely used for the past 40 years.

Moreover, according to a study that was done in Denmark over a 17-year period on more than 3,315 pregnant women who were treated with Diflucan (fluconazole), 50% of them were more likely to have had a miscarriage than women who were not exposed to miconazole.

Also, a 2016 study that was issued in The Journal of the American Medical Association established that the use of fluconazole during pregnancy is linked with an increased risk of miscarriage compared with risk among unexposed women.

Image source – Shutterstock

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