Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Vaginal and vulval fungal infections
Antifungal (Imidazole)
First line:
Green crossFluconazole

- suitable for self-care
150mg oral capsule: £0.72 (1)Fluconazole is recommended as first line due to ease of use and cost-effectiveness.
Not licensed for under 16 years or over 60 years if bought over the counter.
Antifungal (Triazole)
Second line:
Green crossClotrimazole

- suitable for self-care
500mg intra vaginal pessary: £5.60 (1)
2% topical cream / 500mg intra vaginal pessary combi-pack: £5.73 (1)
1% topical cream: £1.24 (20g)
Clotrimazole pessaries are second line due to higher cost.
Not licensed under 16 years or over 60 years if bought over the counter.
Vaginal atrophy
First line:
as Vagirux®10mcg intra vaginal pessary: £11.34 (24)
A cream containing an oestrogen may be applied on a short-term basis to improve the vaginal epithelium in menopausal atrophic vaginitis. It is important to bear in mind that topical oestrogens should be used in the smallest effective amount to minimise systemic effects.
The risk of endometrial hyperplasia and carcinoma is increased when systemic oestrogens are administered alone for prolonged periods. The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain; treatment should be reviewed at least annually, with special consideration given to symptoms of endometrial hyperplasia and carcinoma.

Vagirux is a cost-effective alternative to Vagifem - Approved at October 2020 PAMM
Vagifem 25mcg pessaries were discontinued February 2013
Second line:
as Vagifem®10mcg intra vaginal pessary: £16.72 (24)
Estriolas Ovestin®0.1% intra vaginal cream: £4.45 (15g)
Selective oestrogen receptor modulators
Ospemifeneas Senshio®60mg oral tablet: £39.50