Oral Thrush Medications: What To Know About Your Treatment Options
Key takeaways:
Oral thrush is caused by an overgrowth of the fungus Candida albicans in your mouth.
Topical antifungal medications, like clotrimazole and nystatin, are used to treat mild oral thrush.
Oral antifungal medications, like fluconazole, can treat thrush that doesn’t respond to topical medications.
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Table of contents
Oropharyngeal candidiasis, commonly known as oral thrush, is a type of yeast infection in your mouth and throat. It’s caused by an overgrowth of the fungus Candida albicans (C. albicans), an organism that is normally found in the mouth. It only becomes a problem when there’s too much of it.
Oral thrush is more likely to occur in people whose immune system isn’t working as well as it should. This includes older adults, and people with cancer or HIV. Other risk factors for oral thrush include wearing dentures, poor oral hygiene, and smoking.
Certain medications can increase your risk of thrush, too. For example, antibiotics and steroids can make C. albicans growth harder to control. And chemotherapy can damage the mouth and weaken your immune system, making oral thrush more likely. Babies are also more likely to get oral thrush because their immune systems aren’t fully developed when they’re born.
But there’s good news. Oral thrush medications are available to help treat this condition. Read on to learn more about the options.
What are the best oral thrush medications?
Antifungals are a broad group of medications that can treat oral thrush. They do this by changing the cell wall of the fungus. This can either prevent the fungus from growing, or cause it to die.
The best medication for oral thrush depends on how severe it is. Below, we’ll talk about oral thrush treatment options for mild cases and more serious cases.
Why is thrush common in babies? In babies, whose immune systems aren’t fully developed, oral thrush is more likely to occur.
Is it thrush or something else? If you see white patches on yours or your child’s tongue, it can be a few different things.
How can you maintain good oral hygiene? Maintaining good oral health can help prevent thrush. Here is a list of must-have dental products from a dental hygienist.
Mild oral thrush treatment
If you have a mild case of thrush, your prescriber may recommend clotrimazole lozenges, nystatin liquid suspension, or miconazole (Oravig) buccal tablets (which are dissolved against your cheek).
These oral thrush treatment options deliver medication directly to the oral mucosa (inside of the mouth) to the mouth area only. They aren’t absorbed by the body, so they have fewer side effects and drug interactions than medications that are swallowed by mouth or given intravenously (IV).
Moderate-to-severe oral thrush treatment
If your symptoms are more severe or the medications discussed above don’t work, your prescriber may recommend an oral medication. The first-choice oral option is fluconazole (Diflucan). It’s available as tablets or a liquid suspension.
If fluconazole doesn’t work or you don’t tolerate it well, itraconazole (Sporanox) solution and posaconazole (Noxafil) suspension are alternative options. While these medications also come as pills, only the liquid forms are FDA approved for oral thrush. Other options for severe oral thrush are used off-label — meaning they’re being used in a way that’s not FDA approved. These include:
Voriconazole (Vfend)
Amphotericin B (Ambisome)
Caspofungin (Cancidas)
Micafungin (Mycamine)
Amphotericin B, caspofungin, and micafungin are only available as IV medications.
How do you take oral thrush medications?
It depends on which medication you’re prescribed.
The easiest and safest way to treat mild oral thrush is to use clotrimazole or nystatin, which are known as “topical antifungals” because they don’t get absorbed by the body. Clotrimazole is a lozenge that you suck on until it dissolves. Nystatin is a liquid that you swish around in your mouth.
For more severe or difficult to treat thrush, you’ll need an oral or IV antifungal. General dosage recommendations are below. But always follow your prescriber’s instructions when taking an antifungal.
Mild oral thrush treatment
Medication | Dosage Form | Dose | Treatment duration | Notes |
|---|---|---|---|---|
Lozenge | 10 mg orally 5 times daily | 7-14 days | Dissolve lozenge slowly and completely. | |
Liquid suspension | 400,000-600,000 units orally 4 times daily | 7-14 days | Shake well before using. Swish the liquid in your cheek for as long as possible before swallowing. | |
Buccal tablet | 50 mg once daily | 7-14 days | Ask your pharmacist for instructions on how to use this tablet, as it’s trickier to use than your typical pill. |
Moderate to severe oral thrush treatment (oral options only)
Medication | Dosage Form | Dose | Treatment duration | Notes |
|---|---|---|---|---|
Tablet or liquid suspension | 100-200 mg orally once daily | 7-14 days | You can take fluconazole with or without food, but nausea may occur. Taking it with food may help lessen nausea. Shake well before using if taking the liquid suspension. | |
Liquid suspension | 400 mg orally twice daily for 3 days, then 400 mg daily for the remainder of treatment | Up to 28 days | Shake well before using. Take during a meal or within 20 minutes of a meal. | |
Liquid solution | 200 mg orally once daily | Up to 28 days | Take on an empty stomach. | |
Liquid suspension | 200 mg orally twice daily | Varies | Shake well before using. Do not mix with any other liquid. Take an hour before or after a meal. |
Since amphotericin B, caspofungin, and micafungin are only available as IV medications, they are given in a hospital setting. They’re usually reserved for situations when an oral medication doesn’t work.
How quickly will you feel symptom relief?
For mild cases of thrush, you may start to feel relief within a few days. But, it’s important to take the full course of antifungals prescribed for you, even if you feel better before you finish your medication. This ensures you’ve treated your oral thrush completely.
What side effects can you expect from oral thrush medications?
The table below discusses common side effects of oral thrush medications. Rarely, serious side effects can occur. If you experience trouble breathing, unusual bleeding, or mood changes, seek emergency care.
Medication | Common side effects |
|---|---|
Clotrimazole | Changes in liver tests, nausea, and an unpleasant feeling in your mouth |
Nystatin | Mouth irritation, nausea, vomiting, stomach upset, and diarrhea |
Miconazole | Diarrhea, nausea, vomiting, headache |
Headache, nausea, and stomach pain | |
Posaconazole | Diarrhea, low potassium levels, fever, and nausea |
Itraconazole | Diarrhea, nausea, abdominal pain, vomiting, and fever |
Voriconazole | Changes in vision, nausea, fever, and rash |
How do you know if you need treatment for oral thrush?
Oral thrush has distinct symptoms that make it easier to identify without needing lab tests. You might notice white patches on your inner cheek, roof of your mouth, or tongue. These patches may be able to be wiped off, but this often leads to bleeding.
You may also feel pain or a burning sensation in the mouth. Combined with a loss of taste, these symptoms can make it difficult to eat.
If you or your child have any of these signs of oral thrush, contact your prescriber to see if you need treatment.
Can oral thrush go away on its own?
It’s possible that mild cases of oral thrush can clear up on their own. But often, treatment is needed. Oral thrush that isn’t treated can last months or even years. That’s why it’s important to talk to a healthcare professional and find out if treatment is necessary.
What happens if oral thrush isn’t treated? Oral thrush doesn’t usually cause serious health issues, but it can be uncomfortable. And, if it’s left untreated and doesn’t improve on its own, it can spread to other areas of the body such as the brain, heart, and esophagus. It could also affect your eyes and joints. And if you have a weakened immune system, you are at greater risk of complications.
Frequently asked questions
While salt water rinses can be beneficial for general oral health, there’s no data that indicates it can heal oral thrush. However, it won’t hurt. It may have soothing, cleansing, and antiseptic properties and relieve symptoms of oral thrush.
Dry mouth, dehydration, and poor oral hygiene can cause a white tongue, which may be mistaken for oral thrush. Health conditions such as leukoplakia, mouth ulcers (such as canker sores), and syphilis can also cause white patches in the mouth or on the tongue. But with these conditions, the patches can’t be rubbed away.
Let your healthcare professional know if you see white patches on your tongue. They can evaluate the cause and recommend the best treatment.
Yes, you should still brush your teeth and tongue if you have oral thrush. And remember to do this regularly, as brushing your tongue and teeth twice daily can keep your mouth free of infection, and possibly prevent oral thrush from happening in the first place.
The bottom line
Oral thrush is caused by an overgrowth of a particular type of fungus, Candida albicans. People with weakened immune systems are more likely to get oral thrush, and some medications can cause it too. This includes antibiotics and steroids.
Usually, oral thrush is easily treated with oral “topical” medications like clotrimazole lozenges or nystatin liquid suspension. If your thrush is more severe, you may need an oral medication like fluconazole (Diflucan). If you think you have oral thrush, talk to your healthcare professional to see which treatment option is best for you.
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References
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