Monistat vs. Diflucan (Fluconazole): Comparison of Effectiveness

Published August 29th, 2021 by Bridget Reed
Fact Checked by
Chris Riley
Medically Reviewed:
Camille Freking

Overview | Conditions Treated | Effectiveness | Side Effects | Drug Interactions

An estimated 75 percent of women will experience a vaginal yeast infection at some point during their lifetime, and many women will experience multiple yeast infections. Although common, vaginal yeast infections are incredibly uncomfortable and painful, and women want relief quickly.

When comparing Monistat vs. Diflucan, two of the most popular yeast infection treatments on the market, here’s what you need to know about the effectiveness of each.

Overview

Monistat and Diflucan are two of the most popular options for the treatment of yeast infections. While they both can help alleviate your symptoms, there are some significant differences between the two medications.

Monistat

Monistat is an over-the-counter antifungal that is used for the treatment of vaginal yeast infections. The medication is available in three different formulas, including Monistat 1, Monistat 3, and Monistat 7.

Monistat 1 is the strongest formula and delivers the highest dose in a single treatment. The combination pack includes a miconazole nitrate vaginal insert that can be administered once. It also contains an external vaginal cream that can be applied once or twice per day for up to seven days or as long as symptoms last.

Monistat 3 is considered a regular strength formula and is applied as one dose every day over the course of three days. The combination pack includes miconazole prefilled applicators that are administered as a single every day for three days. It also includes an external cream that can be applied for symptoms for up to seven days.

Monistat 7 is a low-dose treatment that is applied in seven treatments over the course of seven days. The medication is administered as a low-dose miconazole nitrate cream. A combination pack is also available that includes an external cream for itch relief.

Monistat’s website states that each of its formulas works equally effectively to treat vaginal yeast infections and works in approximately the same amount of time. Patients should expect to feel some relief within three days and complete relief within seven days.

Diflucan

Diflucan is a prescription medication that is sometimes referred to by the name of its active ingredient, fluconazole. First approved by the U.S. Food and Drug Administration (FDA) in 1993, Diflucan belongs to a class of antifungal medications called triazoles. Diflucan is considered a first-generation triazole. Diflucan is typically given orally once per day and can be taken with or without food. The medication can be purchased in the form of a tablet or a liquid.

Conditions Treated

Monistat

Monistat is used for the treatment of vaginal yeast infections. Vaginal yeast infections are a specific type of fungal infection that is usually caused by the overgrowth of the fungus candida albicans, which is found naturally in the vagina.

Under normal circumstances, the vagina naturally contains a balance of yeast, including candida albicans, and a certain type of bacteria, lactobacillus, that prevents the overgrowth of yeast. However, it is relatively common for this balance to become disrupted, which allows the candida to grow unchecked.

Common causes of vaginal yeast infections include:

  • The use of antibiotics
  • Uncontrolled diabetes
  • A compromised immune system
  • Pregnancy
  • The use of medications that increase estrogen levels, such as hormonal contraceptives

Diflucan

Diflucan is best known for the treatment of vaginal yeast infections, which affect approximately 75 percent of women over the course of their lifetime. However, the medication can also be used to treat a number of other fungal infections, including yeast infections of the mouth, esophagus, throat, abdomen, blood, lungs, and other organs. 

People who are particularly likely to develop yeast infections, including those who are immunocompromised, those undergoing cancer treatments such as radiation or chemotherapy, and individuals who are preparing for a bone marrow transplant, can also use Diflucan to help prevent the development of a yeast infection.

In some cases, Diflucan may be prescribed for the treatment of fungal meningitis, a fungal infection of the membranes covering the brain and spine.

Effectiveness

Monistat

As a topical medication, Monistat begins working immediately to start treating the symptoms of a fungal infection caused by candida albicans. As a result, Monistat can start relieving the symptoms of a vaginal yeast infection more quickly than oral Diflucan, which must be digested and absorbed into the bloodstream. Monistat 1, which includes a vaginal insert as well as a symptom relief cream, begins to provide initial relief from individual symptoms within one hour and starts to provide relief for all symptoms within about four hours.

Diflucan

Studies show that a single dose of Diflucan is as effective as Monistat. As a result, patients taking Diflucan can expect their symptoms to resolve with one dose of the prescription drug. However, Diflucan must be absorbed into the bloodstream after digestion, so it may take longer to start working.

Clinical studies show that Diflucan typically takes about four hours to provide initial relief of at least one symptom and about 16 hours to begin providing relief for all symptoms.

Although Diflucan works more slowly to provide relief, it still begins working relatively quickly. Patients who prefer to avoid the mess that can sometimes be associated with topical and intravaginal products can still find relief from yeast infection symptoms in less than a day when using Diflucan.

Side Effects

Monistat

As an over-the-counter medication, Monistat is associated with relatively few side effects. Some patients report experiencing a mild increase in vaginal irritation, itching, or burning after inserting a Monistat antifungal vaginal insert, while others report abdominal cramping. Rarely, some patients may experience serious side effects, such as abdominal pain, headache, or severe vaginal burning, itching, swelling, or irritation. The product may also cause hives or a skin rash in some patients.

Diflucan

Diflucan is convenient to use and is not associated with the mess and inconvenience sometimes associated with Monistat, but, the medication is available by prescription only due to the possibility of systemic side effects. 

As a result, some people are deterred from taking the medication, while others may not be able to take the drug safely. Common side effects associated with fluconazole include:

  • Headache
  • Dizziness
  • Diarrhea
  • Upset stomach
  • Nausea
  • Vomiting
  • Change in ability to taste food

If you experience any of the above symptoms in a manner that is severe or lasts for an extended period of time, contact your doctor.

Rarely, Diflucan has been known to cause side effects that are potentially serious. Patients experiencing any of the following side effects should contact their immediately and seek emergency medical attention:

  • Extreme tiredness
  • Flu-like symptoms
  • Pale stools
  • Lack of energy
  • Pain in the upper right part of the stomach
  • Unusual bleeding or bruising
  • Loss of appetite
  • Rash
  • Hives
  • Blistering or peeling skin
  • Itching
  • Swelling of the face, tongue, eyes, feet, lower legs, throat, lips, hands, or ankles
  • Yellowing of the eyes or skin
  • Dark urine
  • Seizures
  • Difficulty breathing or swallowing

Drug Interactions

Monistat

Monistat is associated with very few drug interactions. However, it is important to give your doctor a list of medications that you are taking, including prescription drugs, over-the-counter medications, dietary supplements, and herbal supplements, as they may contribute to developing yeast infections more frequently. 

Certain medications may interact with Monistat:

  • Anisindione
  • Dicumarol
  • Warfarin

Diflucan

Because Diflucan is taken orally and absorbed into the bloodstream, it is associated with a longer list of side effects than Monistat, and the medication may be unsafe for use in certain individuals. 

People who are allergic to Diflucan, fluconazole, or any other antifungal medication, including the following, should alert their doctor or pharmacist prior to taking fluconazole:

  • Itraconazole
  • Ketoconazole
  • Posaconazole
  • Voriconazole

Individuals taking any of the following medications will likely not be able to use fluconazole safely:

  • Quinidine
  • Terfenadine
  • Erythromycin
  • Pimozide
  • Astemizole
  • Cisapride

The following medications are known to react with fluconazole and can increase your risk of experiencing side effects or make the medication less effective:

  • Amitriptyline
  • Amphotericin B
  • Blood thinners
  • Calcium channel blockers
  • Carbamazepine
  • Celecoxib
  • Statin medications
  • Cyclophosphamide
  • Cyclosporine
  • Diuretics
  • Fentanyl
  • Isoniazid
  • Losartan
  • Methadone
  • Midazolam
  • Nevirapine
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Oral contraceptives
  • Oral medication for diabetes
  • Phenytoin
  • Prednisone
  • Rifabutin
  • Rifampin
  • Saquinavir
  • Sirolimus
  • Tacrolimus
  • Theophylline
  • Tofacitinib
  • Triazolam
  • Valproic acid
  • Vinblastine
  • Vincristine
  • Vitamin W
  • Voriconazole
  • Zidovudine

This may not be a complete list of drug interactions. Consult a healthcare provider for other possible interactions. 

Summary

If you are suffering from a vaginal yeast infection, the good news is that you have two equally effective options. Both Monistat, a topical medication available over the counter, and Diflucan, a prescription medication taken orally, have been shown to be equally effective. 

Monistat is associated with fewer side effects and fewer drug interactions than Diflucan, and it may start working more quickly than Diflucan to relieve your symptoms. However, Diflucan is more convenient and less messy than Monistat.

Sources:

Yeast infection (vaginal) - Symptoms and causes | Mayo Clinic

Triazole antifungals: a review | National Library of Medicine

Fluconazole | National Library of Medicine

Yeast Infection Treatment | Monistat.com

Speed to Symptom Relief | Monistat.com

Single-dose oral fluconazole versus single-dose topical miconazole for the treatment of acute vulvovaginal candidosis | National Library of Medicine 

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