Monistat vs. Diflucan: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Vaginal yeast infections are a relatively common and very treatable condition that many women face. These infections are typically caused by an overgrowth of a fungal group known as candida albicans, which is present in the normal vaginal flora of most women. When certain conditions allow the overgrowth of vaginal candida, also known as candidiasis, it leads to symptoms that may include vaginal tenderness, itching, discharge, and/or odor. The sensitivity of this condition leaves many women looking for a quick and effective treatment option. Monistat and Diflucan are two treatment options for vulvovaginal candidiasis.

RELATED: Can men get yeast infections?

What are the main differences between Monistat vs. Diflucan?

Monistat is an over-the-counter treatment option for vaginal yeast infections. It (miconazole) fights fungal infections by decreasing the production of ergosterol. This causes damage to the cell wall of the fungus, allowing the escape of nutrients needed for the fungus to thrive.

Monistat comes in a variety of treatment combinations which can include vaginal ovules (suppositories) and/or vaginal creams for both internal and external applications. There are products for one-day, three-day, or seven-day treatment durations. Many of the Monistat formulations have generic options available. Over the counter use of Monistat products is not intended for anyone under the age of 12.

Diflucan (fluconazole) is a prescription treatment for yeast infections that works in a similar fashion to Monistat in that it decreases the production of ergosterol. The damage this causes to the cell wall membrane will not allow the fungus to live. Diflucan is available as an oral tablet in 50 mg, 100 mg, 150 mg, and 200 mg strengths. It is also available as an oral suspension and injectable solution. Obtaining a prescription for Diflucan requires evaluation by a physician, and in some cases, a specimen may be required. Diflucan can be prescribed in both children and adults.

Main differences between Monistat vs. Diflucan
	Monistat	Diflucan
Drug class	Azole antifungal	Azole antifungal
Brand/generic status	Brand and generic available	Brand and generic available
What is the generic name?	Miconazole	Fluconazole
What form(s) does the drug come in?	Vaginal ovule (suppository) and cream	Oral tablet and suspension, injectable
What is the standard dosage?	Combination of internal and external vaginal application for 1, 3, or 7 days	150 mg as a one time dose, or every other day for 3 total doses
How long is the typical treatment?	1-7 days	1-14 days
Who typically uses the medication?	Females 12 years of age or older	Adults or children under doctor’s orders

Conditions treated by Monistat vs. Diflucan

Monistat formulations are intended for the treatment of vulvovaginal candidiasis (vaginal yeast infections) in females who have been previously diagnosed with a vaginal yeast infection and are having recurring symptoms. Monistat is not intended for use by anyone who has never been diagnosed with a vaginal yeast infection. Women who are having first-time symptoms consistent with a vaginal yeast infection but have never been diagnosed should be evaluated by a physician first. 

Diflucan is also indicated for the treatment of vaginal yeast infections but has a variety of other approved uses by the U.S. Food and Drug Administration (FDA) which include candida growth in the urinary tract, abdomen, heart, esophagus, oral cavity, blood, and bone. Diflucan may also be used in the treatment of fungal growth on the nails and feet. Patients who are immunocompromised may benefit from prophylactic treatment with Diflucan to prevent fungal overgrowth. A rare condition, cryptococcal meningitis, may also be treated with Diflucan. A Diflucan treatment duration for vaginal yeast infections can range from one to fourteen days depending on the treatment history and complexity of the patient’s infection. 

Condition	Monistat	Diflucan
Vaginal candidiasis	Yes	Yes
Oropharyngeal candidiasis	No	Yes
Esophageal candidiasis	No	Yes
Candiduria	No	Yes
Candidemia	No	Yes
Endocarditis	No	Yes
Cryptococcal meningitis	No	Yes
Candidiasis prophylaxis	No	Yes
Tinea corporis, Tinea pedis, Tinea versicolor	No	Yes
Coccidioidomycosis	No	Yes (off-label)

Is Monistat or Diflucan more effective?

Monistat and Diflucan are each effective treatment options for vaginal yeast infections and have been compared in a variety of ways. In some women, vaginal yeast infections may be recurrent and bothersome, and the simplicity of a one-day treatment option may be the most appealing. In a study comparing the single-dose treatment of Monistat and Diflucan, Diflucan was found to have slightly higher cure rates, verified by lab tests and symptomatic improvement, though these differences were not statistically significant. More importantly, short term clinical cure was achieved in 94% of Monistat patients and 100% of Diflucan patients. Therefore, both Monistat and Diflucan are highly effective treatment options for vaginal yeast infections. 

One factor that is important in women affected by vaginal yeast infections is how quickly the symptoms begin to show resolution. Vaginal tenderness, itching, and odor can be extremely bothersome, and if left untreated, can affect other lifestyle activities. A study published in 2015 compared the time to symptomatic relief of vaginal itching, burning, and irritation when treated locally with a one-day miconazole combination treatment (1200 mg ovule + external cream) or systemically with single-dose fluconazole 150 mg. The results of this study found that local treatment with miconazole resulted in relief of at least one symptom in one hour versus four hours with systemic fluconazole treatment. Furthermore, all symptoms were relieved in four hours with local miconazole treatment versus sixteen hours with systemic fluconazole treatment. The time it takes to achieve symptomatic relief is an important factor when choosing the best treatment course.

Only your physician can diagnose a vaginal yeast infection and decide what course of treatment is best for you in treating initial and recurring infections.

Coverage and cost comparison of Monistat vs. Diflucan

Monistat is an over-the-counter medication, and may not be covered by Medicare or other prescription insurance plans.The retail cost of Monistat can range from $18 to $24 depending on the formulation. Your doctor can prescribe Monistat, even though a prescription is not required. With a prescription, you can purchase Monistat for around $15 with a SingleCare coupon. 

Diflucan is only available by prescription and is usually covered by Medicare and most other insurance plans. The average retail price of a single 150 mg dose of Diflucan is around $80. With a coupon from SingleCare, you can obtain the generic for around $8.

	Monistat	Diflucan
Typically covered by insurance?	No	Yes
Typically covered by Medicare?	No	Yes
Standard dosage	3-day combination pack	Single 150 mg dose
Typical Medicare copay	N/A	<$10 depending on coverage
SingleCare cost	$15-$19	$7-$8

RELATED: How much is fluconazole without insurance?

Common side effects of Monistat and Diflucan

Monistat and Diflucan are generally both well tolerated. The most common adverse events for Monistat products are irritation, burning, and itching. These may be difficult to discern from the symptoms relating to the vaginal yeast infection.

Diflucan may cause headaches in a significant number of patients. Other side effects of Diflucan may include skin rash, dizziness, and gastrointestinal intolerance. 

This may not be a complete list of side effects. Your doctor or pharmacist can provide a complete list and additional information on the side effects of Monistat and Diflucan.

	Monistat		Diflucan
Side Effect	Applicable?	Frequency	Applicable?	Frequency
Local irritation	Yes	Not defined	No	n/a
Local itching	Yes	Not defined	No	n/a
Local burning	Yes	Not defined	No	n/a
Headache	No	n/a	Yes	2-13%
Skin rash	No	n/a	Yes	2%
Dizziness	No	n/a	Yes	1%
Nausea	No	n/a	Yes	2-7%
Abdominal pain	No	n/a	Yes	2-6%
Diarrhea	No	n/a	Yes	2-3%

Source: Monistat (DailyMed) Diflucan (DailyMed)

Drug interactions of Monistat vs. Diflucan

Monistat is generally very safe to take with other medications. There is a chance that intravaginal use of miconazole products may result in enough significant systemic absorption to interfere with Coumadin (warfarin) metabolism, causing an increase in plasma levels of warfarin. Therefore, intravaginal use of miconazole in patients taking warfarin is generally not recommended as a precaution. 

Diflucan is a strong inhibitor of cytochrome P-450 enzyme subtype CYP2C19, as well as a moderate inhibitor of subtypes CYP2C9 and CYP3A4. This results in a variety of potential drug interactions as these enzymes play important roles in the processing and absorption of many other drugs. Diflucan may interact with blood thinners, antibiotics, oral contraceptives, and other commonly used medications. In addition, Diflucan has been associated with an adverse event known as QT prolongation, a serious irregular heart rhythm. When Diflucan is taken with other drugs that cause QT prolongation, their effects may be potentiated and this effect is potentially fatal. Drugs whose QT prolongation effect may be increased when taken with Diflucan include amiodarone, astemizole, pimozide, quinidine, quetiapine, and erythromycin.

The following table provides a sample of drug interactions, but may not be a complete list. A medical professional can provide additional information and a complete list of interactions.

Drug	Drug Class	Monistat	Diflucan
Estrogen	Hormone/ oral contraceptive	No	Yes
Hydrochlorothiazide	Diuretic	No	Yes
Rifampin	Antitubercular	No	Yes
Warfarin	Anticoagulant	Yes	Yes
Phenytoin	Anticonvulsant	No	Yes
Zidovudine	Antiviral	No	Yes
Theophylline	PDE inhibitor	No	Yes
Glipizide	Antidiabetic/ sulfonylurea	No	Yes
Cyclosporine Tacrolimus	Immunosuppressants	No	Yes
Erythromycin	Macrolide antibiotic	No	Yes
Amiodarone Dronedarone Quinidine	Antiarrhythmic	No	Yes

Warnings of Monistat vs. Diflucan

Women experiencing symptoms of a vaginal yeast infection for the very first time should consult their physician for confirmation of the diagnosis before initiating treatment with any product. 

Monistat may interfere with the integrity of latex products and therefore may damage products such as condoms or diaphragms. While using Monistat, you should refrain from using other vaginal products such as tampons, douches, or spermicides. Vaginal intercourse is not recommended while using Monistat products. Monistat products may cause skin sensitivities such as itching, burning, and irritation. If you are pregnant or breastfeeding, you should consult with your doctor before using Monistat.

Diflucan has been associated with rare, but serious, liver damage and should be used with caution in patients with pre-existing hepatic disease. Your doctor may monitor your liver enzymes while on Diflucan, especially if you are on it for an extended duration of treatment. Rare cases of a life-threatening allergic reaction, also known as anaphylaxis, to Diflucan have been reported. 

Diflucan should be avoided if you are pregnant, especially in the first trimester.

There are other concurrent conditions that may complicate your yeast infection treatment plan. These can include any condition in which you are immunocompromised such as an impaired immune system (such as from an HIV infection) or a previous bone marrow transplant. Pre-existing liver disease or kidney disease may also affect your treatment options. It is very important for your doctor to be involved in planning your treatment in these cases. 

Frequently asked questions about Monistat vs. Diflucan

What is Monistat?

Monistat is an over-the-counter treatment for vaginal yeast infections. It is available in a variety of treatment options which include vaginal ovules and creams. Treatment duration with Monistat may be one, three, or seven days depending on the product chosen. 

What is Diflucan?

Diflucan is a prescription medication used to treat vaginal yeast infections, as well as a variety of other fungal infections. It is available as an oral tablet or solution, as well as an injection. Treatment of vaginal yeast infections may range from one to fourteen days depending on the complexity of the infection.

Are Monistat and Diflucan the same?

While both Monistat and Diflucan are antifungal medications used to treat vaginal yeast infections, they are not the same. Monistat is available for purchase without a prescription and is used locally in the vaginal area. Diflucan is a prescription medication and is taken orally for systemic absorption.

Is Monistat or Diflucan better?

Monistat and Diflucan are both proven, effective treatments for vaginal yeast infections. Monistat may provide a faster resolution of symptoms such as itching, burning, and irritation. Diflucan has a more broad use in fungal infections other than vaginal candidiasis.

Can I use Monistat or Diflucan while pregnant?

Diflucan should not be used while pregnant. In general, local antifungals, such as Monistat, are the preferred products to treat vaginal yeast infections while pregnant. You should consult with your physician before using Monistat products while pregnant. 

Can I use Monistat or Diflucan with alcohol?

Alcohol is not contraindicated with either Monistat or Diflucan. You should consult with your doctor prior to consuming alcohol while on Diflucan as it has been known to cause rare hepatotoxicity. Patients who consume alcohol on a regular basis may be at an increased risk of liver damage.

Does Monistat work better than Diflucan?

Monistat and Diflucan have shown similar effective cure rates for vaginal candidiasis. Monistat has been shown to provide resolution of local symptoms such as itching, burning, and irritation faster than Diflucan.

Can I use fluconazole and Monistat together?

Monistat and fluconazole each effectively achieve resolution of vaginal yeast infections independently. Miconazole used intravaginally results in some systemic absorption and may interact with oral, systemically absorbed fluconazole. These medications should not be used together without the consent and monitoring of your physician.

How long should it take for Diflucan to work?

Diflucan begins resolving symptoms in 4 hours, with complete resolution in as soon as 16 hours for uncomplicated cases. More complex cases or repeated infections may require longer treatment durations to achieve complete resolution.

How do I know if my antifungal medicine is working? 

The first symptom to resolve is typically the vaginal discharge and odor, and that can happen in the first day or two after treatment begins. Shortly thereafter, the local itching should start to diminish. Finally, the vaginal redness, swelling, and irritation will resolve. Once all of these symptoms have resolved, you can assume your vaginal yeast infection has been sufficiently treated. If this occurs before your specified treatment duration has ended, continue to follow the instructions for the treatment or those prescribed by your healthcare professional until you have completed treatment. Sometimes, these symptoms may recur after a short period of time, and treatment may need to be extended in order to fully eliminate the infection. If the infection keeps recurring consistently, seek the advice of your medical professional as a different treatment type or duration may be needed. 

Why does my yeast infection medicine burn? 

It is not uncommon to experience burning when applying medication such as a topical cream vaginally to treat a yeast infection. Typically, this is due to the skin already being irritated and inflamed from the yeast infection. For many women, vaginal burning is a symptom of the yeast infection itself. Applying anything topically, even water may be irritating enough to cause a burning sensation until the yeast infection begins to heal. 

There is a chance that if your skin begins burning after applying a topical medication that you are allergic to one of the ingredients. This, unfortunately, could be the active ingredient miconazole. If you feel the burning sensation continue to get worse and not better after use, seek medical advice from your healthcare professional immediately and stop using the product until they direct you on the best course. If after continued topical and/or oral treatment for your yeast infection, you still continue to experience burning, you need to see your healthcare professional. There could be something else going on, such as bacterial vaginosis (a bacterial infection in your vagina) and you may need another type of treatment altogether. It is for this reason that you should never begin OTC treatment for a vaginal yeast infection if you have never been medically diagnosed with a yeast infection. 

How effective are non-antifungal medications for yeast infections? 

Antifungal medications are considered the treatment of choice for yeast infections, however, there are some non-antifungal treatments that may aid in symptom relief or prevention of yeast infections. Probiotics are sometimes recommended by your healthcare provider to replace or expand upon your own natural flora. You may hear probiotics sometimes referred to as the “good bacteria,” and what is meant by that is probiotic formulations typically contain bacterial strains we normally have in our body. These resident bacteria are important to keeping a good bacterial balance in your body as they help prevent the overgrowth of harmful bacteria such as Clostridium difficile which can cause a painful and dangerous gastrointestinal infection. They also keep yeast strains such as Candida albicans in check, which may lead to fewer vaginal yeast infections. Probiotics do have side effects, one of the most notable is flatulence, or gas in the gastrointestinal tract. You should consult your health care provider before using. There are many different types of probiotics, and your healthcare professional or pharmacist can help you select the most appropriate one. 

Some infections may be resistant to traditional antifungal treatments or you may just want a treatment option that is not an antifungal. Boric acid is an antiseptic medication that is available without a prescription in a vaginal suppository form. Clinical studies have shown it to be a valid treatment option, though the cure rates do not seem to be as high as antifungal medications.  This product is known to cause vaginal burning in a significant number of patients treated with it, so it is important to ask your healthcare professional for advice before deciding on it a as treatment.

There have been reports of patients using products such as essential oils, garlic, and apple cider vinegar to treat vaginal yeast infections. There is little to no scientific data on these treatment options, and you should consult your healthcare professional before considering these.