Monistat vs. Diflucan: Which is better for yeast infections?

In this article:

• Main differences
• Conditions treated by Monistat vs. Diflucan
• Efficiacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• Main differences
• Conditions treated by Monistat vs. Diflucan
• Efficiacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

Vaginal yeast infections are a relatively common and very treatable condition that many women face, with the Centers for Disease Control and Prevention (CDC) suggesting that as many as 75% of women will experience at least one episode, and 40-45% suffer from two or more episodes. These infections are typically caused by an overgrowth of a fungal group known as Candida, most commonly Candida albicans, which is present in the normal vaginal flora of most women. Sometimes, certain conditions allow the overgrowth of vaginal candida, also known as candidiasis, while in other cases, there are no precipitating factors identified to result in an episode of vulvovaginal candidiasis (VVC). Either way, the symptoms are similar and may include vaginal tenderness, itching, cottage cheese-like 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. Its active ingredient, 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, thus killing it.

Monistat comes in a variety of treatment combinations which can include vaginal ovules (suppositories) and/or vaginal creams and ointments 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 anti-fungal medication for yeast infections that works in a similar fashion to Monistat. Diflucan is available as an oral pill 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 healthcare provider, and in some cases, a specimen may be required. Diflucan can be prescribed in both children and adults.

Main differences of Monistat vs. 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, repeat dose at 72 hours in those with moderate symptoms
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 one of many topical azole OTC medications intended for the treatment of vulvovaginal candidiasis (vaginal yeast infections) in females. Monistat is not intended to self-treat 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 should be evaluated by a physician first because there are many other conditions that may present similarly to a yeast infection but are, in fact, not. 

Diflucan is also indicated for the treatment of vaginal yeast infections as per CDC guidelines but has a variety of other approved uses by the U.S. Food and Drug Administration (FDA) which include Candida growth in areas of the body that should be sterile. Diflucan may also be used in the treatment of fungal growth on the nails, feet, and skin which are usually caused by a different type of fungal infection, known as dermatophytes. Patients who are immunocompromised may benefit from prophylactic treatment with Diflucan to prevent fungal infections. A rare condition, Cryptococcal meningitis, may also be treated with Diflucan as part of a prolonged course. Lastly, Diflucan is a treatment option for some endemic mycoses, such as blastomycosis and coccidiomycosis. Diflucan treatment duration for vaginal yeast infections can range from one day to a couple of weeks depending on the treatment history, specific Candida species causing infection, and complexity of the patient’s infection. 

Is Monistat or Diflucan more effective?

Monistat and Diflucan are each effective treatment options for vaginal yeast infections. In some women, vaginal yeast infections may be recurrent and bothersome, and the simplicity of a single-dose product 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. A meta-analysis of 26 clinical trials, including a total of 5007 participants, reported non-significant differences in short-term and long-term clinical cure rates between oral Diflucan compared with topical azoles, like Monistat. Therefore, both Monistat and Diflucan are highly effective treatment options for vaginal yeast infections. 

A factor that is important in women affected is how quickly the yeast infection symptoms begin to show resolution. 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 miconazole ovule plus external cream) or systemically with single-dose fluconazole 150 mg. The results of this study found that the biggest difference between miconazole treatments and single-dose fluconazole is that those receiving 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 $24 to $34 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 $20 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 2, 150 mg doses of Diflucan is around $160. With a coupon from SingleCare, you can obtain the generic version of Diflucan for around $15.

	Monistat	Diflucan
Typically covered by insurance?	No	Yes
Typically covered by Medicare?	No	Yes
Standard dosage	3-day combination pack	1 to 2 doses of 150 mg tablets
Typical Medicare copay	N/A	<$10 depending on coverage
SingleCare cost	$20	$15

RELATED: How much is fluconazole without insurance?

Common side effects of Monistat vs. Diflucan

Monistat and Diflucan are generally both well tolerated. The most common side effects of Monistat products are local irritation, burning, and itching. These may be difficult to discern from the symptoms relating to the vaginal yeast infection, the active ingredient, or even inactive ingredients.

Potential side effects of Diflucan are headaches. Other side effects of fluconazole may include skin rash, dizziness, and gastrointestinal intolerance. 

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

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 metabolism 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 additive, 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. A medical professional can provide additional information and a complete list of interactions.

Warnings of Monistat and Diflucan

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. Pregnant women or those who are breastfeeding should consult with their 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 during pregnancy, especially in the first trimester.

Other concurrent conditions 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 malignancy and associated treatments). Pre-existing liver 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 external use only topicals. 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 broader 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 during pregnancy. 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 Diflucan and Monistat together?

Monistat and Diflucan 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 within the first day after treatment begins. Shortly thereafter, the local itching should start to diminish. Finally, the vaginal redness, swelling, and irritation will resolve. Once all 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 to fully eliminate the infection, prophylaxis implemented, or alternative diagnostics and therapies trialed. 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, you are allergic to one of the ingredients. This, unfortunately, could be the active ingredient of miconazole. If you feel the burning sensation continues 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. I,f 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 non-pharmacologic and some non-antifungal treatment modalities which may aid in symptom relief or prevention of recurrent yeast infections. Behavioral changes like reducing risk factors for infection in general, including improved blood glucose control in those with diabetes mellitus, are one approach. Probiotics and changes to diet are sometimes recommended by your healthcare provider to replace or expand upon your own natural flora. They theoretically may 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. 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 antifungals, 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 its 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 generally should be avoided.