The script as I write it costs 300 to 350 Canadian dollars for two weeks
(that's 42 cents US, no just joking, about 200-225 US dollars). Most drug
plans cover it here, but not government drug plans. Ketoconazole and
itraconazole are cheaper, but still pretty hefty.

Furthermore, although these drugs help the deep breast pain quite regularly
and well, they don't do much for nipple soreness. They can prevent recurrent
nipple soreness though.

I now use gentian violet once daily, combined with apno (all purpose nipple
ointment) after all other feeds when I suspect Candida seriously.

APNO

mupirocin 2% ointment (10 grams)
nystatin 100,000 unit/ml ointment (10 grams)
clotrimazole 10% (vaginal cream) (10 grams)
betamethasone 0.1% ointment (10 grams)

The pharmacist mixes it all together and it is applied sparingly after each
feeding.  Do not wash or wipe it off.  You need a prescription for it. If
Candida is less likely, I leave out clotrimazole.  If it is really unlikely,
I leave out clotrimazole and gentian violet.

Jack Newman, MD, FRCPC