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Econazole (Monograph)

Drug class: Azoles
ATC class: D01AC03
VA class: DE102
Chemical name: (±)-1-[2-[(4-Chlorophenyl)methoxy]-2-(2,4-dichlorophenyl)ethyl]-1H-imidazole mononitrate
Molecular formula: C18H15Cl3N2OβHNO3
CAS number: 68797-31-9

Introduction

Antifungal; azole (imidazole derivative).2 3

Uses for Econazole

Dermatophytoses

Treatment of tinea corporis (body ringworm) and tinea cruris (jock itch) caused by Epidermophyton floccosum, Microsporum audouinii, M. canis, M. gypseum, Trichophyton mentagrophytes, T. rubrum, or T. tonsurans.60 61

Treatment of tinea pedis (athlete’s foot) caused by E. floccosum, M. audouinii, M. canis, M. gypseum, T. mentagrophytes, T. rubrum, or T. tonsurans.60 61

Topical antifungals usually effective for treatment of uncomplicated tinea corporis or tinea cruris.46 47 50 51 52 62 An oral antifungal may be necessary when tinea corporis or tinea cruris is extensive, dermatophyte folliculitis is present, infection is chronic or does not respond to topical therapy, or patient is immunocompromised because of coexisting disease or concomitant therapy.46 47 50 51 52 62

Topical antifungals usually effective for treatment of uncomplicated tinea pedis.46 47 50 51 52 62 An oral antifungal may be necessary for treatment of hyperkeratotic areas on the palms and soles,47 52 for chronic moccasin-type (dry-type) tinea pedis,46 47 51 and for tinea unguium (fingernail or toenail dermatophyte infections, onychomycosis).46 47 50 51 52 62

Pityriasis (Tinea) Versicolor

Treatment of pityriasis (tinea) versicolor caused by Malassezia furfur (Pityrosporum orbiculare or P. ovale).60 61 62

Topical antifungals usually effective; an oral antifungal (with or without a topical antifungal) may be necessary in patients who have extensive or severe infections or have failed to respond to or have frequent relapses with topical therapy.48 49 51 62

Cutaneous Candidiasis

Treatment of cutaneous candidiasis caused by Candida albicans.60 61

Econazole Dosage and Administration

Administration

Topical Administration

Apply topically to the skin as a 1% cream.60 61

Do not apply to the eye60 61 or administer intravaginally.39

Apply a sufficient amount of cream to cover affected areas.60 61

Dosage

Pediatric Patients

Dermatophytoses
Tinea Corporis or Tinea Cruris
Topical

Apply once daily for 2 weeks.60 61 62

If clinical improvement does not occur after treatment, reevaluate diagnosis.60 61 Occasionally, a treatment duration of ≥6 weeks may be necessary.15 17 18 19 62

Tinea Pedis
Topical

Apply once daily for 1 month.60 61 62

If clinical improvement does not occur after treatment, reevaluate diagnosis.60 61 Occasionally, a treatment duration of ≥6 weeks may be necessary.15 17 18 19

Pityriasis (Tinea) Versicolor
Topical

Apply once daily for 2 weeks.60 61 62

If clinical improvement does not occur after treatment, reevaluate diagnosis.60 61

Cutaneous Candidiasis
Topical

Apply twice daily (morning and evening) for 2 weeks.60 61 62

If clinical improvement does not occur after treatment, reevaluate diagnosis.60 61 Occasionally, a treatment duration of ≥6 weeks may be necessary.15 17 18 19

Adults

Dermatophytoses
Tinea Corporis or Tinea Cruris
Topical

Apply once daily for 2 weeks.60 61

If clinical improvement does not occur after treatment, reevaluate diagnosis.60 61 Occasionally, a treatment duration of ≥6 weeks may be necessary.15 17 18 19

Tinea Pedis
Topical

Apply once daily for 1 month.60 61

If clinical improvement does not occur after treatment, reevaluate diagnosis.60 61 Occasionally, a treatment duration of ≥6 weeks may be necessary.15 17 18 19

Pityriasis (Tinea) Versicolor
Topical

Apply once daily for 2 weeks.60 61

If clinical improvement does not occur after treatment, reevaluate diagnosis.60 61

Cutaneous Candidiasis
Topical

Apply twice daily (morning and evening) for 2 weeks.60 61

If clinical improvement does not occur after treatment, reevaluate diagnosis.60 61 Occasionally, a treatment duration of ≥6 weeks may be necessary.15 17 18 19

Special Populations

No special population dosage recommendations at this time.60 61

Detailed Econazole topical dosage information

Cautions for Econazole

Contraindications

Known hypersensitivity to econazole or any ingredient in the formulation.60 61

Warnings/Precautions

Warnings

Administration Precautions

For external use only.60 61 Use only for topical application to the skin; not for ophthalmic60 61 or intravaginal use.39

Fetal/Neonatal Morbidity and Mortality

Fetotoxicity and embryotoxicity demonstrated in animals receiving oral econazole.60 61 (See Pregnancy under Cautions.)

Sensitivity Reactions

Hypersensitivity Reactions

Contact dermatitis reported following topical application of econazole or other imidazole-derivative azole antifungals.55 56 57 58 59

If irritation or sensitivity occurs, discontinue the drug.60 61

Possible cross-sensitization among the imidazoles.44 45 55 56 57 58 59

Specific Populations

Pregnancy

Category C.60 61

Use during first trimester of pregnancy only when considered essential to the welfare of the patient; use during second and third trimesters only if clearly needed.60 61 (See Fetal/Neonatal Morbidity and Mortality under Cautions.)

Lactation

Distributed into milk following oral administration in rats; not known whether distributed into human milk.60 61 Use caution.60 61

Pediatric Use

No unusual adverse effects reported when used in children ≥3 months of age.16 24

Common Adverse Effects

Burning,14 60 61 stinging,15 17 60 61 pruritus,19 60 61 erythema.14 60 61

Drug Interactions

Specific Drugs

Drug

Interaction

Corticosteroids (hydrocortisone, triamcinolone acetonide)

Corticosteroids inhibit antifungal activity of econazole against Saccharomyces cerevisiae and Candida albicans36

Econazole does not alter activity of corticosteroid36

No effect on antibacterial activity of econazole against Staphylococcus36
Econazole topical drug interactions (more detail)

Econazole Pharmacokinetics

Absorption

Bioavailability

Minimal systemic absorption occurs following topical application to skin.13 60 61

Distribution

Extent

About 7.6–9.6% of a topical dose found in stratum corneum;13 also found in epidermis and middle region of dermis.13 60 61

Distributed into milk following oral administration in rats; not known whether distributed into human milk.60 61

Elimination

Elimination Route

Systemically absorbed drug excreted in urine and feces (<1% of topical dose).2 11 13 60 61

Stability

Storage

Topical

Cream

20–25°C60 or <30°C.61

Actions and Spectrum

Advice to Patients

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Econazole Nitrate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Cream

1%*

Econazole Nitrate Cream (with benzoic acid)

Perrigo

AHFS DI Essentials™. © Copyright 2024, Selected Revisions July 1, 2007. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

References

1. Ortho. Spectazole (econazole nitrate 1%) cream prescribing information. Raritan, NJ; 1990 Jun.

2. Heel RC, Brogden RN, Speight TM et al. Econazole: a review of its antifungal activity and therapeutic efficacy. Drugs. 1978; 16:177-201. http://www.ncbi.nlm.nih.gov/pubmed/98315?dopt=AbstractPlus

3. Thienpont D, Van Cutsem J, Van Nueten JM et al. Biological and toxicological properties of econazole, a broad-spectrum antimycotic. (German) Arzneim-Forsch. 1975; 25:224-30.

4. Borgers M. Mechanism of action of antifungal drugs, with special reference to the imidazole derivatives. Rev Infect Dis. 1980; 2:520-34. http://www.ncbi.nlm.nih.gov/pubmed/7003674?dopt=AbstractPlus

5. Marriot MS. Inhibition of sterol biosynthesis in Candida albicans by imidazole-containing antifungals. J Gen Microbiol. 1980; 117:253-5. http://www.ncbi.nlm.nih.gov/pubmed/6993625?dopt=AbstractPlus

6. Preusser HJ. Effects of in vitro treatment with econazole on the ultrastructure of Candida albicans. Mykosen. 1976; 19:304-16.

7. Haller I, Plempel M. Experimental in vitro and in vivo comparison of modern antimycotics. Curr Med Res Opin. 1978; 5:315-27.

8. Schar G, Kayser FH, Dupont MC. Antimicrobial activity of econazole and miconazole in vitro and in experimental candidiasis and aspergillosis. Chemotherapy. 1976; 22:211-20. http://www.ncbi.nlm.nih.gov/pubmed/817875?dopt=AbstractPlus

9. Odds FC. Laboratory evaluation of antifungal agents: a comparative study of five imidazole derivatives of clinical importance. J Antimicrob Chemother. 1980; 6:749-61. http://www.ncbi.nlm.nih.gov/pubmed/7440468?dopt=AbstractPlus

10. Bergan T, Vangdal M. In vitro activity of antifungal agents against yeast species. Chemotherapy. 1983; 29:104-10. http://www.ncbi.nlm.nih.gov/pubmed/6301773?dopt=AbstractPlus

11. Raab W. Clinical pharmacology of modern topical broad-spectrum antimicrobials. Curr Ther Res. 1977; 22:65-82.

12. Holt RJ, Azmi A. Miconazole-resistant Candida. Lancet. 1978; 1:50-1. Letter.

13. Schaefer H, Stuttgen G. Absolute concentrations of an antimycotic agent, econazole, in the human skin after local application. (German) Arzneim-Forsch. 1976; 26:432-5.

14. Gisslen H, Hersle K, Mobacken H et al. Topical treatment of dermatomycoses and tinea versicolor with econazole cream 1% (Pevaryl). Curr Ther Res. 1977; 21:681-4.

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16. Mackie RM. Topical econazole in cutaneous fungal infections. Practitioner. 1980; 224:1311, 1313. http://www.ncbi.nlm.nih.gov/pubmed/7220455?dopt=AbstractPlus

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19. Grigoriu D, Grigoriu A. Double-blind comparison of the efficacy, toleration and safety of tioconazole base 1% and econazole nitrate 1% creams in the treatment of patients with fungal infections of the skin or erythrasma. Dermatologica. 1983; 166(Suppl. 1):8-13. http://www.ncbi.nlm.nih.gov/pubmed/6350072?dopt=AbstractPlus

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24. Herz G. Experiences with triamcinolone acetonide 0.1% plus econazole nitrate 1% in paediatric dermatology. J Int Med Res. 1983; 11:320-3. http://www.ncbi.nlm.nih.gov/pubmed/6642071?dopt=AbstractPlus

25. Rubin A, Russell JM, Mauff A. Efficacy of econazole in the treatment of candidiasis and other vaginal discharges. S Afr Med J. 1980; 57:407-8. http://www.ncbi.nlm.nih.gov/pubmed/7403993?dopt=AbstractPlus

26. Brown D Jr, Binder GL, Gardner HL et al. Comparison of econazole and clotrimazole in the treatment of vulvovaginal candidiasis. Obstet Gynecol. 1980; 56:121-3. http://www.ncbi.nlm.nih.gov/pubmed/7383476?dopt=AbstractPlus

27. Balmer JA. Three-day therapy of vulvovaginal candidiasis with econazole: a multicentric study comprising 996 cases. Am J Obstet Gynecol. 1976; 126:436-41. http://www.ncbi.nlm.nih.gov/pubmed/984105?dopt=AbstractPlus

28. Bloch B, Kretzel A. Econazole nitrate in the treatment of candidal vaginitis. S Afr Med J. 1980; 58:314-6. http://www.ncbi.nlm.nih.gov/pubmed/6157203?dopt=AbstractPlus

29. Popkin DR. Econazole in the treatment of vaginal candidiasis. Curr Ther Res. 1982; 32:948-51.

30. Larsson B, Kjaeldgaard A. Combined vaginal and vulval treatment of vaginal candidiasis with econazole. Curr Ther Res. 1980; 27:664-9.

31. Verma BS. Econazole in vaginal candidosis. Curr Ther Res. 1979; 26:634-9.

32. Fredricsson B, Frisk A, Hagstrom B et al. Vaginal mycoses: aspects on diagnosis and their treatment with econazole nitrate. Curr Ther Res. 1980; 27:309-22.

33. Stettendorf S, Benijts G, Vignali M et al. Three-day therapy of vaginal candidiasis with clotrimazole vaginal tablets and econazole ovules: a multicenter comparative study. Chemotherapy. 1982; 28(Suppl. 1):87-91. http://www.ncbi.nlm.nih.gov/pubmed/6761088?dopt=AbstractPlus

34. Udwadia RB, Dlo MS, Rathod V et al. Econazole: a study of its role in otomycosis. Curr Ther Res. 1982; 31:954-9.

35. Momii A, Funai K, Shingu H et al. Toxicological studies on econazole nitrate. IX. Mutagenicity tests with several bacterial strains. Iyakuhin Kenkyu. 1979; 10:351-7.

36. Raab W, Gmeiner B. Interactions between econazole, a broad-spectrum antimicrobic substance, and topically active glucocorticoids. Dermatologica. 1976; 153:14-22. http://www.ncbi.nlm.nih.gov/pubmed/791715?dopt=AbstractPlus

37. Scrafani JT. Superficial fungal infections and their treatment. US Pharm. 1978; 3:26-40.

38. Thorne EG (Ortho Pharmaceutical Corporation, Raritan, NJ): Personal communication; 1984 Mar 21.

39. Reviewers’ comments (personal observations); 1984 Mar 20.

40. Kern R, Zimmermann FK. Physiological effects of econazole nitrate on yeast cells. Mykosen. 1978; Suppl. 1:339-45.

41. Preusser HJ, Rostek H. Econazole effects on Trichophyton rubrum and Candida albicans—electron microscopic and cytochemical studies. Mykosen. 1978; Suppl. 1:314-21.

42. Hantschke D. In vitro sensitivity tests with antimycotic imidazole derivatives and evaluation of results. Mykosen. 1978; Suppl. 1:222-9.

43. Ryley JF, Wilson RG, Barrett-Bee KJ. Azole resistance in Candida albicans. Sabouraudia. 1984; 22:53-63.

44. Raulin C, Frosch PJ. Contact allergy to imidazole antimycotics. Contact Dermatitis. 1988; 18:76-80. http://www.ncbi.nlm.nih.gov/pubmed/2966706?dopt=AbstractPlus

45. Raulin C, Frosch PJ. Contact allergy to oxiconazole. Contact Dermatitis. 1987; 16:39-40. http://www.ncbi.nlm.nih.gov/pubmed/3816206?dopt=AbstractPlus

46. Gupta AK, Einarson TR, Summerbell RC et al. An overview of topical antifungal therapy in dermatomycoses: a North American perspective. Drugs. 1998; 55:645-74. http://www.ncbi.nlm.nih.gov/pubmed/9585862?dopt=AbstractPlus

47. Piérard GE, Arrese JE, Piérard-Franchimont C. Treatment and prophylaxis of tinea infections. Drugs. 1996; 52:209-24. http://www.ncbi.nlm.nih.gov/pubmed/8841739?dopt=AbstractPlus

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54. Reviewers’ comments (personal observations) on Sulconazole 84:04.08.

55. Bigardi AS, Pigatto PD, Altomare G. Allergic contact dermatitis due to sulconazole. Contact Dermatitis. 1992; 26:281-2. http://www.ncbi.nlm.nih.gov/pubmed/1395584?dopt=AbstractPlus

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57. Jones SK, Kennedy CTC. Contact dermatitis from tioconazole. Contact Dermatitis. 1990; 22:122-3. http://www.ncbi.nlm.nih.gov/pubmed/2138969?dopt=AbstractPlus

58. Baes H. Contact sensitivity to miconazole with ortho-chloro cross-sensitivity to other imidazoles. Contact Dermatitis. 1991; 24:89-93. http://www.ncbi.nlm.nih.gov/pubmed/1828223?dopt=AbstractPlus

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60. Perrigo. Econazole nitrate cream, 1% prescribing information. Allegan, MI; Undated.

61. Taro Pharmaceuticals. Econazole nitrate cream 1% prescribing information. Brampton, Ontario, Canada. 2001 Sept.

62. American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006.

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