Sertaconazole (Monograph)

Brand name: Ertaczo
Drug class: Azoles
VA class: DE102
Chemical name: (±)-1-[2,4-Dichloro-β-[(7-chlorobenzo[b]thien-3-yl)methoxy]phenylethyl]-imidazole mononitrate
Molecular formula: C₂₀H₁₅Cl₃N₂OSH NO₃
CAS number: 99592-32-2

Introduction

Antifungal; azole (imidazole derivative).¹

Uses for Sertaconazole

Dermatophytoses

Treatment of interdigital tinea pedis (athlete’s foot) caused by Epidermophyton floccosum, Trichophyton mentagrophytes, or T. rubrum in immunocompetent adults and children ≥12 years of age.^{1 2 16}

Topical antifungals usually effective for treatment of uncomplicated tinea pedis;^{13 25} an oral antifungal usually necessary for treatment of hyperkeratotic areas on the palms and soles, for chronic moccasin-type (dry-type) tinea pedis, and for treatment of tinea unguium (onychomycosis).^{13 23 25}

Treatment of tinea corporis^{† [off-label]} (ringworm of the body),¹⁶ tinea cruris^{† [off-label]} (jock itch),¹⁶ or tinea manuum^{† [off-label]} (hand ringworm)¹⁶ caused by E. floccosum, Microsporum (including M. canis), or Trichophyton (including T. mentagrophytes, T. rubrum, and T. schonleinii).^{16 19}

Topical antifungals usually effective for uncomplicated tinea corporis, tinea cruris, and tinea manuum; an oral antifungal usually 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.^{13 20 23 25}

Pityriasis (Tinea) Versicolor

Treatment of pityriasis (tinea) versicolor^{† [off-label]} caused by Malassezia furfur (Pityrosporum orbiculare or P. ovale).^{17 19}

Topical treatment usually effective; an oral antifungal (alone or in conjunction with a topical agent) may be necessary in patients who have extensive or severe infections or who fail to respond to or have frequent relapses with topical therapy.^{21 22 23}

Cutaneous Candidiasis

Treatment of superficial cutaneous candidiasis caused by Candida albicans^{† [off-label]}.^{18 19}

Sertaconazole Dosage and Administration

Administration

Topical Administration

Apply topically to the skin as a 2% cream.¹

Do not apply to the eye or administer orally or intravaginally.¹

Avoid contact with the nose, mouth, and other mucous membranes.^{1 19 20 21}

Do not use with occlusive dressings or wrappings, unless otherwise directed by clinician.¹

Apply a sufficient amount of cream twice daily; rub gently into affected area (e.g., between the toes) and immediately surrounding healthy skin.¹

Dosage

Available as sertaconazole nitrate; dosage expressed in terms of sertaconazole nitrate.¹

Pediatric Patients

Dermatophytoses

Tinea Pedis (Interdigital)

Topical

Children ≥12 years of age: Apply twice daily for 4 weeks.¹

If clinical improvement does not occur after 2 weeks of treatment, reevaluate the diagnosis.¹

Adults

Dermatophytoses

Tinea Pedis (Interdigital)

Topical

Apply twice daily for 4 weeks.¹

If clinical improvement does not occur after 2 weeks of treatment, reevaluate the diagnosis.¹

Tinea Corporis,†Tinea Cruris†, andTinea Manuum†

Topical

Has been applied twice daily for 4 weeks.^{16 17}

Pityriasis (Tinea) Versicolor†

Topical

Has been applied twice daily for 4 weeks.¹⁷

Cutaneous Candidiasis†

Topical

Has been applied twice daily for 4 weeks.¹⁸

Cautions for Sertaconazole

Contraindications

• Known hypersensitivity to sertaconazole, other imidazoles, or any ingredient in the formulation.¹

Warnings/Precautions

Sensitivity Reactions

Hypersensitivity Reactions

Contact dermatitis reported rarely following topical application.^{1 5}

If irritation or sensitivity occurs, discontinue the drug and initiate appropriate therapy.^{1 5}

Possible cross-sensitization among the imidazoles.^{1 5}

General Precautions

Selection and Use of Antifungals

Prior to initiation of therapy, confirm diagnosis by direct microscopic examination of scrapings from infected tissue mounted in potassium hydroxide (KOH) or by culture.¹

Specific Populations

Pregnancy

Category C.¹

Lactation

Not known whether distributed into milk following topical application of 2% cream.¹ Use with caution.¹

Pediatric Use

Safety and efficacy not established in children <12 years of age.¹

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.¹

Common Adverse Effects

Contact dermatitis, dry skin, burning skin, application site reaction, skin tenderness.¹

Sertaconazole Pharmacokinetics

Absorption

Bioavailability

Does not appear to be appreciably absorbed systemically following topical application to skin.¹

Not detected in plasma following repeated application of 2% cream to diseased skin.¹

Distribution

Extent

Not known whether distributed into milk following topical application of 2% cream.¹

Stability

Storage

Topical

Cream

25°C (may be exposed to 15–30°C).¹

Actions and Spectrum

• Imidazole-derivative azole antifungal.^{1 10 11}

• Usually fungistatic; may be fungicidal at high concentrations.^{6 12}

• Presumably exerts its antifungal activity by altering cellular membranes, resulting in increased membrane permeability, secondary metabolic effects, and growth inhibition.^{1 6 11}

• Fungistatic activity may result from interference with ergosterol synthesis.^{1 6 8 10 11 12} Fungicidal activity at high concentrations may result from a direct physiochemical effect on the fungal cell membrane.^{6 8 12}

• Spectrum of antifungal activity includes many fungi, including dermatophytes and yeasts.^{1 3 4 6 8 10 14 15} Also has in vitro activity against some gram-positive bacteria.⁴

• Dermatophytes: Active in vitro against Epidermophyton floccosum,^{1 7 8 9 14} Microsporum audouini,^{7 8 9 14} M. canis,^{7 8 9 14 15} M. gypseum,^{7 8 9 14 15} M. racemosum,⁹ Trichophyton erinacei,⁹ T. interdigitale,^{7 9 14} T. mentagrophytes,^{1 7 8 9 14 15} T. rubrum,^{1 7 8 9 14 15} T. schoenleinii,^{7 9} T. soudanese,⁹ T. terreste,⁹ T. tonsurans,^{7 9} T. verrucosum,⁷ and T. violaceum.^{7 9}

• Also active in vitro against Malassezia furfur (Pityrosporum orbiculare or P. ovale).^{10 14}

• Candida: Active in vitro against C. albicans,^{4 6 8 14 15} C. beigelii,^{6 14} C. dubliniensis,⁴ C. famata,⁸ C. glabrata (formerly Torulopsis glabrata),^{4 6 7 8 14} C. guilliermondii,^{4 6 7 8} C. holmii,⁴ C. humicola,^{4 7 8} C. inconspicua,⁴ C. intermedia,^{4 8} C. krusei,^{4 6 8 14 15} C. lambica, ⁴ C. lipolytica,⁴ C. lusitaniae,^{4 6} C. parapsilosis,^{4 6 8 15} C. pulcherrima,⁴ C. pseudotropicalis,^{6 14 15} C. rugosa,⁴ and C. tropicalis.^{4 6 8 14 15}

• Although clinical importance unknown, T. mentagrophytes, T. rubrum, and M. canis clinical isolates with in vitro resistance to sertaconazole reported.⁹ Some of these also were resistant to other imidazoles (e.g., clotrimazole, fluconazole, ketoconazole, miconazole, tioconazole).⁹

• C. albicans serotype B vaginal isolate with in vitro resistance to sertaconazole and other imidazoles (e.g., econazole, fluconazole, itraconazole, ketoconazole miconazole) reported.⁴

• Importance of applying to affected areas as directed and avoiding contact with eyes, nose, mouth, or other mucous membranes.¹ Importance of not using occlusive dressings, unless otherwise directed by clinician.¹

• Importance of washing hands after applying the cream.¹

• Advise patients to dry affected areas thoroughly before applying cream if it is used after bathing.¹

• Use only for condition prescribed.¹

• Importance of completing full course of therapy, even if symptoms improve; importance of contacting clinician if skin condition worsens during therapy or if improvement does not occur after completing full course of therapy.¹

• Importance of discontinuing drug and consulting clinician if treated area becomes irritated (e.g., redness, itching, burning, blistering, swelling, or oozing).¹

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, and any concomitant illnesses.¹

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹

• Importance of informing patients of other important precautionary information.¹ (See Cautions.)

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.

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