Topical Dermatological Antifungals
Wash hands before and after use.
Applied topically to affected areas of the skin. Avoid contact with the eyes.
Avoid heat, flame, and smoking during an immediately after applying the foam formulation.
erythema / Early / 3.0-3.0
skin irritation / Early / 3.0-3.0
pruritus / Rapid / 3.0-3.0
rash / Early / Incidence not known
Common Brand Names
Econasil, Ecoza, Spectazole, Zolpak
Topical imidazole antifungal
Active against dermatophytes and Candida albicans
For treatment of cutaneous candidiasis and tinea infections, including tinea versicolor
Dosage And Indications
Apply a sufficient amount of cream to the affected areas once daily. Tinea cruris and corporis should be treated for 2 weeks to reduce the possibility of recurrence. Patients with tinea versicolor usually exhibit clinical and mycological clearing after 2 weeks of treatment.
Apply to affected area(s) twice daily for 2 weeks.
Apply a sufficient amount of cream to the affected areas once daily. Treat for 1 month to reduce the possibility of recurrence.
Apply topically to affected areas once daily for 4 weeks.
Apply topically to affected areas once daily for 4 weeks.
Econazole is poorly absorbed into the systemic circulation through intact skin; < 1% is recovered in the urine and feces. Therefore, no dosage adjustments are necessary.Renal Impairment
Econazole is poorly absorbed into the systemic circulation through intact skin; < 1% is recovered in the urine and feces. Therefore, no dosage adjustments are necessary.
Corticosteroids: (Minor) In vitro studies indicate that corticosteroids inhibit the antifungal activity of econazole against C. albicans in a concentration-dependent manner. When the concentration of the corticosteroid was equal to or greater than that of econazole on a weight basis, the antifungal activity of econazole was substantially inhibited. When the corticosteroid concentration was one-tenth that of econazole, no inhibition of antifungal activity was observed.
Nystatin: (Moderate) The combination of econazole and nystatin represents duplication of therapy whenever the drugs are used by similar routes and are usually avoided.
Warfarin: (Moderate) Coadministation of econazole and warfarin has resulted in enhanced anticoagulant effect. In many of these cases, absorption of econazole may have been increased by applying the drug under occlusion, to the genitals, or over large body surface areas. If these drugs are used in combination, closely monitor the International Normalized Ratio (INR) and/or prothrombin time.
Econasil/Econazole/Econazole Nitrate/Spectazole/Zolpak Topical Cream: 1%
Ecoza Topical Foam: 1%
Maximum dosage information not available.Geriatric
Maximum dosage information not available.Adolescents
Maximum dosage information for the foam is not available; safety and efficacy not established for the cream.Children
12 years: Maximum dosage information for the foam is not available; safety and efficacy not established for the cream.
< 12 years: Safety and efficacy not established.
Safety and efficacy not established.
Mechanism Of Action
Like other imidazoles, econazole exerts its effect by disrupting normal fungal cell membrane permeability. Ergosterol is an essential component of the fungal cell membrane. Econazole may inhibit ergosterol synthesis by interacting with 14-alpha-lanosterol demethylase, a cytochrome P-450 enzyme necessary for converting lanosterol to ergosterol. Inhibition of ergosterol synthesis results in increased cellular permeability, causing leakage of cellular contents such as phosphorous-containing compounds and potassium. Econazole is usually fungistatic.
Econazole is applied topically to the skin. It is not for ophthalmic use. Less than 1% of an applied dose is recovered in urine and feces.Topical Route
Following topical application of econazole, systemic absorption is extremely low. Although most of the applied drug remains on the skin surface, drug concentrations found in the stratum corneum greatly exceed the MIC for dermatophytes. Inhibitory concentrations are achieved in the epidermis and as deep as the middle region of the dermis. Use of an occlusive dressing appears to only slightly increase the extent of dermal penetration of the drug.
Pregnancy And Lactation
Use econazole cream during the first trimester of pregnancy only when considered essential to the welfare of the patient and during the second or third trimesters of pregnancy only if clearly needed. No data are available on econazole use in pregnant women to evaluate a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Econazole has not been shown to be teratogenic when administered orally to animals. However, fetotoxic or embryotoxic effects were observed in rats orally receiving 10 to 80 times the human dermal dose. In animal reproduction studies, econazole did not cause malformations at oral doses of 40 or 80 times the human dermal dose.
There is no information available on the presence of econazole in human milk, the effects on the breast-fed infant, or the effects on milk production after topical application of econazole to women who are breast-feeding. It is not known whether econazole is excreted in human milk. The lack of clinical data during lactation precludes a clear determination of the risk of econazole to an infant during lactation. Because many drugs are excreted in human milk, use caution when econazole is administered to a nursing woman. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for econazole and any potential adverse effects on the breast-fed infant from econazole or from the underlying maternal condition. Fluconazole, clotrimazole, miconazole, and nystatin may be potential alternatives to consider during breast-feeding. However, assess site of infection, local susceptibility patterns, and specific microbial susceptibility before choosing an alternative agent. After oral administration of econazole to lactating rats, econazole and/or metabolites were excreted in milk and were found in nursing pups.