Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Cream, External, as nitrate:
Generic: 1% (15 g, 30 g, 85 g)
Foam, External, as nitrate:
Ecoza: 1% (70 g) [contains propylene glycol, trolamine (triethanolamine)]
Pharmacology
Mechanism of Action
Alters fungal cell wall membrane permeability; may interfere with RNA and protein synthesis, and lipid metabolism
Pharmacokinetics/Pharmacodynamics
Absorption
Cream: <10%
Metabolism
Cream: Hepatic to more than 20 metabolites
Excretion
Cream: Urine (<1%); feces (<1%)
Time to Peak
Foam: 6.8 ± 5.1 hours
Use: Labeled Indications
Fungal infection:
Cream: Treatment of tinea pedis, tinea cruris, and tinea corporis caused by Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans, Microsporum canis, Microsporum audouini, Microsporum gypseum, and Epidermophyton floccosum in the treatment of cutaneous candidiasis, and in the treatment of tinea versicolor.
Foam: Treatment of interdigital tinea pedis caused by Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum in patients 12 years and older
Contraindications
Cream: Hypersensitivity to econazole or any component of the formulation
Foam: There are no contraindications listed in the manufacturer's labeling. Documentation of allergenic cross-reactivity for imidazole antifungals is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.
Dosage and Administration
Dosing: Adult
Tinea pedis: Topical: Cream, Foam: Apply sufficient amount to cover affected areas once daily for 4 weeks
Tinea cruris, tinea corporis, tinea versicolor: Topical: Cream: Apply sufficient amount to cover affected areas once daily for 2 weeks
Cutaneous candidiasis: Topical: Cream: Apply sufficient quantity twice daily (morning and evening) for 2 weeks
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Candidiasis cutaneous (including diaper dermatitis): Limited data available: Infants, Children, and Adolescents: Topical: Cream: Apply sufficient amount to cover affected area twice daily (Bradley 2015; Kliegman 2015)
Tinea corporis, tinea cruris, and tinea versicolor (smaller lesions): Children and Adolescents: Limited data available: Topical: Cream: Apply sufficient amount to cover affected area once daily for 4 weeks (Bradley 2015)
Tinea pedis:
Cream: Children and Adolescents: Limited data available: Topical: Apply sufficient amount to cover affected area once daily for 4 weeks (Bradley 2015)
Foam: Children ≥12 years and Adolescents: Topical: Apply sufficient amount to cover affected area once daily for 4 weeks
Administration
Topical: For external use only. Not for oral, ophthalmic, or vaginal use. Avoid contact with the eyes.
Storage
Cream: Store below 30°C (86°F).
Foam: Store at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Do not expose to heat and/or store at temperatures >49°C (120°F) even when the container is empty. Do not store in direct sunlight. Do not refrigerate or freeze.
Drug Interactions
Vitamin K Antagonists (eg, warfarin): Econazole may increase the serum concentration of Vitamin K Antagonists. Monitor therapy
Adverse Reactions
1% to 10%: Dermatologic: Burning sensation of skin (3%), erythema (3%), pruritus (3%), stinging of the skin (3%)
<1%, postmarketing, and/or case reports: Application site reaction, pruritic rash
Warnings/Precautions
Concerns related to adverse effects:
- Irritation: Discontinue if sensitivity or irritation occurs.
Dosage form specific issues:
- Foam: Avoid heat, flame, and smoking during and immediately following application; topical foam is flammable.
Other warnings/precautions:
- Appropriate use: For topical use only; avoid contact with eyes, mouth, nose, or other mucous membranes
Monitoring Parameters
Reassess diagnosis if no clinical improvement after completion of treatment course.
Pregnancy
Pregnancy Considerations
Information related to econazole use in pregnancy is primarily from use for other indications and route of administration. Until more data are available, it is suggested to avoid use in the first trimester and apply sparingly during the second and third trimesters if needed for topical fungal infections (Patel 2017).
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber severe skin irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
