econazole
Regulatory sources consulted
Approved indications
- Ecoza 1% foam: interdigital tinea pedis caused by susceptible dermatophytes in patients aged 12 years or older.
- Econazole 1% cream: tinea pedis, cruris, or corporis, cutaneous candidiasis, and tinea versicolor.
Contraindications
Absolute
- The cream is contraindicated in patients with hypersensitivity to any ingredient; the foam label states no contraindications.
Clinical warnings
- Major warning · The foam is flammable: avoid heat, flame, and smoking during and immediately after application; do not puncture or incinerate the pressurized container. — openFDA Ecoza foam set ID 0bb5fa27-32ed-ed13-e063-6394a90a1577
- The cream is for cutaneous use only and must not be used ophthalmically. — DailyMed econazole nitrate cream set ID 64d82b8b-d749-4bfe-ba3e-25836d54e115
- With the foam, application-site reactions occurred in fewer than 1% of clinical-trial participants. — openFDA Ecoza foam set ID 0bb5fa27-32ed-ed13-e063-6394a90a1577
Drug interactions
- HighWarfarin
Mechanism: Topical econazole may enhance anticoagulation, especially under occlusion, on the genital area, or over a large body surface that increases absorption.
Recommendation: Consider monitoring INR or prothrombin time, especially with extensive, genital, or occluded application.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=64d82b8b-d749-4bfe-ba3e-25836d54e115
Adverse events
Common (≥1%)
Cream: burning, itching, stinging, or erythema (approximately 3% combined)
Pregnancy and lactation
FDA category: C (clasificación histórica de la FDA para la espuma)
Foam: use during pregnancy only if the potential benefit justifies fetal risk. Cream: use in the first trimester only if essential and in the second or third only if clearly needed. It is unknown whether econazole passes into human milk; use cautiously while breastfeeding.
Recent literature (PubMed)
Filamentous fungal infections of the cornea known as filamentous fungal keratitis (FK) are challenging to treat. Topical natamycin 5% is usually first-line treatment following the results of several landmark clinical trials. However, even when treated intensively, infections may progress to corneal perforation. Current topical antifungals are not always effective and are often unavailable. Alternatives topical therapies to natamycin include voriconazole, chlorhexidine, amphotericin B and econazole. Surgical therapy, typically in the form of therapeutic penetrating keratoplasty, may be required for severe cases or following corneal perforation. Alternative treatment strategies such as intrastromal or intracameral injections of antifungals may be used. However, there is often no clear treatment strategy and the evidence to guide therapy is often lacking. This review describes the different treatment options and their evidence and provides a pragmatic approach to the management of fungal keratitis, particularly for clinicians working in tropical, low-resource settings where fungal keratitis is most prevalent.
Fungal infections are a growing healthcare concern worldwide. Aspergillus, Candida and Cryptococcus are considered the most important genera of human pathogenic fungi and treatment of their infections is often challenging. The limited efficacy of available antifungal drugs is largely associated with toxicity and the rising rates of resistance. Thus, alternative therapeutic modalities such as the utilization of nanomedicines have emerged and even introduced in clinical practice. These antifungal nanosystems have been explored as drug delivery systems and/or as intrinsic antifungal agents. Although the establishment of direct interactions between nanomaterials and fungi is recognized as being important for activity and, ultimately, clinical success, such matter remains poorly understood. Mechanisms of action leading to fungi inhibition or death upon exposure to antifungal nanomaterials are quite diverse and include cell wall and membrane bonding, structural damage, metabolic changes and genotoxicity. The present review discusses current knowledge on the main mechanisms involved in nanomaterials-fungi interactions, with an emphasis on cell damage processes, while providing relevant hints for the prospective design of innovative antifungal nanomedicines.
Due to the adverse effects associated with long-term administration of antifungal drugs used for treating dermatophytic lesions like tinea unguium, there is a critical need for novel antifungal therapies that exhibit improved absorption and minimal adverse effects. Nanoformulations offer a promising solution in this regard. Topical formulations may penetrate the upper layers of the skin, such as the stratum corneum, and release an appropriate amount of drugs in therapeutic quantities. Liposomes, particularly nanosized ones, used as topical medication delivery systems for the skin, may have various roles depending on their size, lipid and cholesterol content, ingredient percentage, lamellarity, and surface charge. Liposomes can enhance permeability through the stratum corneum, minimize systemic effects due to their localizing properties, and overcome various challenges in cutaneous drug delivery. Antifungal medications encapsulated in liposomes, including fluconazole, ketoconazole, croconazole, econazole, terbinafine hydrochloride, tolnaftate, and miconazole, have demonstrated improved skin penetration and localization. This review discusses the traditional treatment of dermatophytes and liposomal formulations. Additionally, promising liposomal formulations that may soon be available in the market are introduced. The objective of this review is to provide a comprehensive understanding of dermatophyte infections and the role of liposomes in enhancing treatment.
Among the various prominent fungal infections, superficial ones are widespread. A large number of antifungal agents and their formulations for topical use are commercially available. They have some pharmacokinetic limitations which cannot be retracted by conventional delivery systems. While nanoformulations composed of lipidic and polymeric nanoparticles have the potential to overcome the limitations of conventional systems. The broad spectrum category of antifungals i.e. azoles (ketoconazole, voriconazole, econazole, miconazole, etc.) nanoparticles have been designed, prepared and their pharmacokinetic and pharmacodynamic profile was established. This review briefly elaborates on the types of nano-based topical drug delivery systems and portrays their advantages for researchers in the related field to benefit the available antifungal therapeutics.