econazole nitrate: clinical use

Prescribing considerations

• Confirm that symptoms and distribution are consistent with a susceptible fungal infection; first-time, recurrent or treatment-resistant vaginal symptoms warrant clinical assessment.
• The vaginal pessary is not indicated for children under 16 years.
• Avoid simultaneous internal or external genital treatments unless specifically considered appropriate.
• Consider eczema and the irritant potential of the cream's benzoic acid and butylhydroxyanisole.

Contraindications and cautions

• Topical cream: hypersensitivity to econazole or another formulation ingredient.
• Vaginal pessary: hypersensitivity to an imidazole, another vaginal antifungal or a formulation ingredient.

Monitoring

• Monitor the anticoagulant effect more frequently in people taking warfarin or acenocoumarol.
• Stop treatment and assess suspected hypersensitivity or significant chemical irritation.
• Reassess the diagnosis if symptoms do not improve or repeatedly recur.

Clinical pharmacology

Econazole is an imidazole antifungal active against dermatophytes, yeasts and moulds. Absorption through intact skin is low; a small proportion is systemically absorbed after vaginal administration. Systemically available econazole inhibits CYP3A4 and CYP2C9.

Formulation and product differences

• The cream is for cutaneous use and must be kept away from the eyes and mouth.
• The pessary is for intravaginal use, is supplied with an applicator and can impair latex or spermicidal contraception.
• The cream contains benzoic acid and butylhydroxyanisole, which may cause local irritation or contact dermatitis.

Cream

Route: Cutaneous

Strengths: 1%

Pessary

Route: Vaginal

Strengths: 150 mg