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Econazole

  • Topical antifungalsTopical antifungals
  • Pregnancy: avoidAvoid in the first trimester unless a clinician considers it essential; later in pregnancy it is used only if clearly needed.

Topical imidazole cream for ringworm, athlete's foot, skin Candida and pityriasis versicolor; it stays in the skin and very little is absorbed.

Updated

Also called: econazole nitrate

Quick facts

Group
Topical antifungals
Target
Lanosterol 14α-demethylase (CYP51, the fungal ERG11 enzyme)
Used for
Tinea pedis · Cutaneous candidiasis · Pityriasis
Key effects
Burning
Monitor
Response of the rash after some weeks
ATC
D01AC03

No doses: the clinician sets them by the current guideline.

Mechanism of action

The figure shows econazole bound to human CYP51, the human counterpart of the fungal enzyme; it occupies the same sterol-demethylase site.

Target in 3D: Lanosterol 14α-demethylase (CYP51, the fungal ERG11 enzyme). PDB structure 3JUS (RCSB PDB, public domain). View the structure at RCSB PDB

Econazole is an imidazole. Its imidazole nitrogen binds the heme iron of the fungal enzyme lanosterol 14α-demethylase (CYP51), so lanosterol is not turned into ergosterol. Ergosterol runs out and methylated sterols pile up; the membrane becomes leaky and the fungus stops growing. Applied to the skin it reaches the outer layers at levels that inhibit dermatophytes, Candida and Malassezia.

  1. The imidazole binds the heme iron of fungal CYP51
  2. Lanosterol is not converted into ergosterol
  3. Toxic methylated sterols accumulate in the membrane
  4. The membrane leaks and fungal growth stops

Indications

Adverse effects

Common

  • Burning, itching, stinging and redness where applied

Contraindications

  • Allergy to econazole or any ingredient of the product

Key interactions

Warfarin
Can increase the anticoagulant effect, above all with occlusion, genital use or large areas; INR is checked.

What is monitored

  • Response of the rash after some weeks; reassess the diagnosis if no improvement
  • INR in patients on warfarin using it over large areas

Administration and safety

  • Topical cream or foam for the skin only; not for the eyes
  • Applied to the affected area and the skin around it, after cleaning and drying
  • Stopped if irritation or sensitisation appears

Pregnancy and breastfeeding

Avoid in the first trimester unless a clinician considers it essential; later in pregnancy it is used only if clearly needed.

Nursing care

  • Teach to keep the area clean and dry and to complete the course after the skin clears
  • Teach hand washing after application and not sharing towels or shoes
  • Ask about warfarin use
  • Report spreading redness, blisters or worsening itch

Pharmacokinetics

Absorption
Very low systemic absorption: less than 1% of the applied dose is recovered in urine and faeces.
Distribution
Reaches the stratum corneum, epidermis and middle dermis at levels that inhibit dermatophytes.

Test yourself

Think of the answer, then tap the question to see it.

Which fungal enzyme does econazole inhibit?

Lanosterol 14α-demethylase (CYP51), so ergosterol is not made.

Which skin infections is econazole used for?

Tinea pedis, cruris and corporis, cutaneous candidiasis and pityriasis versicolor.

Why is the INR checked in a patient on warfarin who uses econazole over large areas?

Even topical econazole can enhance warfarin's effect, especially with occlusion or large areas.

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Connections

← Back to the class: Topical antifungals

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - ECONAZOLE NITRATE cream (DailyMed (U.S. National Library of Medicine), 2026); Crystal structure of human lanosterol 14alpha-demethylase (CYP51) in complex with econazole (RCSB Protein Data Bank, 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.