[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Topical antifungals](https://durgical.com/en/pharmacology/classes/topical-antifungals/) › Econazole # Econazole ## Topical antifungals? Topical antifungals ## Pregnancy: avoid? Avoid 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 Nov 12, 2026 Also called: econazole nitrate ## Quick facts **Group** [Topical antifungals](https://durgical.com/en/pharmacology/classes/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. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Clinical What the labels mean - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action ✂**Lanosterol 14α-demethylase (CYP51, the fungal ERG11 enzyme)**Econazole ⓘ 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](https://www.rcsb.org/structure/3JUS) · Drag to rotate · pinch to zoom 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. - The imidazole binds the heme iron of fungal CYP51 - Lanosterol is not converted into ergosterol - Toxic methylated sterols accumulate in the membrane - The membrane leaks and fungal growth stops ## Indications - Tinea pedis, tinea cruris and tinea corporis (dermatophytes) [Dermatophytosis (tinea) and onychomycosis →](https://durgical.com/en/conditions/dermatophytosis-and-onychomycosis/) - Cutaneous candidiasis [Cutaneous and mucocutaneous candidiasis →](https://durgical.com/en/conditions/cutaneous-and-mucocutaneous-candidiasis/) - Pityriasis (tinea) versicolor [Pityriasis versicolor →](https://durgical.com/en/conditions/pityriasis-versicolor/) ## Adverse effects ### Common - Burning, itching, stinging and redness where applied ### Serious (rare, important) - Allergic contact dermatitis, rare ## 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. ## Memory aid «ECOnazole is ECOnomic with the blood»: almost nothing is absorbed, yet it can still nudge warfarin's INR. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/econazole/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## What the labels mean **Pregnancy: avoid** Avoid in the first trimester unless a clinician considers it essential; later in pregnancy it is used only if clearly needed. ## Connections ## Related drugs 4 - [Clotrimazole](https://durgical.com/en/pharmacology/clotrimazole/) - [Miconazole](https://durgical.com/en/pharmacology/miconazole/) - [Ketoconazole](https://durgical.com/en/pharmacology/ketoconazole/) - [Terbinafine](https://durgical.com/en/pharmacology/terbinafine/) ## Related conditions 3 - [Dermatophytosis (tinea) and onychomycosis](https://durgical.com/en/conditions/dermatophytosis-and-onychomycosis/) - [Cutaneous and mucocutaneous candidiasis](https://durgical.com/en/conditions/cutaneous-and-mucocutaneous-candidiasis/) - [Pityriasis versicolor](https://durgical.com/en/conditions/pityriasis-versicolor/) [← Back to the class: Topical antifungals](https://durgical.com/en/pharmacology/classes/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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=74e5bbc9-eaea-405e-b64b-b3527c5ea084) (DailyMed (U.S. National Library of Medicine), 2026); [Crystal structure of human lanosterol 14alpha-demethylase (CYP51) in complex with econazole](https://www.rcsb.org/structure/3JUS) (RCSB Protein Data Bank, 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=D01AC03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/econazole/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/econazole/