Coumadin and Econazole Cream

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

In rare cases, using warfarin together with econazole topical has led to bleeding complications, possibly due to increased blood levels of warfarin. Following application of econazole topical, some of the medication may be absorbed into the bloodstream. Although the amount absorbed is typically very small and not expected to cause problems with other medications, absorption may be significantly increased when occlusive dressings are used over the application site or when econazole topical is applied over large areas of the body or to the genital area. Talk to your doctor if you have any questions or concerns. You may need more frequent monitoring of your INR after starting econazole topical or whenever it is discontinued, and appropriate adjustments made in your warfarin dosage if necessary. You should seek immediate medical attention if you experience any unusual bleeding or bruising, or have other signs and symptoms of bleeding such as dizziness; lightheadedness; red or black, tarry stools; coughing up or vomiting fresh or dried blood that looks like coffee grounds; severe headache; and weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Limited data suggest that econazole administered topically may potentiate the hypoprothrombinemic effect of warfarin and other coumarins. The mechanism of interaction has not been established, but may involve econazole inhibition of CYP450 isoenzymes responsible for the metabolism of coumarin anticoagulants, in particular CYP450 2C9 and 3A4. The interaction has been described in a few isolated case reports, primarily when econazole was applied under occlusion, to the genital area, or to large areas of the body possibly leading to increased systemic absorption of econazole. In one published case, a 79-year-old patient on warfarin therapy experienced bruising and bleeding in association with an INR of 12 following application of econazole cream to the scrotum and inner thigh area. In another case, an 84-year-old woman treated with acenocoumarol for 10 years developed bilateral cervical hematoma and upper airway obstruction with symptoms of dyspnea and difficulty speaking after approximately two weeks of three times daily econazole application to skin corresponding to 12% of her body surface area. Her INR exceeded laboratory limits. She recovered after treatment with oxygen, prothrombin complex concentration, and vitamin K1.

MANAGEMENT: As systemic absorption of econazole is extremely low following topical administration, an interaction with coumarin anticoagulants would not ordinarily be expected. However, close monitoring of International Normalized Ratio (INR) and/or prothrombin time may be indicated, especially when econazole is applied under occlusion or to large areas of the body or the genital area.

Coumadin

Generic Name: warfarin

Brand name: Coumadin, Jantoven

Synonyms: n.a.

What is Coumadin?

Econazole Cream

Generic Name: econazole topical

Brand name: Econazole Nitrate, Ecoza, Spectazole

Synonyms: Econazole topical, Econazole

What is Econazole Cream?