Topical imidazole antifungal
Pregnancy: UK SPC §4.6 verbatim. Pregnancy: 'Systemic absorption of econazole is low (< 10%) after topical application to the intact skin in humans. There are no adequate and well-controlled studies on adverse effects from the use of Pevaryl Topical cream in pregnant women, and no other relevant epidemiological data are available. Animal studies have shown reproductive toxicity (see section 5.3). Because there is systemic absorption, use of Pevaryl Topical Cream is not recommended during pregnancy.' Breast-feeding: 'It is not known whether cutaneous administration of Pevaryl Topical cream results in sufficient systemic absorption of econazole nitrate to produce detectable quantities in breast milk in humans. A risk to the breast-fed child cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from Pevaryl Topical Cream therapy taking into account the benefit of breast-feeding for the child and benefit of therapy for the woman. If Pevaryl Topical Cream is used while breast-feeding, care should be taken to ensure the cream is not applied to the nipple or surrounding area.' Fertility: 'Results of econazole animal reproduction studies showed no effects on fertility.'
Econazole nitrate
Brand names: Pevaryl, Ecostatin, Gyno-Pevaryl
Econazole nitrate is a topical imidazole antifungal used for dermatophyte infections, cutaneous and vulvovaginal candidiasis, and pityriasis versicolor.
Adult dose
Dose:Cutaneous candidiasis, dermatophytosis and pityriasis versicolor: apply econazole nitrate 1% cream twice daily to the affected part and rub into the skin gently with the finger. SCOPE — this dose covers the CUTANEOUS (topical) route only, which is this dermatology page's primary route; the page's secondary VAGINAL route (Gyno-Pevaryl) is not covered by this source and must be sourced separately from a vaginal-product SPC.
Route: Topical (cutaneous). §4.2: 'For cutaneous administration.' §4.4: 'For external use only. Care should be taken not to get Pevaryl Topical Cream in the eyes or mouth. If the product is accidently applied to the eyes the patient should wash with clean water or saline and seek medical attention if symptoms persist.'
Frequency: Twice daily. Usual treatment duration is 2 to 4 weeks; if no improvement in symptoms is experienced after 4 weeks, the treatment should be reassessed.
§4.2 verbatim and in full: 'For cutaneous administration. Dosage The dosage regimen is the same for all patients. Apply twice daily to the affected part and rub into the skin gently with the finger. The usual treatment duration is 2 to 4 weeks. If no improvement in symptoms is experienced after 4 weeks, the treatment should be reassessed.' §4.1 verbatim and in full: 'For the treatment of cutaneous candidiasis, dermatophytosis and pityriasis versicolor.' STRENGTH IS QUOTE-PINNED: the product is Pevaryl 1% Topical Cream, and §4.8 independently names the strength — 'The safety of econazole nitrate cream (1%) and econazole nitrate emulsion (1%) was evaluated in 470 subjects who participated in 12 clinical trials'. NO MAXIMUM DOSE IS STATED — §4.2 sets no ceiling on the quantity applied; its only limit is one of DURATION (reassess at 4 weeks), which is not a dose ceiling and has therefore been left out of the maxDose field and recorded here instead. A later matcher fix swapped the product to the UK cutaneous cream SPC that the hold asked for, and it confirms the twice-daily frequency the page always carried — the US foam's once-daily frequency is a different formulation and has NOT been used. CAUTION IN ECZEMA — §4.4: 'Care should be taken in the presence of eczematous dermatitis.' DISCONTINUE ON REACTION — §4.4: 'If a reaction suggesting sensitivity or chemical irritation should occur, use of the medication should be discontinued.' EXCIPIENTS — §4.4: 'This medicine contains 30 mg benzoic acid in each tube of 15 g which is equivalent to 2 mg/g cream. This medicine contains 60 mg benzoic acid in each tube of 30 g which is equivalent to 2 mg/g cream. Benzoic acid may cause local irritation. Benzoic acid may increase jaundice (yellowing of the skin and eyes) in newborn babies (up to 4 weeks old). Butylhydroxyanisole (E320): May cause local skin reactions (e.g. contact dermatitis) or irritation to the eyes and mucous membranes.' ANTICOAGULANT INTERACTION — §4.5 (whose text sits inside the bundle's 'warnings' value, as eMC does not expose it as a separate section heading): 'Econazole administered systemically is known to inhibit CYP3A4/2C9. Due to the limited systemic availability after topical application, clinically relevant interactions are rare. However, in patients on oral anticoagulants, such as warfarin, and acenocoumarol caution should be exercised and anticoagulant effect should be monitored more frequently. Adjustment of the oral anticoagulant dosage may be necessary during the treatment with econazole and after its termination.' RENAL/HEPATIC: no renal- or hepatic-impairment dosing statement appears anywhere in the fetched sections.
Paediatric dose
Dose:Same as adults — §4.2: 'The dosage regimen is the same for all patients.' Apply the 1% cream twice daily to the affected part and rub into the skin gently with the finger.
Route: Topical (cutaneous); for external use only
Frequency: Twice daily; usual treatment duration 2 to 4 weeks, reassess if no improvement after 4 weeks
This is the label's own statement, not a scaled or extrapolated figure: §4.2 sets one regimen for all patients and states no paediatric age restriction and no weight-based dose, so no per-kg figure exists and the weight calculator is intentionally not populated. NEWBORNS — §4.4 excipient warning: 'Benzoic acid may increase jaundice (yellowing of the skin and eyes) in newborn babies (up to 4 weeks old).' Verify against a current children's formulary before use in a neonate.
Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.
Contraindications
§4.3 verbatim and in full: 'Pevaryl Topical Cream is contraindicated in individuals who have shown hypersensitivity to any of its ingredients.'
Not a §4.3 contraindication but a route restriction (§4.4): 'For external use only. Care should be taken not to get Pevaryl Topical Cream in the eyes or mouth.'
Not a §4.3 contraindication but a §4.4 caution: 'Care should be taken in the presence of eczematous dermatitis.'
Not a §4.3 contraindication but a §4.4 excipient caution: contains benzoic acid (2 mg/g cream), which may cause local irritation and may increase jaundice in newborn babies up to 4 weeks old; and butylhydroxyanisole (E320), which may cause local skin reactions such as contact dermatitis
Side effects
§4.8 verbatim: 'Based on pooled safety data from these clinical trials, the most commonly reported (≥1% incidence) adverse reactions were (with % incidence): pruritus (1.3%), skin burning sensation (1.3%), and pain (1.1%).' — from 470 subjects across 12 clinical trials of econazole nitrate cream 1% and emulsion 1%
Common (≥1/100 to <1/10): pruritus, skin burning sensation, pain
Uncommon (≥1/1,000 to <1/100): erythema, discomfort
Frequency not known (post-marketing): hypersensitivity, angioedema, contact dermatitis, rash, urticaria, blister, skin exfoliation, swelling
§4.4: if a reaction suggesting sensitivity or chemical irritation occurs, use of the medication should be discontinued
Monitoring
Clinical response of the treated lesions — reassess treatment if no improvement in symptoms after 4 weeks (§4.2)
In patients on oral anticoagulants such as warfarin or acenocoumarol, monitor the anticoagulant effect more frequently; adjustment of the oral anticoagulant dosage may be necessary during treatment with econazole and after its termination (§4.5)
Watch for sensitivity or chemical irritation and discontinue if it occurs (§4.4)
In eczematous dermatitis, apply with care (§4.4)
If accidentally applied to the eyes, wash with clean water or saline and seek medical attention if symptoms persist (§4.4)
Clinical monograph
How it works
It inhibits fungal cytochrome P450-dependent lanosterol 14-alpha-demethylase, impairing ergosterol synthesis and disrupting the integrity of the fungal cell membrane.
Prescribing in practice
It is for external (or intravaginal) use only and should be kept away from the eyes; discontinue if marked local irritation or a hypersensitivity reaction occurs.
Treatment should usually be continued for a period after the lesions have healed to reduce the risk of relapse.
Intravaginal and some topical formulations may damage latex condoms and diaphragms, reducing their reliability.
Monitoring
No specific laboratory monitoring is required; assess clinical response and watch for local irritation or contact sensitisation.
Counselling the patient
Apply to the affected area and surrounding skin as directed and complete the full course even once symptoms settle.
Stop and seek advice if the skin becomes red, itchy or sore beyond the treated infection.
Avoiding reliance on latex barrier contraceptives while using vaginal formulations is advisable.
Evidence & guidelines
Topical imidazoles such as econazole are well-established first-line agents for superficial fungal skin infections in standard dermatological practice.
Reference: NICE CKS Candidiasis; NICE CKS Tinea; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing.
The structured dose values shown have been reviewed by a clinician.
Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.