Interaction between Warfarin and Econazole (topical)
Moderate
Metabolism
| ID | DDInter1951 and DDInter617 |
| Interaction |
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.
pleural pain
dehydration
head injury
Cardiac decompensation
hyperlipaemia
arterial pressure NOS decreased
Pain
neuropathy peripheral
loss of consciousness
emesis
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| 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. |
| References | |
| Alternative for Warfarin |
B01A
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| Alternative for Econazole (topical) |
G01A
Methazolamide
Dorzolamide (ophthalmic)
Diclofenamide
Clioquinol (topical)
Lactic acid
Amphotericin B (lipid complex)
Diiodohydroxyquinoline
Sulfacetamide (ophthalmic)
Chloramphenicol (ophthalmic)
Amphotericin B (cholesteryl sulfate)
Econazole
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.