Warfarin Institute of America
DEDICATED TO YOUR HEALTH SINCE 2000
ECONAZOLE INTERACTION WITH WARFARIN
Brand Name: Spectazole
The first case report was presented by Mary K. Fors, R.Ph. at the Anticoagulation Forum meeting in Washington DC during May 2001.
An 84 year-old white male was taking warfarin for stroke prophylaxis while in atrial fibrillation. His INR was maintained between 2.5 and 3.5 on warfarin 35 to 45 mg/wk. He developed a yeast/staph infection with psoriasis with multiple sites of skin disruption. He took dicolxacillin 1 GM daily for 30 days and used econazole 1% topical at varying frequencies for several months depending upon the severity of the psoriasis. On day 200 of the econazole treatment, his INR was 15 as measured by CoaguChek Plus and 29 by venipuncture for verification. While continuing econazole treatment, his warfarin dosage requirement declined to as low as 16.25 mg/wk. During the treatment, other medications, diet, activity and health status remained stable. As the psoriasis cleared, econazole use declined and the warfarin requirement gradually returned to baseline.
The author states that econazole is a known inhibitor of cytochrome P-450 enzymes. There may have been systemic absorption of econazole through the disrupted skin (no blood level determination of econazole was possible.)
This interaction should be considered as a possibility when someone taking warfarin develops an elevated INR in conjunction with disrupted skin.
©2001 Mary K. Fors Used by permission.
A second case report was published by Lang and Leclercq in J Am Acad Dermatol. 2006 Nov;55(5 Suppl):S117-9.
This reaction also happens with other members of this family: fluconazole, itraconazole, ketoconazole, metronidazole, miconazole and voriconazole.
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Last modified October 22, 2006