Skip to Content

Oxiconazole Nitrate

Class: Azoles
ATC Class: G01AF17
VA Class: DE102
Chemical Name: 1-(2,4-Dichlorophenyl)-2-(1H-imidazol-1-yl)ethanone (Z)-O-[(2,4-Dichlorophenyl)methyl]oxime mononitrate
Molecular Formula: C18H13C14N3O•HNO3
CAS Number: 64211-46-7
Brands: Oxistat

Medically reviewed on Jul 2, 2018

Introduction

Antifungal; azole (imidazole derivative).1 2 3 7 8 9 11 12 14 20 27 34 43

Uses for Oxiconazole Nitrate

Dermatophytoses

Treatment of tinea corporis (body ringworm)1 20 24 25 28 and tinea cruris (jock itch)1 20 24 25 caused by Epidermophyton floccosum,1 20 25 27 28 Microsporum canis,20 25 27 28 M. gypseum,25 Trichophyton mentagrophytes,1 20 25 27 28 T. rubrum,1 20 25 27 28 or T. verrucosum.20 28

Treatment of tinea pedis1 20 24 25 or tinea manuum24 25 caused by E. floccosum,20 25 27 28 M. canis,20 25 27 28 M. gypseum,25 T. mentagrophytes,1 20 25 27 28 T. rubrum,1 20 25 27 28 or T. verrucosum.20 28

Topical antifungals usually effective for treatment of uncomplicated tinea corporis or tinea cruris.35 36 39 40 41 An oral antifungal may be necessary when tinea corporis or tinea cruris is extensive, dermatophyte folliculitis is present, infection is chronic or does not respond to topical therapy, or patient is immunocompromised because of coexisting disease or concomitant therapy.35 36 39 40 41

Topical antifungals usually effective for treatment of uncomplicated tinea pedis or tinea manuum.36 39 41 An oral antifungal may be necessary for treatment of hyperkeratotic areas on the palms and soles, for chronic moccasin-type (dry-type) tinea pedis, and for tinea unguium (fingernail or toenail dermatophyte infections, onychomycosis).36 41

Pityriasis (Tinea) Versicolor

Treatment of pityriasis (tinea) versicolor caused by Malassezia furfur (Pityrosporum orbiculare or P. ovale).1

Topical antifungals usually effective; an oral antifungal (with or without a topical antifungal) may be necessary in patients who have extensive or severe infections or failed to respond to or have frequent relapses with topical therapy.37 38 40

Cutaneous Candidiasis

Treatment of cutaneous candidiasis caused by Candida albicans or C. tropicalis.27 28

Oxiconazole Nitrate Dosage and Administration

Administration

Topical Administration

Apply topically to the skin as a 1% cream or lotion.1

Do not apply to the eye1 or administer intravaginally.1 32 33

Avoid contact with the nose, mouth, and other mucous membranes.1

Do not use with occlusive dressings or wrappings, unless otherwise directed by clinician.1

Shake lotion well before using.1

Apply a sufficient amount of cream or lotion; rub gently into affected area and immediately surrounding healthy skin.1

Dosage

Available as oxiconazole nitrate; dosage expressed in terms of oxiconazole.1

Pediatric Patients

Dermatophytoses
Tinea Corporis or Tinea Cruris
Topical

Apply 1% cream once or twice daily for 2 weeks.1

If clinical improvement does not occur after treatment, reevaluate diagnosis.1

Tinea Pedis
Topical

Apply 1% cream once or twice daily for 1 month.1

If clinical improvement does not occur after treatment, reevaluate diagnosis.1

Pityriasis (Tinea) Versicolor
Topical

Apply 1% cream once daily for 2 weeks.1

If clinical improvement does not occur after treatment, reevaluate diagnosis.1

Normalization of hyper- or hypopigmented patches on trunk, neck, arms, and upper thighs is variable and may take months.1

Adults

Dermatophytoses
Tinea Corporis or Tinea Cruris
Topical

Apply 1% cream or lotion once or twice daily for 2 weeks.1

If clinical improvement does not occur after treatment, reevaluate diagnosis.1

Tinea Pedis
Topical

Apply 1% cream or lotion once or twice daily for 1 month.1

If clinical improvement does not occur after treatment, reevaluate diagnosis.1

Pityriasis (Tinea) Versicolor
Topical

Apply 1% cream once daily for 2 weeks.1

If clinical improvement does not occur after treatment, reevaluate diagnosis.1

Normalization of hyper- or hypopigmented patches on trunk, neck, arms, and upper thighs is variable and may take months.1

Special Populations

No special population dosage recommendations at this time.1

Cautions for Oxiconazole Nitrate

Contraindications

Known hypersensitivity to oxiconazole or any ingredient in the formulation.1

Warnings/Precautions

Warnings

Application Precautions

For external use only.1 Use only for topical application to the skin; not for ophthalmic1 or intravaginal use.1 32 33

Sensitivity Reactions

Hypersensitivity Reactions

Contact dermatitis reported following topical application of oxiconazole or other imidazole-derivative azole antifungals.1 21 22 47

If irritation or sensitivity occurs, discontinue the drug and initiate appropriate therapy.1

Possible cross-sensitization among the imidazoles.21 22 44 45 46 47 48

Specific Populations

Pregnancy

Category B.1

Lactation

Distributed into milk; caution if used in nursing women.1 32

Pediatric Use

Cream may be used in pediatric patients; has been used in children ≤10 years of age without unusual adverse effect.1

Safety and efficacy of lotion not established in children.1

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether safety and efficacy differ from that in younger adults.1

Available data to date indicate no difference in safety compared with younger adults; dosage adjustment not recommended.1

Common Adverse Effects

Pruritus, burning, irritation, stinging.1

Interactions for Oxiconazole Nitrate

No formal drug interaction studies to date.1

Oxiconazole Nitrate Pharmacokinetics

Absorption

Bioavailability

Only low concentrations absorbed systemically following topical application to skin.1

Distribution

Extent

Topical application to skin results in highest concentrations in epidermis and lower concentrations in upper and deeper corneum.1 In vitro on animal skin, oxiconazole 1% cream was retained in the horny layer of the epidermis for up to 96 hours after topical application.10 20

Distributed into milk.1 32

Not known whether systemically absorbed oxiconazole crosses the placenta.32 33

Elimination

Elimination Route

Systemically absorbed drug excreted in urine (<0.3% of topical dose).1

Stability

Storage

Topical

Cream and Lotion

15–30C;1 cream is stable for 24 months after the date of manufacture.32

Actions and Spectrum

  • Imidazole-derivative azole antifungal.1 2 3 7 8 9 11 12 14 20 27 34 43

  • Usually fungistatic;3 7 8 34 may be fungicidal at high concentrations or against very susceptible organisms.3 7 34

  • Presumably exerts its antifungal activity by altering cellular membranes, resulting in increased membrane permeability, secondary metabolic effects, and growth inhibition.3 4 5 9 Fungistatic activity may result from interference with ergosterol synthesis.1 4 5 9 34

  • Spectrum of antifungal activity includes many fungi, including yeasts and dermatophytes.1 2 3 7 11 12 14 20 34 Also has in vitro activity against some gram-positive bacteria.3 20

  • Dermatophytes: Active in vitro against Epidermophyton floccosum,1 3 7 Microsporum audouinii,1 7 M. canis,1 2 3 7 M. gypseum,1 3 7 Trichophyton mentagrophytes,1 2 3 6 7 16 T. rubrum,1 2 3 7 T. tonsurans,1 7 and T. violaceum.1

  • Candida: Active in vitro against Candida albicans,1 2 3 11 12 16 C. glabrata (Torulopsis glabrata),2 3 11 C. guilliermondii,3 C. krusei,2 3 C. parapsilosis,2 3 11 and C. tropicalis.2 3

  • Other fungi: Active in vitro against Malassezia furfur (Pityrosporum orbiculare).1 7 Also active in vitro against Aspergillus flavus,2 3 11 A. fumigatus,2 3 11 A. nidulans,3 A. niger,3 Cryptococcus neoformans,3 11 Epidermophyton floccosum,1 3 7 Exophiala werneckii,7 Petriellidium boydii,11 and Sporothrix schenkii.11

  • Bacteria: Active in vitro against Actinomadura madurae,3 Corynebacterium minutissimum,20 Nocardia asteroides,3 N. brasiliensis,3 and Streptomyces somaliensis.3

  • Cross-resistance can occur among the azole antifungals.7 32 Some C. albicans resistant to ketoconazole show cross-resistance to oxiconazole and other imidazole-derivative antifungals as well as to triazole derivatives.32

  • Some strains of M. furfur (Pityrosporum orbiculare) resistant to oxiconazole in vitro are cross-resistant to econazole.7

Advice to Patients

  • Importance of completing full course of treatment, even if symptoms improve.1

  • Importance of contacting clinician if skin condition worsens during therapy or if improvement does not occur after completing full course of therapy.1

  • Importance of applying to affected areas as directed and avoiding contact with eyes, nose, mouth, or mucous membranes.1

  • Importance of not using occlusive dressings, unless otherwise directed by clinician.1

  • Importance of washing hands after applying oxiconazole.1

  • Importance of discontinuing use and contacting clinician if treated area becomes irritated (e.g., itching, burning, blistering, swelling, oozing).1 32 33

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Oxiconazole Nitrate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Cream

1% (of oxiconazole)

Oxistat (with benzoic acid and propylene glycol)

GlaxoSmithKline

Lotion

1% (of oxiconazole)

Oxistat (with benzoic acid and propylene glycol)

GlaxoSmithKline

AHFS DI Essentials. © Copyright 2018, Selected Revisions July 1, 2007. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. GlaxoSmithKline Consumer Healthcare LP. Oxistat (oxiconazole nitrate) cream and lotion 1% prescribing information. Pittsburgh, PA; 2002 Aug.

2. Odds FC, Webster CE, Abbott AB. Antifungal relative inhibition factors: BAY I-9139, bifonazole, butoconazole, isoconazole, itraconazole (R 51211), oxiconazole, Ro 14- 4767/002, sulconazole, terconazole and vibunazole (BAY n-7133) compared in vitro with nine established antifungal agents. J Antimicrob Chemother. 1984; 14:105-14. http://www.ncbi.nlm.nih.gov/pubmed/6094418?dopt=AbstractPlus

3. Polak A. Oxiconazole, a new imidazole derivative: evaluation of antifungal activity in vitro and in vivo. Arzneimittelforschung. 1982; 32:17-24. http://www.ncbi.nlm.nih.gov/pubmed/7037014?dopt=AbstractPlus

4. Odds FC, Cheesman SL, Abbott AB. Suppression of ATP in Candida albicans by imidazole and derivative antifungal agents. Sabouraudia. 1985; 23:415-24. http://www.ncbi.nlm.nih.gov/pubmed/3913012?dopt=AbstractPlus

5. Polak-Wyss A, Lengsfeld H, Oesterhelt G. Effect of oxiconazole and Ro 14-4767/002 on sterol pattern in Candida albicans. Sabouraudia. 1985; 23:433-42. http://www.ncbi.nlm.nih.gov/pubmed/3913013?dopt=AbstractPlus

6. Hanel H, Raether W, Dittmar W. Evaluation of fungicidal action in vitro and in a skin model considering the influence of penetration kinetics of various standard antimycotics. Ann NY Acad Sci. 1988; 544:329-37. http://www.ncbi.nlm.nih.gov/pubmed/3214073?dopt=AbstractPlus

7. Shadomy S, Wang H, Shadomy HJ. Further in vitro studies with oxiconazole nitrate. Diagn Microbiol Infect Dis. 1988; 9:231-7. http://www.ncbi.nlm.nih.gov/pubmed/3180708?dopt=AbstractPlus

8. Beggs WH. Influence of growth phase on the susceptibility of Candida albicans to butoconazole, oxiconazole, and sulconazole. J Antimicrob Chemother. 1985; 16:397-9. http://www.ncbi.nlm.nih.gov/pubmed/3902762?dopt=AbstractPlus

9. Hay RJ. Recent advances in the management of fungal infections. Q J Med. 1987; 64:631-9. http://www.ncbi.nlm.nih.gov/pubmed/3328211?dopt=AbstractPlus

10. Polak A. Antifungal activity of four antifungal drugs in the cutaneous retention time test. Sabouraudia. 1984; 22:501-3. http://www.ncbi.nlm.nih.gov/pubmed/6523308?dopt=AbstractPlus

11. Gebhart RJ, Espinel-Ingroff A, Shadomy S. In vitro susceptibility studies with oxiconazole (Ro 13-8996). Chemotherapy. 1984; 30:244-7. http://www.ncbi.nlm.nih.gov/pubmed/6086246?dopt=AbstractPlus

12. Mallie M, Jouvert S, Bastide M et al. Activité comparée de huit composés azolés sur Candida albicans: pouvoir fongistatique et cytologie en microscopie électronique a balayage. Pathol Biol. 1988; 36:575-80. http://www.ncbi.nlm.nih.gov/pubmed/3043361?dopt=AbstractPlus

13. Garuti L, Giovanninetti G, Ferranti A et al. Synthesis and antimycotic activity of some benzyloxyimino compounds. Pharmazie. 1987; 42:378-81. http://www.ncbi.nlm.nih.gov/pubmed/3671457?dopt=AbstractPlus

14. Kerridge D. Mode of action of clinically important antifungal drugs. Adv Microbiol Physiol. 1986; 27:1-72.

15. Timm U, Zell M, Herzfeld L. Sensitive gas-liquid chromatographic method for the determination of oxiconazole in plasma. J Chromatogr. 1982; 229:111-20. http://www.ncbi.nlm.nih.gov/pubmed/7085818?dopt=AbstractPlus

16. Dittmar W, Jovic N. Laboratory techniques alternative to in vivo experiments for studying the liberation, penetration and fungicidal action of topical antimycotic agents in the skin, including ciclopiroxolamine. Mykosen. 1987; 30:326-42. http://www.ncbi.nlm.nih.gov/pubmed/3657856?dopt=AbstractPlus

17. Walters KA. Penetration of chemicals into, and through, the nail plate. Pharm Int. 1985; 6:86-9.

18. Stuttgen G, Bauer E. Permeation of labelled oxiconazole: comparison between the autoradiographic and the horizontal-slice technique in human skin. Mykosen. 1985; 28:138-47. http://www.ncbi.nlm.nih.gov/pubmed/3990703?dopt=AbstractPlus

19. Stuttgen G, Bauer E. Bioavailability, skin- and nail penetration of topically applied antimycotics. Mykosen. 1982; 25:74-80. http://www.ncbi.nlm.nih.gov/pubmed/7062934?dopt=AbstractPlus

20. Ramelet AA, Walker-Nasir E. One daily application of oxiconazole cream is sufficient for treating dermatomycoses. Dermatologica. 1987; 175:293-5. http://www.ncbi.nlm.nih.gov/pubmed/3319722?dopt=AbstractPlus

21. Raulin C, Frosch PJ. Contact allergy to imidazole antimycotics. Contact Dermatitis. 1988; 18:76-80. http://www.ncbi.nlm.nih.gov/pubmed/2966706?dopt=AbstractPlus

22. Raulin C, Frosch PJ. Contact allergy to oxiconazole. Contact Dermatitis. 1987; 16:39-40. http://www.ncbi.nlm.nih.gov/pubmed/3816206?dopt=AbstractPlus

23. Gouveia DC, Jones da Silva C. Oxiconazole in the treatment of vaginal candidiasis: single dose versus 3-day treatment with econazole. Pharmatherapeutica. 1984; 3:682-5. http://www.ncbi.nlm.nih.gov/pubmed/6463068?dopt=AbstractPlus

24. Wagner W. Comparison of clinical efficacy and tolerability of oxiconazole, one dose versus two doses daily. Mykosen. 1986; 29:280-4. http://www.ncbi.nlm.nih.gov/pubmed/3762589?dopt=AbstractPlus

25. Arreaza de Arreaza F, De Torres ED, Maaz TB. Estudio comparativo doble ciego de RO-13-8996 con miconazole en relacion a su eficacia y tolerancia local en pacientes con dermatomicosis. Med Cutan Ibero Lat Am. 1984; 12:57-61. http://www.ncbi.nlm.nih.gov/pubmed/6376980?dopt=AbstractPlus

26. Cetera C. Trattamento della candidiasi vaginale con un nuovo derivato imidazolico, l’oxiconazolo. Boll Chim Farm. 1985; 124(Suppl):13-20S. http://www.ncbi.nlm.nih.gov/pubmed/4015863?dopt=AbstractPlus

27. Gip L. Comparison of oxiconazole (Ro 13-8996) and econazole in dermatomycoses. Mykosen. 1984; 27:295-302. http://www.ncbi.nlm.nih.gov/pubmed/6382000?dopt=AbstractPlus

28. Wagner W, Reckers-Czaschka R. Oxiconazole in dermatomycosis: a double-blind, randomized comparison with bifonazol. Mykosen. 1987; 30:484-92. http://www.ncbi.nlm.nih.gov/pubmed/3325843?dopt=AbstractPlus

29. Vanden Bossche H, Lauwers W, Willemsens G et al. Molecular basis for the antimycotic and antibacterial activity of N-substituted imidazoles and triazoles: the inhibition of isoprenoid biosynthesis. Pestic Sci. 1984; 15:188-98.

30. Thomas AH. Suggested mechanisms for the antimycotic activity of the polyene antibiotics and the N-substituted imidazoles. J Antimicrob Chemother. 1986; 17:269-79. http://www.ncbi.nlm.nih.gov/pubmed/3516967?dopt=AbstractPlus

31. Sud IJ, Feingold DS. Mechanisms of action of the antimycotic imidazoles. J Invest Dermatol. 1981; 76:438-41. http://www.ncbi.nlm.nih.gov/pubmed/7017013?dopt=AbstractPlus

32. Vonderweidt J (Glaxo Inc, Research Triangle Park, NC): Personal communication; 1989 Jul 14.

33. Reviewers’ comments (personal observations); 1989 Jul.

34. Fromtling RA. Overview of medically important antifungal azole derivatives. Clin Microbiol Rev. 1988; 1:187-217. http://www.ncbi.nlm.nih.gov/pubmed/3069196?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=358042&blobtype=pdf

35. Gupta AK, Einarson TR, Summerbell RC et al. An overview of topical antifungal therapy in dermatomycoses: a North American perspective. Drugs. 1998; 55:645-74. http://www.ncbi.nlm.nih.gov/pubmed/9585862?dopt=AbstractPlus

36. Piérard GE, Arrese JE, Piérard-Franchimont C. Treatment and prophylaxis of tinea infections. Drugs. 1996; 52:209-24. http://www.ncbi.nlm.nih.gov/pubmed/8841739?dopt=AbstractPlus

37. Sunenshine PJ, Schwartz RA, Janniger CK. Tinea versicolor: an update. Cutis. 1998; 61:65-72. http://www.ncbi.nlm.nih.gov/pubmed/9515210?dopt=AbstractPlus

38. Assaf RR, Weil ML. The superficial mycoses. Dermatol Clin. 1996; 14:57-67. http://www.ncbi.nlm.nih.gov/pubmed/8821158?dopt=AbstractPlus

39. Lesher JL. Recent developments in antifungal therapy. Dermatol Clin. 1996; 14:163-9. http://www.ncbi.nlm.nih.gov/pubmed/8821170?dopt=AbstractPlus

40. Hay RJ. Dermatophytosis and other superficial mycoses. In: Mandel GL, Douglas RG Jr, Bennett JE, eds. Principles and practices of infectious disease. 4th ed. New York: Churchill Livingston; 1995: 2375-86.

41. Drake LA, Dincehart SM, Farmer ER et al. Guidelines of care for superficial mycotic infections of the skin: tinea corporis, tinea cruris, tinea faciei, tinea manuum, and tinea pedis. J Am Acad Dermatol. 1996; 34:282-6. http://www.ncbi.nlm.nih.gov/pubmed/8642094?dopt=AbstractPlus

42. Drake LA, Dinehart SM, Farmer ER et al. Guidelines of care for superficial mycotic infections of the skin: pityriasis (tinea) versicolor. J Am Acad Dermatol. 1996; 34:287-9. http://www.ncbi.nlm.nih.gov/pubmed/8642095?dopt=AbstractPlus

43. Reviewers’ comments (personal observations) on Sulconazole 84:04.08.

44. Bigardi AS, Pigatto PD, Altomare G. Allergic contact dermatitis due to sulconazole. Contact Dermatitis. 1992; 26:281-2. http://www.ncbi.nlm.nih.gov/pubmed/1395584?dopt=AbstractPlus

45. Machet L, Vaillant L, Muller C et al. Contact dermatitis and cross-sensitivity from sulconazole nitrate. Contact Dermatitis. 1992; 26:352-3. http://www.ncbi.nlm.nih.gov/pubmed/1395603?dopt=AbstractPlus

46. Jones SK, Kennedy CTC. Contact dermatitis from tioconazole. Contact Dermatitis. 1990; 22:122-3. http://www.ncbi.nlm.nih.gov/pubmed/2138969?dopt=AbstractPlus

47. Baes H. Contact sensitivity to miconazole with ortho-chloro cross-sensitivity to other imidazoles. Contact Dermatitis. 1991; 24:89-93. http://www.ncbi.nlm.nih.gov/pubmed/1828223?dopt=AbstractPlus

48. Marren P, Powell S. Contact sensitivity to tioconazole and other imidazoles. Contact Dermatitis. 1992; 27:129-30. http://www.ncbi.nlm.nih.gov/pubmed/1395626?dopt=AbstractPlus

Hide