Sertaconazole

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# Overview
Sertaconazole is a azole antifungal that is FDA approved for the treatment of interdigital tinea pedis in immunocompetent patients 12 years of age and older, caused by: Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum.   Common adverse reactions include contact dermatitis, dry skin, burning skin, application site skin tenderness.

# Adult Indications and Dosage

## FDA-Labeled Indications and Dosage (Adult)

### Indications
- ERTACZO (sertaconazole nitrate) cream, 2%, is indicated for the topical treatment of interdigital tinea pedis in immunocompetent patients 12 years of age and older, caused by: Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum

### Dosage
- In the treatment of interdigital tinea pedis, ERTACZO cream, 2%, should be applied twice daily for 4 weeks. Sufficient amount of ERTACZO cream, 2%, should be applied to cover both the affected areas between the toes and the immediately surrounding healthy skin of patients with interdigital tinea pedis.
- Not for ophthalmic, oral, or intravaginal use.

### DOSAGE FORMS AND STRENGTHS
- Cream, 2%. Each gram of ERTACZO cream, 2%, contains 17.5 mg of sertaconazole (as sertaconazole nitrate, 20 mg) in a white cream base.

## Off-Label Use and Dosage (Adult)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Sertaconazole in adult patients.

### NonGuideline-Supported Use
- Candidal vulvovaginitis
- Tinea

# Pediatric Indications and Dosage

## FDA-Labeled Indications and Dosage (Pediatric)
There is limited information regarding FDA-Labeled Use of Sertaconazole in pediatric patients.

## Off-Label Use and Dosage (Pediatric)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Sertaconazole in pediatric patients.

### NonGuideline-Supported Use
There is limited information regarding Off-Label NonGuideline-Supported Use of Sertaconazole in pediatric patients.

# Contraindications
- None

# Warnings
- If irritation develops, treatment should be discontinued and appropriate therapy instituted.
- Physicians should exercise caution when prescribing ERTACZO cream, 2%, to patients known to be sensitive to imidazole antifungals, since cross-reactivity may occur.

# Adverse Reactions

## Clinical Trials Experience
- Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug, and may not reflect the rates observed in practice.
- In clinical trials, cutaneous adverse events occurred in 7 of 297 (2%) subjects (2 of them severe) receiving ERTACZO cream, 2%, and in 7 of 291 (2%) subjects (2 of them severe) receiving vehicle. These reported cutaneous adverse events included contact dermatitis, dry skin, burning skin, application site skin tenderness.
- In a dermal sensitization trial, 8 of 202 evaluable subjects tested with ERTACZO cream, 2%, and 4 of 202 evaluable subjects tested with vehicle, exhibited a slight erythematous reaction in the challenge phase. There was no evidence of cumulative irritation or contact sensitization in a repeated insult patch test involving 202 healthy volunteers.

## Postmarketing Experience
- The following adverse reactions have been identified during post-approval use of ERTACZO cream, 2%. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
- In post-marketing surveillance for ERTACZO cream, 2%, the following were reported:
- Cutaneous adverse events: erythema, pruritus, vesiculation, desquamation, and hyperpigmentation.

# Drug Interactions
There is limited information regarding Sertaconazole Drug Interactions in the drug label.

# Use in Specific Populations

### Pregnancy
Pregnancy Category (FDA): C
- There are no adequate and well-controlled studies conducted with ERTACZO cream in pregnant women. ERTACZO cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- Reproduction studies have not been performed with ERTACZO cream. Sertaconazole nitrate did not produce any evidence of maternal toxicity, embryotoxicity or teratogenicity in rats and rabbits at an oral dose of 160 mg/kg/day (40 times (rats) and 80 times (rabbits) the maximum recommended human dose based on a body surface area comparison). A reduction in live birth indices and an increase in the number of still-born pups were seen at doses of 80 and 160 mg/kg/day sertaconazole nitrate in an oral peri- and post-natal development study in rats.
Pregnancy Category (AUS):
- Australian Drug Evaluation Committee (ADEC) Pregnancy Category
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Sertaconazole in women who are pregnant.

### Labor and Delivery
There is no FDA guidance on use of Sertaconazole during labor and delivery.

### Nursing Mothers
- It is not known if sertaconazole is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when prescribing ERTACZO cream, 2%, to a nursing woman.

### Pediatric Use
- The efficacy and safety of ERTACZO cream, 2%, have not been established in pediatric patients below the age of 12 years.

### Geriatic Use
- Clinical trials of ERTACZO cream, 2%, did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

### Gender
There is no FDA guidance on the use of Sertaconazole with respect to specific gender populations.

### Race
There is no FDA guidance on the use of Sertaconazole with respect to specific racial populations.

### Renal Impairment
There is no FDA guidance on the use of Sertaconazole in patients with renal impairment.

### Hepatic Impairment
There is no FDA guidance on the use of Sertaconazole in patients with hepatic impairment.

### Females of Reproductive Potential and Males
There is no FDA guidance on the use of Sertaconazole in women of reproductive potentials and males.

### Immunocompromised Patients
There is no FDA guidance one the use of Sertaconazole in patients who are immunocompromised.

# Administration and Monitoring

### Administration
- Topical application

### Monitoring
There is limited information regarding Monitoring of Sertaconazole in the drug label.

# IV Compatibility
There is limited information regarding IV Compatibility of Sertaconazole in the drug label.

# Overdosage
There is limited information regarding Overdose of Sertaconazole in the drug label.

# Pharmacology

## Mechanism of Action
- Sertaconazole, an azole antifungal agent, inhibits fungal cytochrome P-450-mediated 14 alpha-lanosterol demethylase enzyme. This enzyme functions to convert lanosterol to ergosterol. Ergosterol is a key component of fungal cell membranes and lack of this component leads to fungal cell injury by leakage of key constituents in the cytoplasm from the cell.

## Structure
- ERTACZO (sertaconazole nitrate) cream, 2%, is for topical application. It contains the azole antifungal, sertaconazole nitrate. Sertaconazole nitrate contains one asymmetric carbon atom and exists as a racemic mixture of equal amounts of R and S enantiomers.
- Sertaconazole nitrate is designated chemically as ()-1-thien-3-yl)methoxy]phenethyl]imidazole nitrate. It has a molecular weight of 500.8. The molecular formula is C20H15Cl3N2OS  HNO3, and the structural formula is as follows:
- Sertaconazole nitrate is a white or almost white powder. It is practically insoluble in water, soluble in methanol, sparingly soluble in alcohol and in methylene chloride. Each gram of ERTACZO cream, 2%, contains 17.5 mg of sertaconazole (as sertaconazole nitrate, 20 mg) in a white cream base of ethylene glycol, glyceryl isostearate, glycolized saturated glycerides, light mineral oil, methylparaben, polyethylene glycol palmitostearate, polyoxyethylened saturated glycerides, sorbic acid and purified water.

## Pharmacodynamics
There is limited information regarding Pharmacodynamics of Sertaconazole in the drug label.

## Pharmacokinetics
- In a multiple dose pharmacokinetic trial that included 5 male subjects with interdigital tinea pedis (range of diseased area, 42 - 140 cm2; mean, 93 cm2), ERTACZO cream, 2%, was topically applied every 12 hours for a total of 13 doses to the diseased skin (0.5 grams sertaconazole nitrate per 100 cm2). Sertaconazole concentrations in plasma measured by serial blood sampling for 72 hours after the thirteenth dose were below the limit of quantitation (2.5 ng/mL) of the analytical method used.

### Microbiology
- Sertaconazole nitrate has been shown to be active against isolates of the following microorganisms in clinical infections .

## Nonclinical Toxicology
- In a rat dermal carcinogenicity study, topical administration of sertaconazole nitrate cream for up to 102 weeks did not increase the number of neoplastic lesions compared to control animals, at sertaconazole nitrate doses of up to 800 mg/kg/day (approximately 200 times the maximum recommended human dose based on a body surface area comparison).
- No clastogenic potential was observed in a mouse micronucleus test. Sertaconazole nitrate was considered nonclastogenic in the in vivo mouse sister chromatid exchange assay. There was no evidence that sertaconazole nitrate induced unscheduled DNA synthesis in primary rat hepatocyte cultures.
- At oral doses up to 60 mg/kg/day (16 times the maximum recommended human dose based on a body surface area comparison), sertaconazole nitrate exhibited no toxicity or adverse effects on reproductive performance or fertility in male or female rats.

# Clinical Studies
- In two randomized, double-blind, clinical trials, subjects 12 years and older with interdigital tinea pedis applied either ERTACZO cream, 2%, or vehicle, twice daily for four weeks. Subjects with moccasin-type (plantar) tinea pedis and/or onychomycosis were excluded from the trial. Two weeks after completion of therapy (six weeks after beginning therapy), subjects were evaluated for signs and symptoms related to interdigital tinea pedis.
- Treatment outcomes are summarized in the table below.
- In clinical trials, complete cure in sertaconazole treated subjects was achieved in 32 of 160 (20%) subjects with Trichophyton rubrum, in 7 of 28 (25%) subjects with Trichophyton mentagrophytes and in 1 of 13 (15%) subjects with Epidermophyton floccosum.

# How Supplied
- ERTACZO cream, 2%, is white in color and supplied in tubes in the following size:

## Storage
- Store at 20C-25C (68F-77F); excursions permitted to 15-30C (59-86F)

# Images

## Drug Images

## Package and Label Display Panel

### PRINCIPAL DISPLAY PANEL
PRINCIPAL DISPLAY PANEL - 60 g Tube
NDC 0187-5115-60
ERTACZO 
(sertaconazole nitrate) cream, 2%
For Topical Use Only  Not for Oral, Ophthalmic, or Intravaginal Use

### Ingredients and Appearance

# Patient Counseling Information
- The patient should be instructed to:
- Use ERTACZO cream, 2%, as directed by the physician. The hands should be washed after applying the medication to the affected area(s). Avoid contact with the eyes, mouth, vagina and other mucous membranes. ERTACZO cream, 2%, is for external use only.
- Dry the affected area(s) thoroughly before application, if you wish to use ERTACZO cream, 2%, after bathing.
- Use the medication for the full treatment time recommended by the physician, even though symptoms may have improved.
- Inform the physician if the area of application shows signs of increased irritation, redness, itching, burning, blistering, swelling or oozing.
- Avoid the use of occlusive dressings unless otherwise directed by the physician.
- Do not use this medication for any disorder other than that for which it was prescribed.

### PATIENT PACKAGE INSERT
- ERTACZO cream is a prescription medicine used on the skin (topical) to treat athlete's foot that is between the toes (interdigital tinea pedis) in people 12 years of age and older with normal immune systems.
- It is not known if ERTACZO cream is safe and effective in children under 12 years of age.
- Before using ERTACZO cream, tell your healthcare provider about all of your medical conditions, including if you:
- have any allergies
- are pregnant or plan to become pregnant. It is not known if ERTACZO cream will harm your unborn baby.
- are breastfeeding or plan to breastfeed. It is not known if ERTACZO cream passes into your breast milk.
- Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
- Use ERTACZO cream exactly as your healthcare provider tells you to use it.
- Use ERTACZO cream for the full treatment time, even if your symptoms improve.
- If you take a bath or shower, dry the affected skin areas well before you apply ERTACZO cream.
- Apply ERTACZO cream 2 times a day for 4 weeks to the affected skin areas between your toes and to the healthy skin around the affected areas.
- Wash your hands after you apply ERTACZO cream
- Do not cover the treated skin areas with bandages unless your healthcare provider tells you to.
- The most common side effects of ERTACZO cream include: redness, itching, dry skin, burning, blistering, swelling, drainage and skin tenderness at the treated skin areas. Tell your healthcare provider if you have any of these skin reactions.
- These are not all the possible side effects of ERTACZO cream. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
- Store ERTACZO cream at room temperature, between 68F to 77F (20C to 25C).
- Keep ERTACZO cream and all medicines out of the reach of children.
- Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. You can ask your healthcare provider or pharmacist for information about ERTACZO cream that is written for health professionals. Do not use ERTACZO cream for a condition for which it was not prescribed. Do not give ERTACZO cream to other people, even if they have the same symptoms you have. It may harm them.
- Active ingredient: sertaconazole nitrate
- Inactive ingredients: ethylene glycol, glyceryl isostearate, glycolized saturated glycerides, light mineral oil, methylparaben, polyethylene glycol palmitostearate, polyoxyethylened saturated glycerides, sorbic acid and purified water
- Distributed by: Valeant Pharmaceuticals North America LLC, Bridgewater, NJ 08807
- This Patient Information has been approved by the U.S. Food and Drug Administration.

# Precautions with Alcohol
- Alcohol-Sertaconazole interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

# Brand Names
- Ertaczo

# Look-Alike Drug Names
There is limited information regarding Sertaconazole Look-Alike Drug Names in the drug label.

# Drug Shortage Status

# Price