CICLDENT SHAMPOO

Indications

• Fungal infections of the skin
• Onychomycosis (fungal nail infections)
• Seborrheic dermatitis
• Tinea corporis (ringworm of the body)
• Tinea pedis (athlete's foot)

Dosage

Children: For children, the dosage is typically determined by the pediatrician; refer to the BNF for Children for specific dosing guidance.

Adults: For topical use, ciclopirox is usually applied once or twice daily to the affected area. Refer to the BNF for specific formulations and treatment duration.

Mechanism of action

Ciclopirox acts through the chelation of polyvalent metal cations, such as Fe3+ and Al3+, which inhibit essential enzymes, including cytochromes. This disruption affects mitochondrial electron transport and energy production within the cell. Additionally, ciclopirox modifies the plasma membrane of fungi, leading to disorganization of internal structures. Its anti-inflammatory properties are attributed to the inhibition of 5-lipoxygenase and cyclooxygenase, as well as impacts on DNA repair and cell division.

Pharmacodynamics

Ciclopirox demonstrates broad-spectrum antifungal activity, exhibiting either fungistatic or fungicidal effects against a variety of fungal organisms, including dermatophytes, yeasts, and actinomycetes. It also has significant antibacterial activity against both Gram-positive and Gram-negative bacteria. The anti-inflammatory effects are evident in its ability to inhibit the synthesis of prostaglandins and leukotrienes in human polymorphonuclear cells.

Pharmacokinetics

Ciclopirox is well-absorbed when applied topically, with systemic absorption being minimal. It has a relatively low systemic bioavailability when used as a topical treatment. The pharmacokinetics of ciclopirox may vary based on the formulation and site of application. It is primarily metabolized in the liver, with excretion occurring via the urine.

Pregnancy

Ciclopirox should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Ciclopirox is excreted in breast milk. Caution should be exercised when prescribing to nursing mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Topical solution
• Cream
• Gel
• Shampoo

Mechanism of action

Unlike antifungals such as itraconazole and terbinafine, which affect sterol synthesis, ciclopirox is thought to act through the chelation of polyvalent metal cations, such as Fe³⁺ and Al³⁺. These cations inhibit many enzymes, including cytochromes, thus disrupting cellular activities such as mitochondrial electron transport processes and energy production. Ciclopirox also appears to modify the plasma membrane of fungi, resulting in the disorganization of internal structures. The anti-inflammatory action of ciclopirox is most likely due to inhibition of 5-lipoxygenase and cyclooxygenase. ciclopirox may exert its effect by disrupting DNA repair, cell division signals and structures (mitotic spindles) as well as some elements of intracellular transport.

Pharmacodynamics

Ciclopirox is a broad-spectrum antifungal medication that also has antibacterial and anti-inflammatory properties. Its main mode of action is thought to be its high affinity for trivalent cations, which inhibit essential co-factors in enzymes. Ciclopirox exhibits either fungistatic or fungicidal activity in vitro against a broad spectrum of fungal organisms, such as dermatophytes, yeasts, dimorphic fungi, eumycetes, and actinomycetes. In addition to its broad spectrum of action, ciclopirox also exerts antibacterial activity against many Gram-positive and Gram-negative bacteria. Furthermore, the anti-inflammatory effects of ciclopirox have been demonstrated in human polymorphonuclear cells, where ciclopirox has inhibited the synthesis of prostaglandin and leukotriene. Ciclopirox can also exhibit its anti-inflammatory effects by inhibiting the formation of 5-lipoxygenase and cyclooxygenase.