LOCACORTEN-VIOFORM COMBINATION PRODUCT OINTMENT

Indications

• Allergic conditions
• Dermatitis
• Psoriasis
• Eczema
• Inflammatory skin disorders
• Certain autoimmune diseases
• Asthma exacerbations

Dosage

Adults: Refer to BNF for specific dosing guidance based on the condition being treated. Typically, dosages may vary

Mechanism of action

Flumethasone functions as a glucocorticoid receptor agonist. Upon binding to the glucocorticoid receptor, the receptor-ligand complex translocates to the nucleus, where it influences gene expression. The anti-inflammatory effects are mediated through the induction of lipocortins, which inhibit phospholipase A2, thereby reducing the release of arachidonic acid and subsequently decreasing the production of inflammatory mediators such as prostaglandins and leukotrienes. Additionally, flumethasone suppresses immune system activity by lowering lymphocyte function, decreasing immunoglobulin and complement levels, and impairing antigen-antibody interactions.

Pharmacodynamics

Flumethasone pivalate, being a moderately potent corticosteroid ester, exhibits concentrated anti-inflammatory effects at the application site due to its privalate salt form. This leads to effective and rapid relief from inflammation, exudation, and pruritus. Its pharmacodynamic profile allows for targeted treatment of localized inflammatory conditions, resulting in improved patient outcomes.

Pharmacokinetics

Flumethasone is absorbed following topical application, with its effects being localized due to its ester form. It is bound in circulation primarily to plasma transcortin, but becomes active when unbound. The distribution, metabolism, and excretion details specific to flumethasone are not extensively documented, but general corticosteroid pharmacokinetics suggest hepatic metabolism and renal excretion as key processes in its clearance from the body.

Contra-indications

• Systemic fungal infections
• Hypersensitivity to flumethasone or any of its components
• Active untreated infections
• Peptic ulcer disease

Adverse effects

• Weight gain
• Hypertension
• Hyperglycemia
• Osteoporosis
• Adrenal suppression
• Cushing's syndrome
• Mood changes
• Increased susceptibility to infections

Interactions

• Non-steroidal anti-inflammatory drugs (NSAIDs) may increase gastrointestinal side effects
• Anticoagulants may have altered effects
• Live vaccines may be less effective in patients receiving corticosteroids

Precautions

• Use with caution in patients with a history of tuberculosis
• Monitor for signs of infection
• Long-term use may require tapering to avoid adrenal insufficiency
• Caution in patients with diabetes or hypertension

Pregnancy

Flumethasone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is categorized as a Category C drug.

Breast-feeding

Caution is advised when administering flumethasone to breastfeeding mothers as it is excreted in breast milk.

Storage

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

Formulations

• Topical cream
• Topical ointment
• Injectable solution

Indications

• Topical bacterial skin infections
• Fungal skin infections
• Dermatitis
• Infected eczema

Dosage

Children: Refer to the BNF for Children for specific pediatric dosing recommendations.

Adults: Apply to the affected area as directed by a healthcare professional. Refer to the BNF for specific dosing guidance.

Mechanism of action

Clioquinol is bacteriostatic, however, the precise mechanism of its action is unknown.

Pharmacodynamics

Clioquinol is a broad-spectrum antibacterial with antifungal properties. Application of clioquinol to extensive or eroded areas of the skin may lead to increased protein-bound iodine (PBI) levels within 1 week. Elevated PBI levels may also occur when relatively small areas of the skin are treated with clioquinol for more than 1 week.

Pharmacokinetics

The pharmacokinetics of clioquinol is not well-documented, but it is known that topical application can lead to absorption through the skin, particularly in compromised skin conditions. The systemic absorption may result in increased levels of protein-bound iodine.

Pregnancy

The safety of clioquinol during pregnancy has not been established. It should be used only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Clioquinol is excreted in breast milk. Caution should be exercised when administering to nursing mothers.

Storage

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

Formulations

• Topical cream
• Topical ointment

Mechanism of action

Flumethasone is a glucocorticoid receptor agonist. This complex binds to the nucleus causing a variety of genetic activation and repressions. The antiinflammatory actions of corticosteroids are thought to involve lipocortins, phospholipase A2 inhibitory proteins which, through inhibition arachidonic acid, control the biosynthesis of prostaglandins and leukotrienes. The immune system is suppressed by corticosteroids due to a decrease in the function of the lymphatic system, a reduction in immunoglobulin and complement concentrations, the precipitation of lymphocytopenia, and interference with antigen-antibody binding. Flumethasone binds to plasma transcortin, and it becomes active when it is not bound to transcortin.

Pharmacodynamics

Flumethasone pivalate is a moderately potent difluorinated corticosteroid ester with anti-inflammatory, antipruritic and vasoconstrictive properties. As it is a privalate salt, its anti-inflammatory action is concentrated at the site of application. This local effect on diseased areas results in a prompt decrease in inflammation, exudation and itching.

Mechanism of action

Clioquinol is bacteriostatic, however, the precise mechanism of its action is unknown.

Pharmacodynamics

Clioquinol is a broad-spectrum antibacterial with antifungal properties. Application of clioquinol to extensive or eroded areas of the skin may lead to increased protein-bound iodine (PBI) levels within 1 week. In addition, elevated PBI levels may occur when relatively small areas of the skin are treated with clioquinol for more than 1 week.