LOCACORTEN VIOFORM EAR DROPS

Indications

• Bacterial skin infections
• Fungal skin infections
• Topical antiseptic for minor cuts and abrasions

Dosage

Children: Refer to the BNF for Children for appropriate dosing guidelines in paediatric patients.

Adults: For topical use, apply clioquinol to the affected area as directed by a healthcare professional. Refer to specific prescribing information for detailed dosage instructions.

Mechanism of action

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

Pharmacodynamics

Clioquinol exhibits broad-spectrum antibacterial and antifungal properties. Its application to extensive or eroded areas of the skin can lead to increased protein-bound iodine (PBI) levels within 1 week. Continued treatment on smaller areas beyond 1 week may also result in elevated PBI levels.

Pharmacokinetics

The pharmacokinetics of clioquinol are not extensively characterized; however, it is generally absorbed through the skin when applied topically. Systemic absorption may lead to elevated iodine levels in the body, particularly with prolonged use.

Contra-indications

• Hypersensitivity to clioquinol or any of its components
• History of subacute myelo-optic neuropathy
• Thyroid disease or dysfunction

Adverse effects

• Skin irritation
• Allergic contact dermatitis
• Nausea
• Vomiting
• Diarrhea
• Thyroid dysfunction
• Peripheral neuropathy

Interactions

• May interact with medications affecting thyroid function
• Increased risk of adverse effects if used with other neurotoxic agents

Precautions

• Use with caution in patients with impaired thyroid function
• Monitor thyroid function during prolonged use
• Avoid application to large areas of broken skin

Pregnancy

Clioquinol should only be used in pregnancy if the potential benefit justifies the potential risk to the fetus, as safety has not been established.

Breast-feeding

Clioquinol should be used with caution during breastfeeding, as it is unknown if it is excreted in human milk.

Storage

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

Formulations

• Topical ointment
• Topical cream

Indications

• Inflammatory skin conditions
• Eczema
• Dermatitis
• Psoriasis
• Allergic skin reactions

Dosage

Children: Refer to the BNF for Children; pediatric dosing varies based on age, weight, and condition.

Adults: Refer to the specific product guidelines; doses vary based on formulation and condition treated.

Mechanism of action

Flumethasone is a glucocorticoid receptor agonist. The drug binds to the glucocorticoid receptor, and this complex translocates to the nucleus where it regulates gene expression. This results in the activation and repression of specific genes involved in inflammation and immune response. The anti-inflammatory effects are mediated by the induction of lipocortins, which inhibit phospholipase A2 and subsequently reduce the synthesis of pro-inflammatory mediators such as prostaglandins and leukotrienes. Additionally, flumethasone suppresses immune function through a decrease in lymphocyte activity and the modulation of immunoglobulin levels.

Pharmacodynamics

Flumethasone pivalate exhibits moderate potency as a difluorinated corticosteroid ester. Its anti-inflammatory action is concentrated at the site of application, providing targeted relief from inflammation, exudation, and itching. The drug's vasoconstrictive properties help to reduce redness and swelling in affected areas.

Pharmacokinetics

Flumethasone is typically absorbed through the skin when applied topically. It binds to plasma transcortin, with the active form of the drug being unbound. The pharmacokinetics of flumethasone can vary based on the formulation and site of application, but its localized effect minimizes systemic absorption and related side effects.

Adverse effects

• Skin atrophy
• Striae
• Telangiectasia
• Systemic effects with prolonged use
• Hypopigmentation
• Secondary infections

Interactions

• May enhance the effects of other immunosuppressive agents
• Potential interactions with CYP3A4 inhibitors and inducers

Precautions

• Use with caution in patients with a history of tuberculosis or viral infections
• Monitor for signs of systemic absorption with extensive use or occlusive dressings

Pregnancy

Flumethasone should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Caution is advised.

Breast-feeding

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

Storage

Store at room temperature, away from light and moisture. Do not freeze.

Formulations

• Cream
• Ointment
• Solution

Indications

• Used in drug formulation to enhance solubility
• Metabolic intermediate in lipid metabolism
• Potential use in the synthesis of coenzymes

Dosage

Children: Refer to specific product information or clinical guidelines as dosing may vary depending on the formulation and indication.

Adults: Refer to specific product information or clinical guidelines as dosing may vary depending on the formulation and indication.

Mechanism of action

Pivalate functions as a prodrug in certain contexts, where it is metabolized to release active components. It plays a role in the metabolism of lipids and is involved in the synthesis of certain coenzymes. The specific metabolic pathways include its conversion into pivaloyl-CoA, which participates in fatty acid metabolism.

Pharmacodynamics

Pivalate exhibits its pharmacological effects through its role in metabolic pathways. It can influence energy metabolism and fatty acid synthesis, although its specific pharmacodynamic properties may vary based on the context in which it is used, particularly in combination with other medications.

Pharmacokinetics

Pivalate is absorbed through the gastrointestinal tract and undergoes hepatic metabolism. Its elimination half-life and excretion pathways depend on the specific formulation and context of use. Generally, it is metabolized in the liver, with its metabolites being eliminated primarily through urine.

Pregnancy

There are no established safety data for pivalate in pregnancy. Caution is advised.

Breast-feeding

Limited information available. Caution is advised when administering to breastfeeding mothers.

Storage

Store in a cool, dry place, protected from light.

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.

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.