Topical products - Miscellaneous agents

Alitretinoin (Panretin ® )

Dosing: Initially: apply twice a day to cutaneous Kaposi's sarcoma lesions. The application frequency can be gradually increased to three or four times daily according to individual lesion tolerance. Supplied: [Gel 0.1%]

Becaplermin (Regranex ®)

Platelet derived growth factor for topical treatment of lower extremity diabetic neuropathic ulcers that extend into or beyond the subcutaneous tissue and have an adequate blood supply.

Dosing: Diabetic ulcers: Apply appropriate amount of gel once daily with a cotton swab or similar tool, as a coating over the ulcer. [0.01% gel]

Note: If the ulcer does not decrease in size by ~30% after 10 weeks of treatment or complete healing has not occurred in 20 weeks, continued treatment with becaplermin gel should be reassessed.

Use: Debridement adjunct for the treatment of diabetic ulcers that occur on the lower limbs and feet.
MOA: Recombinant B-isoform homodimer of human platelet-derived growth factor (rPDGF-BB) which enhances formation of new granulation tissue, induces fibroblast proliferation and differentiation to promote wound healing.

Calamine:

Dosing: Apply lotion 3 to 4 times daily as needed.

Capsaicin (ArthriCare®, Zostrix ®)

Use: Topical treatment of pain associated with postherpetic neuralgia, rheumatoid arthritis, osteoarthritis, diabetic neuropathy; postsurgical pain:

Dosing (Adults): Treatment of pain: Topical: Apply to affected area at least 3-4 times/day; application frequency less than 3-4 times/day prevents the total depletion, inhibition of synthesis, and transport of substance-P resulting in decreased clinical efficacy and increased local discomfort.

Admin: Wear gloves to apply; wash hands with soap and water after applying to avoid spreading to eyes or other sensitive areas of the body.

Supplied:
[Topical cream: 0.025% and HP: 0.075%]
[Topical gel: Capsagel®: 0.025% (60 g); 0.05% (60 g); 0.075% (30 g).]

Doxepin (Zonalon ®)

Dosing: Pruritus: apply four times daily for up to 8 days [5% cream]

EMLA ® (lidocaine/prilocaine)

Dosing: Topical anesthesia: apply 2.5g cream or 1 disc to region at least 1 hour before procedure. Cover cream with occlusive dressing.

fluorouracil (Efudex ®)

Dosing: Actinic keratoses: apply twice daily x 2-6 weeks.
Superficial basal cell carcinomas: apply 5% cream/solution twice daily.
Supplied:[1 & 5% cream. 1,2 & 5% solution]

Masoprocol (Actinex ®)

Dosing: Actinic keratoses: apply twice daily.
Supplied:[10% cream]

Pimecrolimus (Elidel ®)

Indication: short-term and intermittent long-term therapy in the treatment of mild to moderate atopic dermatitis in non-immunocompromised patients 2 years of age and older, in whom the use of alternative, conventional therapies is deemed inadvisable because of potential risks, or in the treatment of patients who are not adequately responsive to or intolerant of alternative, conventional therapies .

Dosing:
Directions: Apply a thin layer to the affected skin twice daily and rub in gently and completely. Elidel may be used on all skin surfaces, including the head, neck, and intertriginous areas. Elidel should be used twice daily for as long as signs and symptoms persist. Treatment should be discontinued if resolution of disease occurs. If symptoms persist beyond 6 weeks, the patient should be re-evaluated. Should not be used with occlusive dressings.

Selenium sulfide (Selsun ® )

Dosing: Dandruff, seborrheic dermatitis: apply 5-10 ml lotion/shampoo twice weekly x 2 weeks then less frequently thereafter. Tinea versicolor: apply 2.5% lotion/shampoo once daily x 7 days.

Tacrolimus (Protopic ®)

Immunosuppressant.
Indication: short-term and intermittent long-term therapy in the treatment of patients with moderate to severe atopic dermatitis in whom the use of alternative, conventional therapies are deemed inadvisable because of potential risks, or in the treatment of patients who are not adequately responsive to or are intolerant of alternative, conventional therapies.

Directions (adults): (Oint 0.03% and 0.1%) - Apply a thin layer to the affected skin areas twice daily and rub in gently and completely. Treatment should be continued for one week after clearing of signs and symptoms of atopic dermatitis.

Supplied: Ointment (0.03% and 0.1% for adults, and only 0.03% for children aged 2 to 15 years).

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David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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