Indications

Luliconazole cream is indicated for the topical treatment of interdigital tinea pedis, tinea cruris and tinea corporis caused by the organisms Trichophyton rubrum and Epidermophyton floccosum.

Pharmacology

Luliconazole is a topical antifungal agent. It is a broad-spectrum antifungal agent that belongs to the azole group. It acts against fungus by inhibiting the enzyme lanosterol demethylase and blocks ergosterol synthesis which is an important constituent of fungal cell membrane. Thus it exerts strong fungicidal activity both in-vitro and in-vivo against dermatophytes, Candida albicans, Malassezia spp, Trichophyton and Epidermophyton spp.

Dosage & Administration

Adult & Geriatric:

• Interdigital tinea pedis: Luliconazole cream should be applied to the affected area and approximately 1 inch of the immediate surrounding area(s) once daily for two weeks.

• Tinea cruris and Tinea corporis: Luliconazole cream should be applied to the affected area and approximately 1 inch of the immediate surrounding area(s) once daily for one week.

Pediatric: Safety and effectiveness have not been established.

Contraindications

Luliconazole cream is contraindicated in patients with a history of hypersensitivity to Luliconazole.

Side Effects

Contact dermatitis and cellulitis may occur. Application site reactions were observed in iess than 1% of subjects in clinical trial.

Pregnancy & Lactation

There are no adequate and well-controlled studies of Luliconazole cream in pregnant women. Luliconazole cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Luliconazole is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Luliconazole cream is applied to women who are breastfeeding.

Precautions & Warnings

If there is any unusual allergic reaction with the use of Luliconazole, then treatment should be discontinued and appropriate therapy should be instituted. Luliconazole is recommended for topical use only. It is not intended for ophthalmic, oral or intravaginal use.

Therapeutic Class

Miscellaneous topical agents

Adult Dose

Corticosteroid-responsive Dermatoses
Cream: Apply thin layer to affected areas q12hr and rub in gently and completely; not to exceed 50 g/week

Scalp Psoriasis
Shampoo: Apply thin film to dry scalp qDay; leave in place for 15 min; add water, lather, and then rinse thoroughly

Moderate to Severe Plaque-type Psoriasis
Cream/lotion: Apply to affected area in scalp q12hr for up to 2 weeks if area is less than 10% of the body surface area; not to exceed 50 g/week

Child Dose

<12 years
Safety & efficacy not established

>12 years
Corticosteroid-responsive Dermatoses
Cream: Apply thin layer to affected areas q12hr and rub in gently and completely; not to exceed 50 g/week

Scalp Psoriasis
Shampoo: Apply thin film to dry scalp qDay; leave in place for 15 min; add water, lather, and then rinse thoroughly

Moderate to Severe Plaque-type Psoriasis
Cream/lotion: Apply to affected area in scalp q12hr for up to 2 weeks if area is less than 10% of the body surface area; not to exceed 50 g/week

Renal Dose

Administration

indication

Corticosteroid-responsive Dermatoses, Psoriasis, Scalp Psoriasis, Plaque-type Psoriasis, Vitiligo, Eczema, Alopecia areata, Herpes labialis, Lichen sclerosus, Lichen, Mycosis fungoides, Corticosteroid-responsive dermatoses

Contraindication

Childn <12 yrs. Long-term treatment of ulcerative conditions, rosacea, pruritus; It is contraindicated in rosacea, acne vulgaris, perioral dermatitis, primary cutaneous viral infections (eg. herpes simplex, chickenpox), otitis externa with a perforated eardrum, hypersensitivity to the preparations. Scalp application is contraindicated in infection of the scalp.

Side Effects

Perioral dermatitis, striae esp in flexures. Dermal and epidermal atrophy esp on the face, steroid purpura. Burning, Cracking/fissuring of the skin, Erythema, Folliculitis, Irritation, Numbness, Pruritus, Stinging, Hypopigmentation (high potency topical steroids)

Potentially Fatal: Prolonged usage of large amount of clobetasol propionate can lead to sufficient systemic levels to produce adrenal suppression, Cushing's syndrome, diabetes and hypertension.

Theraputic Class

Clobetasol/Clobetasone & Combined Preparations

Pregnency Category

Category: Not Classified
pregnancy_description

Mode of Action

Clobetasol is a very potent corticosteroid used in short-term treatment of various inflammatory skin conditions. Corticosteroids decrease inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes; inhibiting macrophage accumulation in inflamed areas; reducing leukocyte adhesion to capillary endothelium; reducing capillary wall permeability and edema formation; decreasing complement components; antagonizing histamine activity and release of kinin from substrates; and reducing fibroblast proliferation, collagen deposition, and subsequent scar tissue formation.

Interaction

Increased systemic exposure w/ CYP3A4 inhibitors (eg ritonavir & itraconazole).

Pack And Size

Per Unit Price: Tk. 45.13
Package: 10gm tube

Indications

Indicated in acne vulgaris.

Pharmacology

Clindamycin is a semi-synthetic derivative of lincomycin. It inhibits bacterial protein synthesis by reversibly binding to the 50S ribosomal subunits thus blocking the transpeptidation or translocation reactions of susceptible organisms.

Benzoyl peroxide has mild keratolytic effect and antimicrobial activity which is attributed to its potent oxidizing activity. Clindamycin and Benzoyl peroxide are both active against Propionibacterium acnes, an organism associated with acne vulgaris.

Dosage & Administration

Apply to the affected areas once or twice daily (morning and evening) after the skin is gently washed and p

Interaction

May enhance the action of neuromuscular blocking agents (e.g. atracurium). May antagonise the effects of parasympathomimetics. May competitively inhibit the effects of macrolides, ketolides, streptogramins, linezolid and chloramphenicol. Increased coagulation tests (prothrombin time/INR) and/or bleeding with vit K antagonists (e.g. warfarin, acenocoumarol, fluindione). PABA sunscreens may transiently discolour fabric.

Contraindications

Hypersensitivity to Clindamycin, lincomycin, benzoyl peroxide, or any component of the formulation; history of regional enteritis, ulcerative colitis, pseudomembranous colitis or antibiotic-associated colitis.

Side Effects

Application site pain, Application site exfoliation, Application site irritation, Erythema, Burning, Pruritus, Sunburn, Scaling, Drynes, Colitis, Peelin.

Pregnancy & Lactation

Pregnancy Category- C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

Lactation: Excretion in milk is unknown/ not recommended

Precautions & Warnings

Avoid contact with mouth, eyes, lips & mucous membranes; abraded or eczematous skin. May discolor hair & dyed fabrics. Pregnancy & lactation.

Therapeutic Class

Benzoyl peroxide, Azelaic acid & other preparations

Reconstitution

Refer to individual product recommendations. Some combination products require reconstitution at the time of dispensing by dissolving the Clindamycin powder with purified water, add the solution to the Benzoyl peroxide gel provided and stir until the gel appears homogenous.

Price :

20mg tube 350 tk

Indications

Clindamycin and Tretinoin gel is indicated for the topical treatment of Acne vulgaris.

Pharmacology

This is a combination of lincosamide antibiotic Clindamycin phosphate and retinoid Tretinoin. Clindamycin binds with the 50s ribosomal subunit of susceptible bacteria and prevents elongation of peptide chain by interfering with the peptidyl transfer, thereby suppressing bacterial protein synthesis. Clindamycin inhibits the activity of Propionibacterium acne as reduces the occurrence of acne. Tretinoin decreases the cohesiveness of follicular epithelial cells and increases the turn over thereby brings the comedones out.

Dosage & Administration

Before sleep: Wash the face gently with a mild soap and water, then pat the skin dry. Apply the Gel with finger tips through the face gently.

In the morning: Apply a sunscreen after the application of Gel. Do not wash your face more than 2 or 3 times a day. Apply the sunscreen cream as needed.

Safety and effectiveness in children below 12 years of age have not been established.

Interaction

• Concomitant use of other potentially irritating topical products (medicated or abrasive soaps and cleansers, soaps and cosmetics that have a strong drying effect, products with high concentrations of alcohol, astringents, spices or lime) should be approached with caution.

• While using concomitantly with Erythromycin, the activity of both Clindamycin and Erythromycin are decreased. So, Clindamycin should not be used with Erythromycin concomitantly.

• While using concomitantly with neuromuscular medicine, the activity of the neuromuscular medicine is increased. So, care should be taken during these concomitant uses.

Contraindications

Clindamycin and Tretinoin should not be administered to individuals who are hypersensitive to Clindamycin or Tretinoin or any other component of the Gel.

Side Effects

Erythema, scaling, nasopharyngitis, dry skin, cough, sinusitis and diarrhea are the common side effects.

Pregnancy & Lactation

It is not known whether Clindamycin or Tretinoin is excreted in human milk. Exercise special caution while applying Clindamycin or Tretinoin to a nursing mother.

Precautions & Warnings

Clindamycin and Tretinoin should not be applied to eyes, nose, ear, lips, cut, burn and other infections. After the application of the Gel, keep away from sunlight.

Therapeutic Class

Topical antibiotic & retinoid preparations

Storage Conditions

Keep below 25°C temperature, away from light & moisture. Keep out of the reach of children.

Price :

10gm 120 tk

15gm 150 tk

Indications

Topical therapy for the treatment of acne vulgaris.

Pharmacology

Benzoyl peroxide has mild keratolytic effect and antimicrobial activity due to release of free-radical oxygen which oxidizes bacterial protein. It is active against Staphylococcus epidermidis and Propionibacterium acnes.

Dosage & Administration

Adult: As 2.5-10% preparation: Apply 1-2 times daily after cleansing, may gradually increase to tid if needed. Start with lower strength preparations. As cleanser: Wash 1-2 times daily.
Child: ≥12 yr Same as adult dose.

Interaction

There is no known interaction with other medications which might be used cutaneously and concurrently with Benzoyl Peroxide; however, drugs with desquamative, irritant and drying effects should not be used concurrently with Benzoyl Peroxide gel.

Contraindications

Benzoyl Peroxide gel is contra-indicated in patients with known hypersensitivity to Benzoyl Peroxide.

Side Effects

The major adverse reaction reported to date with Benzoyl Peroxide cutaneous therapy is irritation of the skin including erythema, burning, peeling, dryness, itching, stinging, feeling of skin tension locally at the site of application. This is reversible when treatment is reduced in frequency or discontinued. Allergic contact dermatitis, including face oedema, may occur.

Pregnancy & Lactation

Pregnancy Category C. Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.

Precautions & Warnings

Children, Pregnancy and lactation.

Overdose Effects

Benzoyl Peroxide gel is a preparation indicated for topical treatment only. If the medication is applied excessively, no more rapid or better results will be obtained and severe irritation might develop. In this event, treatment must be discontinued and appropriate symptomatic therapy should be instituted.

Therapeutic Class

Acne treatment preparations

Storage Conditions

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

Price:

50mg 400tk

Indications

For topical application in the treatment of acne vulgaris in which comedones, papules and pustules predominate.

Pharmacology

Although the exact mode of action of Tretinoin is unknown, current evidence suggests that topical Tretinoin decreases cohesiveness of follicular epithelial cells with decreased microcomedo formation. Additionally Tretinoin stimulates mitotic activity and increases turnover of follicular epithelial cells, causing extrusion of the comedones, papules and pustules.

Dosage & Administration

This cream should be applied sparingly to the whole affected area once or twice daily. The skin should be thoroughly cleaned and dried before application. Patient should be advised that 6 to 8 weeks of treatment may be required before a therapeutic effect is observed. Moisturizers and cosmetics may be used during treatment with Tretinoin cream but should not be applied to the skin at the same time. Astringent toiletries should b

Interaction

Other topical acne treatments should be used with caution during treatment with Tretinoin. Particular caution should be exercised when using preparation containing a peeling agent for example benzoyl peroxide. It is also possible to apply Tretinoin and benzoyl peroxide alternately. The suggested regimens are either Tretinoin in the morning and benzoyl peroxide in the evening or the preparations should be used on alternate days.

Contraindications

Tretinoin is contraindicated to those who are highly sensitive to any of the ingredients. This cream should not be used in patients with a personal or family history of cutaneous epithelioma (skin cancer).

Side Effects

Initial external application of Tretinoin generally may cause burning or slight irritation, erythema and peeling at the site of application may also occur. If irritation becomes severe and persists, discontinue application and consult your physicians, if necessary.

Pregnancy & Lactation

There is an inadequate evidence of the safety of topically applied Tretinoin in human pregnancy. Tretinoin has been associated with teratogenicity in human when administered systemically. So the cream should not be used during pregnancy and lactation.

Precautions & Warnings

Avoid contact of Tretinoin with lips, mouth, eyes, eyelids, nostrils or another mucous membrane. If contact in these areas occurs, careful washing with water is recommended. Apply the cream to sensitive areas of skin, such as the neck, with caution. Do not use it on broken, eczematous or sun burned skin.

Therapeutic Class

Topical retinoid and related preparations

Price :

15 mg -65 tk

30 mg -100 tk

Indications

Post-traumatic osteoarthritis, synovitis of osteoarthritis, rheumatoid arthritis, acute and sub-acute bursitis, epicondylitis, acute non-specific tenosynovitis, acute gouty arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, pemphigus, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, bullous dermatitis herpetiformis, severe seborrheic dermatitis, severe psoriasis, bronchial asthma, contact dermatitis, atopic dermatitis, seasonal or perennial allergic rhinitis.

Pharmacology

The antiinflammatory actions of corticosteroids are thought to involve lipocortins, phospholipase A2 inhibitory proteins which, through inhibition of arachidonic acid, control the biosynthesis of prostaglandins and leukotrienes. Firstly, however, these glucocorticoids bind to the glucocorticoid receptors which translocate into the nucleus and bind DNA (GRE) and change genetic expression both positively and negatively. 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.

Dosage & Administration

Adults and children over 12 years of age: Initial dose is 60 mg. Dosage is usually adjusted within the range of 40 to 80 mg. For local areas, dose for adults is up to 10 mg for smaller areas and up to 40 mg for larger areas.

Children 6 to 12 years: Initial dose is 40 mg

Interaction

Aminoglutethimide: Aminoglutethimide may lead to a loss of corticosteroid-induced adrenal suppression. 

Amphotericin B injection and potassium-depleting agents: When corticosteroids are administered concomitantly with potassium-depleting agents (ie, amphotericin B, diuretics), patients should be observed closely for development of hypokalemia. There have been cases reported in which concomitant use of amphotericin B and hydrocortisone was followed by cardiac enlargement and congestive heart failure. 

Antibiotics: Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance. 

Anticholinesterases: Concomitant use of anticholinesterase agents and corticosteroids may produce severe weakness in patients with myasthenia gravis. If possible, anticholinesterase agents should be withdrawn at least 24 hours before initiating corticosteroid therapy.
 
Anticoagulants, oral: Coadministration of corticosteroids and warfarin usually results in inhibition of response to warfarin, although there have been some conflicting reports. Therefore, coagulation indices should be monitored frequently to maintain the desired anticoagulant effect.
 
Antidiabetics: Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. 

Antitubercular drugs: Serum concentrations of isoniazid may be decreased. 

Cholestyramine: Cholestyramine may increase the clearance of corticosteroids. 

Cyclosporine: Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. Convulsions have been reported with this concurrent use. 

Digitalis glycosides: Patients on digitalis glycosides may be at increased risk of arrhythmias due to hypokalemia. 
Estrogens, including oral contraceptives: Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect. 

Hepatic enzyme inducers (eg, barbiturates, phenytoin, carbamazepine, rifampin): Drugs which induce hepatic microsomal drug metabolizing enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased. 

Ketoconazole: Ketoconazole has been reported to decrease the metabolism of certain corticosteroids by up to 60%, leading to an increased risk of corticosteroid side effects. 

Nonsteroidal anti-inflammatory drugs (NSAIDs): Concomitant use of aspirin (or other nonsteroidal anti-inflammatory drugs) and corticosteroids increases the risk of gastrointestinal side effects. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. The clearance of salicylates may be increased with concurrent use of corticosteroids. 

Skin tests: Corticosteroids may suppress reactions to skin tests. 

Vaccines: Patients on prolonged corticosteroid therapy may exhibit a diminished response to toxoids and live or inactivated vaccines due to inhibition of antibody response. Corticosteroids may also potentiate the replication of some organisms contained in live attenuated vaccines. Routine administration of vaccines or toxoids should be deferred until corticosteroid therapy is discontinued if possible.

Contraindications

Triamcinolone Acetonide injection is contraindicated in patients with a sensitivity to the active or inactive ingredients.

Side Effects

Cushingoid syndrome, weakness, bruising or purpura, aggravation of infections, peptic ulcer, activation of latent or aggravation of existing diabetes, altered menstrual cycle, hirsutism.

Pregnancy & Lactation

Triamcinolone Acetonide injection should be used during pregnancy, nursing mothers if the possible benefits of the medication justify the potential hazards to the fetus or nursing infant.

Precautions & Warnings

Triamcinolone Acetonide injection should be used cautiously in patients with ocular herpes simplex, nonspecific ulcerative colitis, active or latent peptic ulcer, renal insufficiency, hypertension, osteoporosis, Cushing's syndrome, diabetes mellitus, congestive heart failure, chronic nephritis.

Use in Special Populations

Use in the elderly: The common adverse effects of systemic corticosteroids such as osteoporosis or hypertension may be associated with more serious consequences in old age. Close clinical supervision is recommended.

Use in children: As corticosteroids can suppress growth, the development of infants and children on prolonged corticosteroid therapy should be carefully observed. Caution should be taken in the event of exposure to chicken pox, measles or other communicable diseases. Children should not be vaccinated or immunized while on corticosteroid therapy. Corticosteroids may also affect endogenous steroid production.

Overdose Effects

Treatment of acute overdosage is by supportive and symptomatic therapy. For chronic overdosage in the face of severe disease requiring continuous steroid therapy, the dosage of the corticosteroid may be reduced only temporarily, or alternate day treatment may be introduced.

Therapeutic Class

Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations

Price:

Indications

This is indicated for steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where superficial bacterial ocular infection or a risk of bacterial ocular infection exists. Ocular steroids are indicated in inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis. It is also indicated in chronic anterior uveitis and corneal injury from chemical, radiation or thermal burns, or penetration of foreign bodies. This is also indicated for the treatment of post-operative inflammation following ocular surgery.

Pharmacology

Loteprednol is a corticosteroid which is thought to act by the induction of phospholipase A2 inhibitory proteins, which control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor arachidonic acid.

Tobramycin is a member of aminoglycoside which shows bactericidal activity by inhibiting protein synthesis of bacteria.

Dosage & Administration

Shake well before use. Apply one drop into the conjunctival sac of the affected eye(s) every four to six hours. During the initial 24 to 48 hours, the dosing may be increased, to every one to two hours.

Interaction

Since Loteprednol Etabonate is not detected in plasma following the topical administration, it is not expected to affect the pharmacokinetics of systemically administered medicinal products.

Contraindications

Contraindicated in most viral diseases of the cornea and conjunctiva. Also contraindicated in individuals with known or suspected hypersensitivity to any of the ingredients of this preparation and to other corticosteroids.

Side Effects

Increased intraocular pressure, burning and stinging upon instillation, vision disorders, discharge, itching, lacrimation disorder, photophobia, corneal deposits, ocular discomfort, eyelid disorder, and other unspecified eye disorders may occur. The incidence of non-ocular adverse events (headache) also reported.

Pregnancy & Lactation

Use in pregnancy: There are no adequate and well-controlled studies in pregnant women. Loteprednol Etabonate & Tobramycin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Use in lactation: Caution should be exercised when Loteprednol Etabonate & Tobramycin is administered to a nursing mother.

Precautions & Warnings

• For ophthalmic use only.

• If this product is used for 10 days or longer, intraocular pressure should be monitored.

• Fungal infections of the cornea are particularly prone to develop coincidentally with long-term use of steroid topically.

• Prolonged use may result in overgrowth of nonsusceptible organisms including fungi. If superinfection occurs, appropriate therapy should be initiated.

• Cross-sensitivity to other aminoglycoside antibiotics may occur.

Use in Special Populations

Use in children: Safety and effectiveness in pediatric patients have not been established.

Therapeutic Class

Ophthalmic steroid - antibiotic combined preparations

Indications

This Scalp preparation is used to treat inflammatory, dry and scaly skin disorders, such as Eczema, Psoriasis.

Pharmacology

Betamethasone Dipropionate is a glucocorticoid  with primarily anti-inflammatory and immunosuppressive effects and Salicylic Acid has keratolytic properties and is applied topically in the treatment of hyperkeratotic. Keratolytic action helps to facilitate the penetration of the corticosteroids easily and Betamethasone Dipropionate is an effective treatment of dermatoses because of their anti-inflammatory, antipruritic and vasoconstrictive actions.

Dosage & Administration

Scalp Ointment-

• Adults: Once twice daily. In most cases, the ointment should be applied to the affected area twice daily for two weeks and is reviewed at that time. The maximum weekly dose should not exceed 60 gm.

• Children: Dosage in children should be limited to 5 days.

Scalp Lotion-

• Apply few drops of this scalp lotion to the affected area and massage gently and thoroughly onto the scalp or skin. The usual frequency of application is twice daily, in the morning and at night.

Interaction

If other drugs or over-the-counter products use at the same time, this may increase the side effects or cause drug not to work properly. This Scalp preparation may interact with the following products such as Acetaminophen, Atropine, Carbonic anhydrase inhibitors, Chlorpropamide, Glucocorticoids.

Contraindications

Contraindicated to the hypersensitivity to any of the ingredients of this Scalp preparation. Also contraindicated to use in tuberculosis and most viral lesions of the skin, particularly herpes simplex, vacinia, varicella. This Scalp preparation should not be used in fungal or bacterial skin infections.

Side Effects

Side effects that have been reported with the application of topical corticosteroids include burning, itching, irritation, dryness, hypopigmentation, perioral dermatitis and allergic contact dermatitis.

Pregnancy & Lactation

It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus and should not be used for prolonged periods of time in pregnant patients. It is not known this drug is secreted in human milk.

Precautions & Warnings

These drugs should not be used in or near the eyes. This Scalp preparation should not be used in various skin infections (Bacterial, Viral or Fungal). If irritation and sensitization develop with the use of this Scalp preparation, treatment should be discontinued. Application of Salicylic Acid to open wounds or damaged skin should be avoided. Long-term continuous therapy should be avoided in all patients irrespective of age.

Therapeutic Class

Topical anti-inflammatory preparations

Storage Conditions

Store in a cool & dry place, protected from light and keep out of the reach of children.

Price: 30 ml bottle -150tk

Indications

6% Salicylic Acid: This topical preparations treat the following common scaly conditions:

• Chronic atopic dermatitis

• Lichen simplex

• Psoriasis 

• Seborrhoeic dermatitis

• Ichthiosis

12% Salicylic Acid: This topical preparations treat the following common scaly conditions:

• Warts (small excessive growths of skin caused by a type of virus. Warts often occur on the fingers or on the back of the hands).

• Verruca (occurs only on the sole of the feet and can be painful. It often looks like a small white ring of skin with a black dot in the centre).

• Corns and Calluses (are hard, thick pads of skin caused by pressure and friction. They usually occur on the feet due to poorly fitting shoes and can occur on the hands).

2% Salicylic Acid: This topical preparation is indicated in-

• Mild to moderate acne

• Blackheads and whiteheads

• Redness & swelling of face

• Pimples

• To prevent future acne breakouts

Description

Salicylic Acid is available by prescription only as a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae and the various ichthyoses (vulgaris, sex-linked and lamellar), keratosis palmaris and plantaris, keratosis pilaris, pityriasis rubra pilaris and psoriasis (including body, scalp, palms and soles).

Pharmacology

Salicylic Acid has a potent keratolytic & a slight antiseptic action when applied topically to the skin. In low concentrations, the drug has keratoplastic activity (correction of abnormal keratinization) & in higher concentrations, the drug has keratolytic activity (causes peeling of skin). Salicylic Acid softens & destroys the stratum corneum by increasing endogenous hydration (water concentration), probably because of decreased pH, which causes the cornified epithelium (horny layer of the skin) to swell, soften, & then desquamate. Necrosis of normal skin has been associated with overuse of the drug. At high concentrations, Salicylic Acid has a caustic effect. Moisture is essential for Salicylic Acid to exert its action on the skin and for maceration and desquamation of epidermal tissue to occur. The drug has weak antifungal & antibacterial activity.

Dosage & Administration

6% & 12% Salicylic Acid: Apply to affected area once daily. Hydrate area for 5 minutes prior to application if possible. Occlude the area at night. Wash off in morning. Salicylic Acid is used in children over 2 years.

2% Salicylic Acid: Apply enough medicine to cover the affected area once daily in 1st week then 2 to 3 times daily from 2nd week and rub gently. After 3-5 minutes rinse face with cool water. Salicylic Acid is used in children over 2 years.

Interaction

Do not use other topical preparations on the treated area unless otherwise directed by your healthcare provider. They may interfere with treatment or increase skin irritation.

Contraindications

It should not be used in any patient known to be sensitive to Salicylic Acid or any other listed ingredients.

Side Effects

An allergic reaction (shortness of breath, closing of the throat, swelling of the lips, face or tongue or hives) or severe skin irritation.

Pregnancy & Lactation

Pregnancy Category C. If used by nursing mothers, it should not be used on the chest area to avoid accidental contamination of the child.

Precautions & Warnings

For external use only. Avoid contact with eyes and other mucous membranes.

Overdose Effects

An overdose of Salicylic Acid topical is unlikely to occur. If the medication has been ingested or an overdose is suspected, the patient needs to be hospitalized immediately.

Therapeutic Class

Topical salicylic preparation

Storage Conditions

Do not store above 30°C. Keep away from light and out of the reach of children.

Price : 6% 30mg tube -65tk

12% 30 mg tube -110 tk

Indications

Imiquimod cream is indicated for the topical treatment of-

• External genital and perianal warts in adults.

• Small superficial basal cell carcinomas in adults.

• Clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp in immunocompetent adult patients when size or number of lesions limit the efficacy and/or acceptability of cryotherapy and other topical treatment options are contraindicated or less appropriate.

Pharmacology

Imiquimod is a toll-like receptor-7 agonist enhancing both the innate and acquired immune response. It activates the production of numerous compounds, including IFN-α, IL-1, -6, -8, -10, -12, and TNF-α, stimulates natural killer cells and the proliferation of B-cells. It also activates Langerhans cells and promotes their migration to the regional lymph nodes. Imiquimod stimulates TH-1 cells to produce IFN-g, which in turn can activate cytotoxic T lymphocytes. These cells provide long-term immune memory, which can offer future protection against the previously encountered virus or tumor.

Dosage & Administration

External genital warts in adults: Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday) prior to normal sleeping hours, and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until the clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts.

Imiquimod cream should be applied in a thin layer and rubbed on the clean wart area until the cream vanishes. Only apply to affected areas and avoid any application on internal surfaces. Imiquimod cream should be applied prior to normal sleeping hours. During the 6 to 10 hour treatment period, showering or bathing should be avoided. After this period it is essential that Imiquimod cream is removed with mild soap and water. Application of an excess of cream or prolonged contact with the skin may result in a severe application site reaction. A single use sachet is sufficient to cover a wart area of 20 cm2 (approx. 3 inches2). Sachets should not be re-used once opened. Hands should be washed carefully before and after application of cream. Uncircumcised males treating warts under the foreskin should retract the foreskin and wash the area daily.

Superficial basal cell carcinoma in adults: Apply Imiquimod cream for 6 weeks, 5 times per week (example: Monday to Friday) prior to normal sleeping hours, and leave on the skin for approximately 8 hours. Before applying Imiquimod cream, patients should wash the treatment area with mild soap and water and dry thoroughly. Sufficient cream should be applied to cover the treatment area, including one centimetre of skin surrounding the tumour. The cream should be rubbed into the treatment area until the cream vanishes. The cream should be applied prior to normal sleeping hours and remain on the skin for approximately 8 hours. During this period, showering and bathing should be avoided. After this period it is essential that Imiquimod cream is removed with mild soap and water. Sachets should not be re-used once opened. Hands should be washed carefully before and after application of cream. Response of the treated tumour to Imiquimod cream should be assessed 12 weeks after the end of treatment. If the treated tumour shows an incomplete response, a different therapy should be used. A rest period of several days may be taken if the local skin reaction to Imiquimod cream causes excessive discomfort to the patient, or if infection is observed at the treatment site. In this latter case, appropriate other measures should be taken.

Actinic keratosis in adults: Treatment should be initiated and monitored by a physician. Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday and Friday) for four weeks prior to normal sleeping hours, and left on the skin for approximately 8 hours. Sufficient cream should be applied to cover the treatment area. After a 4-week treatment-free period, clearance of Actinic Keratosis should be assessed. If any lesions persist, treatment should be repeated for another four weeks. An interruption of dosing should be considered if intense local inflammatory reactions occur or if infection is observed at the treatment site. In this latter case, appropriate other measures should be taken. Each treatment period should not be extended beyond 4 weeks due to missed doses or rest periods. If the treated area does not show complete clearance at a follow-up examination about 8 weeks after the last 4-weeks course of treatment, an additional 4-weeks course of Imiquimod treatment may be considered. A different therapy is recommended if the treated lesion(s) shows insufficient response to Imiquimod. Actinic keratosis lesions that have cleared after one or two courses of treatment and subsequently recur can be re-treated with one or two further courses of Imiquimod cream following an at least 12 weeks treatment pause. Before applying Imiquimod cream, patients should wash the treatment area with mild soap and water and dry thoroughly. Sufficient cream should be applied to cover the treatment area, including one centimetre of skin surrounding the tumour. The cream should be rubbed into the treatment area until the cream vanishes. The cream should be applied prior to normal sleeping hours and remain on the skin for approximately 8 hours. During this period, showering and bathing should be avoided. After this period it is essential that Imiquimod cream is removed with mild soap and water. Sachets should not be re-used once opened. Hands should be washed carefully before and after application of cream.

Information applicable to all indications: If a dose is missed, the patient should apply the cream as soon as he/she remember and then he/she should continue with the regular schedule. However the cream should not be applied more than once a day

Interaction

No interaction studies have been performed. This includes studies with immunosuppressive drugs. Interactions with systemic drugs would be limited by the minimal percutaneous absorption of Imiquimod cream. Due to its immunostimulating properties, Imiquimod cream should be used with caution in patients who are receiving immunosuppressive medication.

Contraindications

Imiquimod cream is contraindicated in patients with hypersensitivity to imiquimod or cream excipients.

Side Effects

Reported side effects are pustules, genital candidiasis, vaginitis, bacterial infection, fungal infection, upper respiratory tract infection, vulvitis, rhinitis, influenza, lymphadenopathy, anorexia, insomnia, depression, irritability, headache, paraesthesia, dizziness, migraine, somnolence, conjunctival irritation, eyelid oedema, tinnitus, flushing, pharyngitis, nasal congestion, pharyngo laryngeal pain, nausea, abdominal pain, diarrhoea, vomitting, rectal disorder, rectal tenesmus, dry mouth, pruritus, folliculitis, rash erythematous, eczema, rash, increased sweating, urticaria, erythema, face oedema, skin ulcer, myalgia, arthralgia, back pain, pain in extremity, dysuria, genital pain in male, penile disorder, dyspareunia, erectile dysfunction, uterovaginal prolapse, vaginal pain, vaginitis atrophic, vulval disorder, and general disorders and administration site disorders such as pruritus, pain, burning, irritation, erythema, reaction, bleeding, papules, rash, inflammation asthenia, malaise, rigors, lethargy, discomfort, fatigue, discharge, oedema, scar, ulcer, vesicle, warmth, pyrexia etc. Reports have been received of localised hypopigmentation and hyperpigmentation following Imiquimod cream use. Clinical studies investigating the use of Imiquimod for the treatment of actinic keratosis have detected a 0.4% frequency of alopecia at the treatment site or surrounding area. Reductions in haemoglobin, white blood cell count, absolute neutrophils and platelets have been observed in clinical trials.

Pregnancy & Lactation

Use in Pregnancy B1. No human study is available. Imiquimod cream should only be used during pregnancy, if the potential benefit justifies the potential risk of fetus. No human study is available. Imiquimod cream should only be used during lactation if the potential benefit justifies the potential risk to the new-born baby.

Precautions & Warnings

Hypersensitivity to the active substance or to any of the excipients.

Use in Special Populations

Use in Children: Imiquimod cream is not recommended below the age of 12 years.
Use in Elderly: Imiquimod cream is recommended in elderly patient.
Effect on ability to drive and use machineries: Imiquimod cream is unlikely to produce any effect.

Overdose Effects

When applied topically, systemic overdosage with Imiquimod cream is unlikely due to minimal percutaneous absorption. Persistent dermal overdosing of Imiquimod cream could result in severe local skin reactions. Following accidental ingestion, nausea, emesis, headache, myalgia and fever could occur after a single dose of 200 mg Imiquimod which corresponds to the content of approximately 16 sachets. The most clinically serious adverse event reported following multiple oral doses of ≥ 200 mg was hypotension which resolved following oral or intravenous fluid administration.

Therapeutic Class

Immunosuppressant, Miscellaneous topical agents

Storage Conditions

Store in a cool & dry place, protected from light. Store at 4°-25°C.

 Price-10mg tube -275tk

Indications

Urea 10% cream is indicated for-

• Ichthyosis and dry skin conditions

• Management of eczemas

• Management of psoriasis

Pharmacology

Topical urea is bacteriostatic, bactericidal, fungistatic, proteolytic, hygroscopic and has mild local anesthetic properties. These actions are dose dependent. Most of its therapeutic applications depend on its hygroscopic properties. The hygroscopic property is due to its ability to cause configurational change in proteins in the stratum corneum. A 10% urea cream has been shown to increase the water holding capacity of ichthyotic scale by 100% after 3 weeks of treatment. There is no information available about percutaneous absorption of urea. Therapeutic effects depend on local concentrations, not on systemic absorption of the drug. If absorbed, urea would be excreted unchanged in the urine.

Dosage & Administration

Urea 10% cream is applied topically. Wash affected areas well, rinse off all traces of soap, dry and apply sparingly twice daily. Occlusive dressings may be used, but are usually unnecessary because of the self-occlusive nature of the cream.

Use in children: Urea 10% cream can be used in all age groups.

Interaction

No hazardous drug interaction has been reported.

Contraindications

This is contraindicated in any other ingredient of this preaparation.

Side Effects

No serious toxicity has been reported with topical urea. Historically it is considered a safe drug. But on some occasions, topical urea has been shown to cause burning and irritation, if applied to inflamed, broken or exudative skin eruptions.

Pregnancy & Lactation

Urea cream can be used during pregnancy and lactation.

Precautions & Warnings

In some instances, urea 10% cream may cause local irritation and edema, when applied to sensitive skin. If the condition is aggravated or there is no improvement the doctor should be consulted. Avoid application to moist or broken skin.

Therapeutic Class

Topical urea preparations

Storage Conditions

Keep out of the reach of children. Do not freeze. Keep at cool and dry place.

Price: 15 gm tube -30tk

Indications

Calcipotriol cream & ointment is indicated for the topical treatment of chronic stable plaque type psoriasis vulgaris in adult patients.

Pharmacology

Calcipotriol is a non-steroidal antipsoriatic agent, derived from vitamin D. Calcipotriol exhibits a vitamin D-like effect by competing for the 1,25(OH)2D3 receptor. Calcipotriol is as potent as 1,25(OH)2D3, the naturally occurring active form of vitamin D, in regulating cell proliferation and cell differentiation, but much less active than 1,25(OH)2D3 in its effect on calcium metabolism. Calcipotriol induces differentiation and suppresses proliferation (without any evidence of a cytotoxic effect) of keratinocytes, thus reversing the abnormal keratinocyte changes in psoriasis. The therapeutic goal envisaged with calcipotriol is thus a normalization of epidermal growth.

Dosage & Administration

Calcipotriol cream & ointment should be applied topically to the affected area twice daily (i.e. in the morning and in the evening). Less frequent application may be indicated after the initial period of treatment. After satisfactory improvement has occurred, treatment should be discontinued. If recurrence takes place after discontinuation, the treatment may be reinstituted. Experience is lacking in the use of calcipotriol for periods longer than 1 year. The maximum recommended weekly dose of calcipotriol cream is 100 gm/week.

Contraindications

Calcipotriol cream & ointment is contraindicated in those patients with a history of hypersensitivity to any of the components of the preparations. It is also contraindicated in patients with known disorders of calcium metabolism.

Side Effects

Photosensitivity reactions, skin discolouration, bullous eruption, skin exfoliation, contact dermatitis and allergic reactions have been reported with topical calcipotriol therapy.

Pregnancy & Lactation

Safety for use in pregnancy has not been established. Therefore calcipotriol should not be used during pregnancy unless benefits clearly outweigh the risks. It is not known whether calcipotriol is excreted in breast milk, therefore, the drug should be used during lactation only if the benefits clearly outweigh the risks. Calcipotriol should not be applied to the chest area during breast feeding to avoid possible ingestion by infants.

Precautions & Warnings

Calcipotriol cream & ointment is not recommended for use in patients with generalized pustular psoriasis, guttate psoriasis and erythrodermic exfoliate psoriasis. Calcipotriol cream & ointment is not recommended for use on the face.

Use in Special Populations

Calcipotriol cream & ointment should not be used in children, as there is inadequate experience with its use.

Therapeutic Class

Topical Vitamin D & related preparations

Storage Conditions

Store below 25° C, away from light and moisture. Do not freeze. Keep all medicines out of reach of children.

Price: 30gm tube-350tk

Indications

Coal Tar Cream is indicated for psoriasis. Soritar Cream has a keratoplastic and antipruritic effect in psoriasis.

Pharmacology

Coal tar has antipruritic, keratoplastic and keratolytic properties. It slows down excessive epidermal cell turnover and is often used topically either alone or in combination with other drugs (e.g. salicyclic acid, sulfur) in conditions such as dandruff, seborrheic dermatitis or psoriasis.

Dosage

Adults and children over 12 years of age: Ensure that the lesions are clean. Apply a thin layer of Coal Tar Cream two or three times a day on to the affected areas massage in gently and leave to dry.

For young children under 12 years of age and the elderly: The emulsion may be diluted by mixing it with a few drops of cooled freshly boiled in the palm of the hand.

Administration

For topical application only.

Contraindications

Coal Tar should not be used when a patient has known sensitivity to Coal Tar or any of the other ingredients. If you have folliculitis and acne vulgaris. Coal Tar Cream should not be used on patients who have disease characterised by photosensitivity such as lupus erythematosus or allergy to sunlight. Coal Tar Cream should not be applied to inflamed or broken skin. Warnings and precautions: For topical administration only. Coal Tar Cream may cause skin irritation, should this occur the treatment should be reviewed and if necessary discontinued. Coal Tar enhances photosensitivity of the skin after applying Coal Tar Cream exposure to direct sunlight should be avoided. Use with care near the eyes and mucous membranes. If any emulsion should accidentally enter the eye, flush with normal saline solution or water. Do not apply to genital and rectal areas. Apply with caution to the face do not get in the eyes. Hydrogenated polyoxyl castor oil may cause skin reactions. Methyl and propyl hydroxybenzoates may cause allergic reactions that might be cause a delayed reaction.

Side Effects

Skin and subcutaneous tissue disorders: Skin irritation, photosensitivity of the skin, Coal Tar Cream may cause acne-like eruptions of the skin. There is an increased risk of skin cancer in psoriatic patients treated with a combination of Coal Tar Cream and UVB radiation has been reported. However epidemiological studies of patients treated with Coal Tar Cream on its own are inconclusive. The risk of toxicity should be taken into account when considering the prescribing this product for the patient.

Pregnancy & Lactation

There is no direct evidence of the safety in pregnant and lactating mother. Coal tar preparations have been in use for many years without apparent ill-consequence. No harmful effects on the health of the child is anticipated with the proper use of coal tar. However it is recommended that the use of coal tar in pregnancy and lactation is restricted to intermittent use in low concentrations on a small percentage of body’s surface, use during the first trimester be avoided.

Overdose Effects

There is no evidence that an overdose of topical Coal Tar Cream would be harmful other than a hypersensitivity to coal tar. Ingestion of Coal Tar Cream may require gastric lavage depending on the quantity taken and should be treated symptomatically.

Therapeutic Class

Coal-tar preparations

Storage Conditions

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

Price : 50gm tube -300tk

Indications

This ointment is indicated for the relief of the inflammatory manifestations of hyperkeratotic and dry corticosteroid responsive dermatoses such as, psoriasis, chronic atopic dermatitis, neurodermatitis (licehen Simplex, Chronicus), lichen planus, eczema (including nummular eczema, hand eczema, eczematous dermatitis), seborrheic dermatitis of the scalp, ichthyosis vulgaris and other ichthyotic conditions.

Pharmacology

Clobetasol Propionate high potency corticosteroid. Corticosteroids decrease inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes; inhibiting macrophage accumulation in inflamed areas; reducing leukocyte adhesion to capillary endothelium; reducing capillary wall permeability and edema formation; decreasing complement components; antagonizing histamine activity and release of kinin from substrates; and reducing fibroblast proliferation, collagen deposition, and subsequent scar tissue formation.

Salicylic acid has a potent keratolytic action and a slight antiseptic action when applied topically. It softens and destroys the stratum corneum by increasing endogenous hydration which causes the horny layer of the skin to swell, soften, and then desquamate. At high concentrations, salicylic acid has a caustic effect. It also possesses weak antifungal and antibacterial activity.

Dosage

Adult: Apply a thin layer of this ointment to the affected skin areas twice daily and rub in gently & completely. For some patients, adequate maintenance therapy may be achieved with less frequent application. As with other higher active corticosteroids, therapy should be discontinued when control has been achieved. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary. It should not be used with occlusive dressing. Treatment beyond 2 consecutive weeks is not exceeding 50 gm/week because of the potential for the drug to suppress the hypothalamic pituitary adrenal axis.

Children: Use in pediatric patients under 12 years of age is not recommended.

Administration

For external use only.

Interaction

There has been no report of interaction with Clobetasol Propionate ointment and cream. There are no known interactions of Salicylic Acid when used as indicated. However, topical salicylic acid may increase the absorption of other topically applied medicines. Concomitant use of Salicylic Acid Ointment and other topical medicines on the same area of skin should therefore be avoided.

Contraindications

ClobetasolPropionatev is contraindicated in patients with hypersensitivity to Clobetasol Propionate. This preparation is contraindicated also in the treatment of primary infected bacterial or fungal skin lesions if no anti-infective agent is used simultaneously, in primary cutaneous viral infections (i.e., herpes simplex, vaccinia and varicella) and in tuberculous skin lesions. Clobetasol Propionate is also contraindicated in dermatoses in children under one year of age, including dermatitis and diaper eruptions. Salicylic Acid is contraindicated in patients displaying salicylate hyersensitivity, or sensitivity to any other ingredient in the preparation.

Side Effects

As with other topical corticosteroids, prolonged use of large amounts of Clobetasol Propionate or treatment of extensive areas can result in sufficient systemic absorption to produce the features of hypercortisolism. This effect is more likely to occur in infants and children, and if occlusive dressings are used. Local atrophy may occur after prolonged treatment. In rare instances, treatment of psoriasis with corticosteroids (or its withdrawal) is thought to have provoked the pustular form of the diseases. Clobetasol Propionate is usually well tolerated, but if signs of hypersensitivity appear, application should be stopped immediately. Possible sensitivity reactions, drying and irritation when using Salicylic Acid.

Pregnancy & Lactation

Topical administration of corticosteroids to pregnant animals can cause abnormalities of fetal development. The relevance of this finding to human beings has not been established. The safe use of Clobetasol Propionate during lactation has not been established. However, the administration of Clobetasol Propionate during pregnancy and lactation should only be considered if the expected benefit to the mother is greater than any possible risk to the fetus. Drugs of this class should not be used extensively in pregnant patients in large amounts or for prolonged periods of time. Whilst there are no known contra-indications to the use of Salicylic Acid ointment during pregnancy and lactation, the safety has not been established. Salicylic Acid ointment shold therefore be used with caution.

Precautions & Warnings

Not for prolonged use in high concentrations and on large areas of the body. Impaired peripheral circulation or diabetes. Avoid broken skin, mouth, eyes, mucous membranes and anogenital region.

Overdose Effects

Acute overdosage is very unlikely to occur, however, in the case of chronic overdosage or misuse, the features of hypercortisolism may appear and in this situation topical steroids should be discontinued gradually. However, because of the risk of acute adrenal suppression this should be done under medical supervision. Symptoms osslystemic salicylate poisoning (tinnitus, dizziness and deafness) have been reported after the application of Salicylic Acid to large areas of skin and for prolonged periods. Salicylism may also occur in the unlikely event of large quantities being ingested. Salicylism is ullikely to occur if Salicylic Acid ointment is used as indicated. Salicylate poisoining is usually associated with plasma concentrations >350 mg/L. Most adult deaths occur in patients whose concentrations exceed 700 ml/L. Single doses less than 100 mg/kg are unlikely to cause serious poisoning.

Therapeutic Class

Clobetasol / Clobetasone & Combined Preparations

Storage Conditions

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

Price : 10mg tube -70 tk

20mg tube – 120tk

Indications

Colchicine are indicated for treatment of acute gout flares. And also indicated in Familial Mediterranean fever (FMF) in adults and children 4 years or older.

Description

Colchicine is FDA-approved to help prevent gout and to treat sudden severe attacks of gout. In gout, crystals of uric acid are deposited in certain joints. White blood cells migrate to the areas of the body where uric acid has been deposited. They attempt to engulf the crystals, and as a result, lactic acid and pro-inflammatory enzymes are released. These substances give rise to the characteristic pain and swelling of gout. Colchicine inhibits the migration of the white blood cells into the inflamged area, causing a reduction in pain and inflammation.

Pharmacology

An acute attack of gout apparently occurs as a result of an inflammatory reaction to crystals of monosodium urate that are deposited in the joint tissue from hyperuric body fluids; the reaction is aggravated as more urate crystals accumulate. Leukocytes migrate to the sites where urate crystals have been deposited and try to engulf the crystals by phagocytosis. As a result lactic acid and proinflammatory enzymes are released which cause inflammation with severe pain, redness, and swelling of the affected joint. Lactic acid favors a local decrease in pH that enhances uric acid deposition. Colchicine inhibits the phagocytosis of uric acid by leukocytes & also diminishes the lactic acid production directly. Thus interrupts the cycle of urate crystal deposition and inflammatory response that sustains the acute attack of gout.

Colchicine is absorbed when given orally, reaching a mean Cmax of 2.5 ng/mL (range 1.1 to 4.4 ng/mL) in 1 to 2 hours after a single dose administered under fasting conditions. The mean apparent volume of distribution is approximately 5 to 8 L/kg. Colchicine binding to serum protein is low (39 ± 5%), primarily to albumin regardless of concentration. CYP3A4 is involved in the metabolism of Colchicine to 2-O-demethylcolchicine and 3-O-demethylcolchicine. Plasma levels of these metabolites are minimal (less than 5% of parent drug). Following multiple oral doses (0.6 mg twice daily), the mean elimination half-life is 26.6 to 31.2 hours.

Dosage & Administration

Acute gouty arthritis:

• First dose- 1 to 1.2 mg (two 0.5 mg or two 0.6 mg tablets) at a time every 2 hours until pain and inflammation aborted.

• The total amount of colchicine needed to control pain and inflammation during an attack usually ranges from 4 to 8 mg.

• Articular pain and swelling typically reduced within 12 hours and are usually gone in 24 to 48 hours, An interval of three days between colchicine courses is advised in order to minimize the possibility of cumulative toxicity.

For prophylaxis during intercritical periods:

• To reduce the frequency of their severity, colchicine may be administered continuously.

• In patients who have less than one attack per year, the usual dose is 0.5 or 0.6 mg per day, three or four days a week.

• For cases involving more than one attack per year, the usual dose is 0.5 or 0.6 mg daily.

• Severe cases may require two or three 0.5 mg or 0.6 mg tablets daily.

For prophylaxis against attacks of gout in patients undergoing surgery:

• In patients with gout, an attack may be precipitated by even a minor surgical procedure. One 0.5 mg tablet or one 0.6 mg tablet three times daily should be administered for three days before and three days after surgery.

Interaction

Co-administration of P-gp and/or CYP3A4 inhibitors (e.g., clarithromycin or cyclosporine) have been demonstrated to alter the concentration of Colchicine

Contraindications

Patients with renal or hepatic impairment should not be given Colchicine in conjunction with Permeability glycoprotein (P-gp) or strong CYP3A4 inhibitors (e.g., clarithromycin or cyclosporine).

Side Effects

Blood dyscrasias: Myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported. Diarrhea and pharyngolaryngeal pain may occur.

Pregnancy & Lactation

Pregnancy Category C. There are no adequate and well-controlled studies with Colchicine in pregnant women. Colchicine is excreted into human milk. Caution should be exercised when administered to a nursing woman.

Use in Special Populations

Pediatric Use: Gout is rare in pediatric patients. Safety and effectiveness of Colchicine in pediatric patients have not been established.

Overdose Effects

The exact dose of colchicine that produces significant toxicity is unknown. Fatalities have occurred after ingestion of a dose as low as 7 mg over a 4-day period, while other patients have survived after ingesting more than 60 mg. A review of 150 patients who overdosed on colchicine found that those who ingested less than 0.5 mg/kg survived and tended to have milder toxicities, such as gastrointestinal symptoms, whereas those who took 0.5 to 0.8 mg/kg had more severe reactions, such as myelosuppression.

Therapeutic Class

Drugs used in Gout

Price = 0.5mg-4 tk

0.6- 5 tk

Indications

Amlexanox is indicated for the treatment of aphthous ulcers.

Pharmacology

The mechanism of action by which Amlexanox accelerates healing of aphthous ulcers is unknown. In vitro studies have demonstrated Amlexanox to be a potent inhibitor of the formation and release of inflammatory mediators (histamine and leukotrienes) from mast cells, neutrophils and mononuclear cells. Given orally to animals, Amlexanox has demonstrated anti-allergic and anti-inflammatory activities and has been shown to suppress both immediate and delayed-type hypersensitivity reactions. The relevance of these activities of Amlexanox to its effects on aphthous ulcers has not been established. After a single oral application of 100 mg of paste (5 mg Amlexanox), maximal serum levels are observed at 2.4 hours. Most of the systemic absorption of Amlexanox is via the gastrointestinal tract and the amount absorbed directly through the active ulcer is not a significant portion of the applied dose. The half-life for elimination was 3.5 +/- 1.1 hours in healthy individuals.

Dosage & Administration

• Apply the paste as soon as possible after noticing the symptoms of an aphthous ulcer. Continue to use the paste four times daily, preferably following oral hygiene after breakfast, lunch, dinner, and at bedtime.

• Dry the ulcer(s) by gently patting it with a soft, clean cloth.

• Wash hands before applying.

• Moisten the tip of the index finger.

• Squeeze a dab of paste approximately ¼ inch (0.5 cm) onto a fingertip.

• Gently dab the paste onto the ulcer. Repeat the process if more than one ulcer are present.

• Wash hands after application.

• Wash eyes promptly if they should come in contact with the paste.

• Use the paste until the ulcer heals. If significant healing or pain relief has not occurred in 10 days, consultation with the physician is required.

Contraindications

Amlexanox oral paste is contraindicated in patients with known hypersensitivity to Amlexanox or other ingredients in the formulation.

Side Effects

Adverse reactions reported by 1-2% of patients were transient pain, stinging and/or burning at the site of application. Infrequent (<1%) adverse reactions in the clinical studies were contact mucositis, nausea, and diarrhea.

Pregnancy & Lactation

US FDA pregnancy category B. Teratology studies were performed with animals at doses up to two hundred and six hundred times, respectively, the projected human daily dose. No adverse fetal effects were observed. There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Amlexanox was found in the milk of lactating rats; therefore, caution should be exercised when administering Amlexanox oral paste to a nursing woman.

Precautions & Warnings

Wash hands immediately after applying Amlexanox oral paste directly to ulcers with the finger tips. In the event that a rash or contact mucositis occurs, discontinue use.

Use in Special Populations

Pediatric Use: Safety and effectiveness of Amlexanox oral paste in pediatric patients have not been established.

Overdose Effects

Ingestion of a full tube of 5 grams of paste would result in systemic exposure well below the maximum nontoxic dose of Amlexanox in animals. Gastrointestinal upset such as diarrhea and vomiting could result from an overdose.

Price : 75 tk

Indications

To prevent and to treat deficiencies of vitamin B2 such as cheilosis, angular stomatitis, glossitis, keratitis, seborrhoeic dermatitis.

Pharmacology

Riboflavin or vitamin B2 is an easily absorbed, water-soluble micronutrient with a key role in maintaining human health. Like the other B vitamins, it supports energy production by aiding in the metabolising of fats, carbohydrates, and proteins. Vitamin B2 is also required for red blood cell formation and respiration, antibody production, and for regulating human growth and reproduction. It is essential for healthy skin, nails, hair growth and general good health, including regulating thyroid activity. Riboflavin also helps in the prevention or treatment of many types of eye disorders, including some cases of cataracts.

Binds to riboflavin hydrogenase, riboflavin kinase, and riboflavin synthase. Riboflavin is the precursor of flavin mononucleotide (FMN, riboflavin monophosphate) and flavin adenine dinucleotide (FAD). The antioxidant activity of riboflavin is principally derived from its role as a precursor of FAD and the role of this cofactor in the production of the antioxidant reduced glutathione. Reduced glutathione is the cofactor of the selenium-containing glutathione peroxidases among other things. The glutathione peroxidases are major antioxidant enzymes. Reduced glutathione is generated by the FAD-containing enzyme glutathione reductase.

Dosage & Administration

For treating low levels of riboflavin (riboflavin deficiency) in adults: 5-30 mg of riboflavin daily in divided doses.

For preventing migraine headaches: 400 mg of riboflavin (Vitamin B2) per day. It may take up to three months to get best results.

For preventing cataracts: approximately 2.6 mg of riboflavin (Vitamin B2)

Interaction

Drying medications (Anticholinergic drugs), Medications for depression (Tricyclic antidepressants), Phenobarbital, Probenecid.

Contraindications

Hypersensitivity to Riboflavin.

Side Effects

Riboflavin is likely safe for most people. In some people, Riboflavin can cause the urine to turn a yellow- orange color. When taken in high doses, Riboflavin might cause diarrhea, an increase in urine, and other side effects.

Pregnancy & Lactation

Riboflavin is likely safe for pregnant or breastfeeding women when taken in the amounts recommended.

Precautions & Warnings

Riboflavin is non-toxic. No warnings or precautions have been established .

Therapeutic Class

Vitamin-B preparations

Storage Conditions

Store at a cool and dry place. Protect from light.

Indications

Nystatin is an antifungal antibiotic active against a wide range of yeasts and yeast like fungi including Candida albicans. It is used for the prevention and treatment of Candida infections of oral cavity, esophagus and intestinal tract. It provides effective prophylaxis against oral candidiasis in those born of mothers with vaginal candidiasis. It is used for the prophylaxis of Candida overgrowth during courses of broadspectrum antibiotics.

Pharmacology

Nystatin is an antifungal antibiotic. Which has fungistatic or fungicidal activity against variety of pathogenic and nonpathogenic yeast and fungi, including Candida albicans. Nystatin exerts its antifungal activity by binding to sterols in the fungal cell membrane. As a result of binding, the membrane is no longer able to function as a selective barrier, and potassium and other cellular constituents are lost. It is poorly absorbed from the gastrointestinal tract.

Dosage & Administration

Children:

• In intestinal and oral candidiasis (thrush): 1,00,000 units (1 ml) should be dropped into the mouth four times daily.The longer the suspension is kept in contact with the affected area in the mouth, before swallowing, the greater will be its effect.

• For prophylaxis in the newborn: The suggested dose is 1,00,000 units (1 ml) once daily or as prescribed by the physician.

Adult:

• For the treatment of intestinal or esophageal candidiasis: 5,00,000 units (5 ml) by mouth 3 or 4 times daily. The dose may be doubled, if required.

• For prophylaxis of intestinal candidiasis in adults: 10,00,000 units (10 ml) daily.

• For prophylaxis to suppress the over growth of Candida albicans in patients receiving broad spectrum antibiotic therapy: 10,00,000 units (10 ml) daily.

• For the treatment of dental sores and oral infection: 1,00,000 units (1 ml) suspension should be dropped into the mouth four times daily.

Elderly: Older people with intestinal candidiasis who are unable to swallow tablets should be given 5,00,000 units (5 ml) suspension four times daily.

Contraindications

There is no known contraindication to the use of Nystatin.

Side Effects

Nausea, vomiting and diarrhoea have occasionally been reported with high doses of Nystatin. No systemic effects or allergic reactions have been associated with its oral dose.

Pregnancy & Lactation

Absorption of Nystatin from the gastrointestinal tract is negligible, therefore no special precautions apply in pregnancy.

Precautions & Warnings

Absorption from the gastrointestinal tract is negligible, therefore no special precaution is required to apply in pregnancy and lactation.

Therapeutic Class

Drugs for subcutaneous and mycoses, Drugs used in Vaginal and Vulval condition

Storage Conditions

Store in a cool and dry place, protect from light. Keep out of reach of children.

Price: 30 ml -46tk

Indications

It is indicated for the repigmentation of idiopathic vitiligo. It is also indicated for the symptomatic control of severe, recalcitrant, disabling psoriasis not adequately responsive to other forms of therapy and when the diagnosis has been supported by biopsy.

Pharmacology

The combination treatment regimen of Psoralen (P) and UVA (Ultraviolet radiation of 320-400 nm wavelength) is commonly known as PUVA. Skin reactivity to UVA radiation is enhanced by the ingestion of Methoxsalen. The drug reaches its maximum bioavailability 1-3 hours after oral administration and may last for up to 8 hours. Methoxsalen is reversibly bound to serum albumin and is also preferentially taken up by epidermal cells. In both mice and man, Methoxsalen is rapidly metabolized. Approximately 95% of the drug is excreted as a series of metabolites in the urine within 24 hours.

The exact mechanism of action of Methoxsalen with the epidermal melanocytes and keratinocytes is not known. The best known biochemical reaction of Methoxsalen is with DNA. Methoxsalen, upon photoactivation, conjugates and forms covalent bonds with DNA (both monofunctional and bifunctional). Reactions with proteins have also been described.

Dosage

Methoxsalen capsules:

Vitiligo therapy: Two Methoxsalen capsules (10 mg each) in one dose taken with milk or food two to four hours before ultraviolet light exposure.

Light exposure: The exposure time to sunlight should comply with the following guide:

• Initial exposure: Light-15 min, Medium-20 min, Dark-25 min

• Second exposure: Light-20 min, Medium-25 min, Dark-30 min

• Third exposure: Light-25 min, Medium-30 min, Dark-35 min

• Fourth exposure: Light-30 min, Medium-35 min, Dark-40 min

Subsequent exposure: Gradually increase exposure based on erythema and tenderness of the amelanotic skin. Therapy should be on alternate days and never two consecutive days.

Psoriasis therapy: The Methoxsalen capsules should be taken 2 hours before UVA exposure with some food or milk, according to the following table:

• <30 kg body weight: 10 mg

• 30-50 kg body weight: 20 mg

• 51-65 kg body weight: 30 mg

• 66-80 kg body weight: 40 mg

• 81-90 kg body weight: 50 mg

• 91-115 kg body weight: 60 mg

• >115 kg body weight: 70 mg

Methoxsalen Lotion: is applied to a well-defined area of vitiligo by the physician and the area is then exposed to a suitable credit of UVA. Initial exposure time should be conservative and not exceed that which is predicted to be one-half the minimal erythema dose. Treatment intervals should be regulated by the erythema response; generally once a week is recommended or less often depending on results. The hands and fingers of the person applying the medication should be protected by gloves or finger cots to avoid photosensitization and possible burns.

Pigmentation may begin after a few weeks but significant repigmentation may require 6 to 9 months of treatment. Periodic re-treatment may be necessary to retain all of the new pigment. Idiopathic vitiligo is reversible but not equally reversible in every patient. Treatment must be individualized. Repigmentation will vary in completeness, time of onset, and duration. Repigmentation occurs more rapidly in fleshy areas such as face, abdomen, and buttocks and less rapidly over less fleshy areas such as the dorsum of the hands or feet.

Administration

Hands and fingers of person applying the lotion should be protected to prevent possible photosensitization and/or burns.

Interaction

May increase plasma concentration of drugs metabolised by CYP2A6 isoenzyme. Additive effect with other systemic or topical photosensitising agents (e.g. anthralin, coal tar, nalidixic acid).

Contraindications

• Patient with idiosyncratic reactions to psoralen compounds

• Patient possessing light sensitive disease including lupus erythematosus, porphyria, erythropoietic protoporphyria, variegate porphyria, xeroderma pigmentosum and albinism

• Patient with melanoma or possessing a history of melanoma

• Patient with invasive squamous cell carcinomas

• Patient with aphakia

Side Effects

The most commonly reported side effect of Methoxsalen alone is nausea, which occurs with approximately 10% of all patients. This effect may be minimized or avoided by instructing the patient to take Methoxsalen with milk or food, or to divide the dose into two portions, taken approximately one-half hour apart. Other effects include nervousness, insomnia and psychological depression.

Pregnancy & Lactation

Pregnancy Category C. Methoxsalen should be given to a woman only if clearly needed. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Methoxsalen is administered to a nursing woman.

Precautions & Warnings

Skin burning: Serious burns from either UVA or sunlight (even through window glass) can result if the recommended dosage of the drug and/or exposure schedules are not maintained.

Carcinogenicity: The increasing risk of carcinoma appears great among patients who are fair skinned or had pre PUVA exposure or prolong treatment with tar UVB, ionizing radiation or arsenic.

Cataractogenicity: Among patients using proper eye protection, there is no evidence for a significantly increased risk of cataracts in association with PUVA therapy.

Patients must not sunbathe during the 24 hours prior to Methoxsalen ingestion and UV exposure.

Use in Special Populations

Pediatric use: Safety in children has not been established.

Overdose Effects

In the event of Methoxsalen overdosage, induce emesis and keep the patient in a darkened room for at least 24 hours. Emesis is beneficial only within the first 2 to 3 hours after ingestion of Methoxsalen, since maximum blood levels are reached by this time.

Therapeutic Class

Methoxsalen preparation

Price – 30 ml -398tk

Indications

Hydroquinone is indicated -

• For the gradual bleaching of hyperpigmented skin conditions such as chloasma, melasma, freckles, senile lentigines and other unwanted areas of melanin hyperpigmentation.

• To reduce hyperpigmentation caused by photosensitization associated with inflammation or with the use of certain cosmetics.

Pharmacology

Hydroquinone is a topical depigmentating agent that produces a reversible depigmentation of the skin by inhibiting enzymatic oxidation of tyrosine to 3,4-dihydroxyphenylalanine and suppressing melanocyte metabolic processes.

Dosage & Administration

Apply a thin film of Hydroquinone Cream to the effected area once daily, at least 30 minutes before bedtime. Gently wash the face and neck with a mild cleanser. Rinse and pat the skin dry. Apply Hydroquinone Cream to the hyperpigmented areas of melasma including about ½ inch of normal appearing skin surrounding each lesion. Rub lightly and uniformly into the skin.

Therapy should be discontinued when control is achieved. During the day, use a sunscreen of SPF 30, and wear protective clothing. Avoid sunlight exposure. Patients may use moisturizers and/or cosmetics during the day. Hydroquinone Cream is for topical use only. It is not for oral, ophthalmic, or intravaginal use.

Contraindications

Hydroquinone is contraindicated to patients with prior history of hypersensitivity or allergic reaction to hydroquinone or other ingredients in the preparation.

Side Effects

No systemic adverse reactions have been reported. Occasional hypersensitivity (localized contact dermatitis) may occur in which case the medication should be discontinued.

Pregnancy & Lactation

Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Lactation: It is not known whether topical hydroquinone is absorbed or excreted in human milk. Caution is advised when topical hydroquinone is used by a nursing mother.

Precautions & Warnings

Hydroquinone is a skin bleaching agent which may produce unwanted cosmetic effects if not used as directed. The physician should be familiar with the contents of this insert before prescribing or dispensing this medication.

Test for skin sensitivity before using by applying a small amount to an unbroken patch of skin to check in 24 hours. Minor redness is not a contraindication, but where there is itching or vesicle formation or excessive inflammatory response, further treatment is not advised. If no bleaching or lightening effect is noted after 2 months of treatment, the medication should be discontinued.

Contact with the eyes and lips should be avoided. Hydroquinone should not be applied to cut or abraded skin.

Overdose Effects

There have been no systemic reactions from the use of topical hydroquinone. Some patients may experience a transient reddening of skin and mild burning sensation which does not preclude treatment.

Therapeutic Class

Hydroquinone Preparations

Price : 10 gm -50 tk

Indications

Azelaic Acid cream is indicated for the topical treatment of mild to moderate inflammatory acne vulgaris.

Pharmacology

Azelaic acid has been shown to possess antimicrobial activity against Propionibacterium acnes and Staphylococcus epidennidis. The antimicrobial action may be attributable to the inhibition of microbial cellular protein synthesis. A normalization of keratinization leading to an anticomedonal effect of Azelaic acid may also contribute to its clinical activity.

Dosage & Administration

After the skin is thoroughly washed and patted dry, a thin film of Azelaic Acid should be gently but thoroughly massaged into the affected areas twice daily, in the morning and evening. The hands should be washed following application. Safety and effectiveness in pediatric patients under 12 years of age have not been established. Or as directed by the physician.

Contraindications

Azelaic acid is contraindicated in individuals who have shown hypersensitivity to any of its components.

Side Effects

Local skin irritation (e.g. erythema, scaling, itching or burning) occurs in occasional cases, usually at the start of treatment. However, in the majority of cases the irritation is mild and regresses as treatment continues.

Pregnancy & Lactation

FDA Pregnancy Category B. This drug should be used during pregnancy only if clearly needed. Caution should be exercised when Azelaic acid is administered to a nursing mother.

Precautions & Warnings

For external use only. If Azelaic acid comes into contact with the eyes they should immediately be thoroughly rinsed with copious amounts of water. The patients should consult a physician if eye irritation persists.

Therapeutic Class

Acne treatment preparations

Price: 10gm tube – 75 tk

Indications

Minoxidil is indicated in the treatment of androgenic alopecia in males and females and stabilisation of hair loss in patients with androgenic alopecia, and also of alopecia areata.

Pharmacology

Minoxidil stimulates hair growth by increasing oxygen, blood and nutrients supply to the hair follicle by widening blood vessels and inhibiting androgen hormone to affect hair follicles.

Following topical application, an average of about 1.4% of the total applied dose is absorbed from the normal intact scalp. Topical Minoxidil absorption is increased by increasing the  dose applied, increasing the frequency of dosing and decreasing the barrier function of the stratum corneum. Serum Minoxidil levels and systemic effects resulting from the administration of topical Minoxidil are governed by the drug’s absorption rate through the skin. Following cessation of topical dosing, approximately 95% of the systemically absorbed drug is eliminated within 4 days. Minoxidil and its metabolites are excreted principally in the urine.

Dosage & Administration

Minoxidil topical solution is for external use only and should be applied when the hair and scalp are clean and dry. Apply 1 ml (7 sprays) of Minoxidil topical solution twice daily at 12-hour intervals to the scalp, beginning at the centre of the affected area and spreading the solution out to cover the entire affected area. The total daily application dose should not exceed 2 ml.

For the best results, Minoxidil topical solution should be allowed to remain on the scalp for about 4 hours before washing. The night-time application should be done 2-4 hours before going to bed to allow the solution to dry out. Minoxidil topical solution should not be massaged into the scalp, but applied lightly. A hair dryer should not be used to speed up the drying of the solution as it may decrease the effectiveness. Minoxidil topical solution should not be mixed with any hair oil. The drug should not be used more than two times a day, or be taken orally or applied to any other part of the body to avoid the risk of adverse effects and unwanted hair growth. More frequent use or longer application time have no effect on hair growth. In case of missing any daily applications of Minoxidil topical solution, the patient should continue with the next application.

Hands should be washed immediately if Minoxidil topical solution is applied with the fingertips. Clinical experience with Minoxidil indicates that twice-daily applications for 4 months or more may be required before there is evidence of hair growth. To arrest hair fall, Minoxidil topical solution should be used for not less than 45 days. Depending upon the severity of hair loss or type and extent of baldness, particular strength of Minoxidil topical solution may be selected.

Interaction

Minoxidil topical solution should not be used along with other topical agents known to alter the stratum corneum barrier such as tretinoin or dithranol, due to the enhanced absorption of Minoxidil. Although there is no clinical evidence, there exists the theoretical possibility of absorbed Minoxidil potentiating orthostatic hypotension caused by peripheral vasodilators.

Contraindications

• Patients with cardiac abnormalities

• Children below 18 years of age

• Patients using occlusive dressings or other medicines on the scalp

• Patients with red, inflamed infection, or irritated or painful scalp (including psoriasis & sunburn)

Side Effects

Commonly encountered side effects in clinical trials with Minoxidil topical solution were minor dermatological reactions. Dermatitis or hypertrichosis may occur. These incidences may occur in 0.1–5% of patients.

Pregnancy & Lactation

Minoxidil topical solution should not be used during pregnancy and lactation.

Precautions & Warnings

Minoxidil topical solution is more likely to cause scalp irritation. If scalp irritation continues or worsen, use of Minoxidil topical solution should be stopped.

Overdose Effects

Increased systemic absorption of Minoxidil may potentially occur if higher-than-recommended doses of Minoxidil are applied to larger surface areas of the body or areas other than the scalp. There are no known cases of Minoxidil overdosage resulting from topical administration of Minoxidil.

Signs and symptoms of Minoxidil overdosage would primarily be cardiovascular effects associated with sodium and water retention, and tachycardia. Fluid retention can be managed with appropriate diuretic therapy. Clinically significant tachycardia can be controlled by administration of a beta-adrenergic blocking agent.

Therapeutic Class

Other scalp preparations

Price : 60 ml -600tk

Indications

Aluminium Chloride Hexahydrate is indicated for the treatment of excessive perspiration of the underarms, hands, feet and scalp.

Pharmacology

Aluminium Chloride Hexahydrate acts locally in the stratum corneum and terminal duct to relieve hyperhidrosis. Aluminium salts cause an obstruction of the ducts of sweat glands at the skin surface. It seems that the metal (Aluminium) ions precipitate with mucopolysaccharides, damaging epithelial cells along with the duct lumen and forms a plug (gel) that blocks sweat output.

Dosage & Administration

Step 1: Apply Aluminium Chloride Hexahydrate topical solution at night after drying the affected areas carefully.

Step 2: Wash off in the morning. Do not re-apply the product during the day.

Step 3: Initially the product may be applied every night until sweating stops during the day. The frequency of application may be reduced to twice a week or less, if excess sweating is stopped during the day.

Interaction

There are no known drug interactions for Aluminium Chloride Hexahydrate topical solution.

Contraindications

Aluminium Chloride Hexahydrate is contraindicated in patients with known hypersensitivity to any of its components.

Side Effects

Aluminium Chloride Hexahydrate is normally well tolerated and adverse effects are only mild and short-lasting. But sometimes irritation of the skin like- stinging, burning, redness, swelling, tingling or itching of treated skin areas may occur. These irritations may be alleviated by use of a weak corticosteroid cream.

Pregnancy & Lactation

There are no restrictions on the use of this medication during pregnancy and lactation.

Precautions & Warnings

For external use only. Do not apply this medication to broken, irritated or recently shaved skin. Avoid contact with eyes, mouth, nose and lips. Avoid direct contact with clothing and polished metal or jewellery surfaces. Keep out of reach of children.

Therapeutic Class

Miscellaneous topical agents