Clotrimazole + Gentamicin + Betamethasone Pharmacology
Clotrimazole + Gentamicin + Betamethasone
1.Fungal infections of skin
2.Allergic conditions of the skin
2.Do not wear occlusive dress over the medicament.
Clean and dry the affected area and apply the medicament with gentle massage 2 -3 times daily for 2 - 4 weeks.
Vaginal candidiasis: Insert 1 applicator full (vaginal cream 1%) intravaginally at night for 1 -2 weeks.
Vaginal tablets 100. 200 and 500mg tablet is available.
Vulvovaginal candidiasis: Insert 100mg tablet intravaginally at bed time for 7 consecutive days or 200 mg tablet for 3 consecutive days or 500 mg tablet for 1 day at night.
Oral lozenge 10 mg is available
Oropharyngeal candidiasis: 1 lozenge orally 5 times daily for 2 weeks
Prophylaxis of Oropharyngeal candidiasis: 1 lozenge is used 3 times daily
Gel: Insert with an applicator intravaginally at night for 1 - 2 weeks.
Powder (1% w/ w): dusted over the body parts as required
Distribution: Distributed extracellularly. CSF penetration & intraocular penetration poor.
Metabolism: Not metabolized
Excretion: Excreted mainly through urine.
2. Allergic manifestations
2. Along with chloramphenicol or tetracycline
3. Renal impairment
4. Labyrinthine disorders
2. Neuromuscular disorders
Infants : Use with caution
4. Urinary Tract Infections.
5. Otitis & Ocular infections.
6. Infections of burns & Skin ulcers
Anaesthetics, Neuromuscular blocking agents (Tubocurarine): Risk of neuromuscular blockade and respiratory paralysis.
Penicillin, Cephalosporins, Carbenicillin, Ticarcillin: Exert antibiotic synergism, especially useful in Pseudomonas infections.
Loop diuretics: Concurrent use of these agents may increase the risk of respiratory paralysis and renal dysfunction.
Lab Tests: Aminoglycoside serum levels: Guard against in vitro inactivation of aminoglycosides by b-lactum antibiotics in patients on combination therapy.
Adults: 2 to 5mg/kg/day; Thrice daily for a week or more
Children: 2 to 2.5mg/kg; Thrice daily.
The drug exerts anti-inflammatory and immunosuppressant actions as follows: - 1) Induce lipocortins in macrophages, endothelium, and fibroblasts which inhibits phospholipase A2 and thus decreases the production of Prostaglandins, leukotriens (LT), and platelet activating factor, 2) Causes negative regulation of genes for cytokines in macrophages, endothelial cells and lymphocytes and thus decreases the production of interleukins (IL-1, IL-2, IL-3, IL-6), TNF-alpha, GM-CSF (granulocyte macrophage colony stimulating factor), Gama interferon and suppresses fibroblast proliferation and T-lymphocyte functions and interferes chemotaxis. 3) Decreases the production of acute phase reactants from macrophages and endothelial cells and interferes complement function. 4) Decreases the production of ELAM-1(Endothelial leukocyte adhesion molecule-1) and ICAM-1(intracellular adhesion molecule-1) in endothelial cells. 5) Inhibit IgE mediated histamine and LT-C4 release from basophiles and the effects of antigen-antibody reaction is not mediated 6) Reduces the production of collagenase and stromolysin and thus prevents tissue destruction.
Topical:-Absorption: It is absorbed in to the systemic circulation and the amount is depending on the potency, amount applied and the nature of the skin at the site of application. Absorption increases at the site of skin damage, inflammation or occlusion
7.Atrophy of adrenal cortex(on prolonged therapy)
8.Suppression of adrenocorticotropic hormone
10.Inhibition of growth in children
20.Delayed wound healing
27.Posterior sub capsular cataract
30.Increased intracranial pressure.
3.Systemic fungal infections
1.Hypersensitivity to Betamethasone and other corticosteroids
2.Untreated bacterial, virus or fungal infections
7.Tuberculosis of the skin
8. Varicose ulcers
9. Skin lesions caused by infections with ring worm, fungi (e.g. Candida, Tinea) or bacteria (e.g. impetigo)
10.Discoid lupus Erythematosus
2.Use lower dosages as much as possible
4.Ocular herpes simplex
11.Congestive heart failure
13.Recent myocardial infarction
23.Non specific Ulcerative colitis
25.Recent intestinal anastomosis
27.Avid contact of the topical dosage form with the eyes
5.Intra-articular and soft tissue inflammation
16.Hypopitutarism following adrenalectomy
Carbamazepine, Primidone: Decreases efficacy.
Oral contraceptives: Increase efficacy of Betamethasone.
Oestrogens: Decreases efficacy of Betamethasone.
Ketoconazole: Increases efficacy of Betamethasone.
Rifampicin: Decreases efficacy.
Betamethasone effects the actions of the following:
Anticholinesterases: Efficacy antagonised in myasthenia gravis.
Oral anticoagulants: Altered response.
Cyclosporine: Increases efficacy leading to enhanced toxicity.
Digitals glycosides: Increases toxicity associated with hypokalaemia.
Isoniazid: Decreases serum levels.
Salicylates: Decreases serum levels.
Diuretics: Increases efficacy may cause increased hypokalaemia and increased hyperglycaemia.
Non-depolarising muscle relaxants - Altered response.
Somatrem: Growth promoting effect inhibited.
Theophyllines: Altered response of either agent.
IUCD: Contraceptive failure.
a) Increases serum cholesterol levels.
b) Increases urine glucose levels.
c) Decreases Thyroid l 131 uptake; Decreases T3 serum levels.
d) Decreases serum potassium.
1 to 6 years: 25 to 50%
7 to 12 years: 50 to 75%
I.M. or I.V.: 4 to 20mg I.M. or as slow I.V. injection. Repeated if required; up to 4 times daily depending up on the severity of condition.
Children: Administered by slow I.V. injection;
1 to 5 years: 2mg
6 to 12 years: 4mg
Intra-articular or soft tissue injection: 0.5 to 9mg depending up on the severity of the condition.
Betamethasone Valerate: Apply to the affected area as thin film 1 - 4 times daily depending upon the severity, skin and rate of absorption.
Dermatoses of the scalp: (Betamethasone Valerate 0.12%): Small amount of foam is applied in to the scalp with gentle massage 2 times a day for up to 2 weeks.
Betamethasone dipropionate: Apply to the affected area as thin film 1 -2times daily
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