Antifungal Clotrimazole Cream 1% , Topical Antifungal Agents Ointment

Antifungal Clotrimazole Cream 1% , Topical Antifungal Agents Ointment

Product : Clotrimazole Cream 1%

Specification : 20g/tube, 30g/tube

Standard : BP, USP

Packing : one tube/box

Indications :

For the treatment of:

i. All dermatomycoses due to moulds and other fungi (e.g. Trichophyton species)

ii. All dermatomycoses due to yeasts (Candida species). These include ringworm (tinea) infections (e.g. athlete’s foot), paronychia, pityriasis versicolor, erythrasma and intertrigo. iii. Skin diseases showing secondary infection with these fungi. iv. Candidal nappy rash, vulvitis and balanitis.

Method of administration :

The cream should be applied thinly and evenly to the affected area 2 – 3 times daily and rubbed in gently. A strip of cream (½ cm long) is enough to treat an area of about the size of the hand.

If the feet are infected, they should be thoroughly washed and dried, especially between the toes, before applying the cream.

Treatment should be continued for at least one month for dermatophyte infections, or for at least two weeks for candidal infections.

Contraindications :

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.

Do not use the cream to treat nail or scalp infections.

Special warnings and precautions for use :

This product contains cetostearyl alcohol, which may cause local skin reactions (e.g. contact dermatitis).

Interactions with other medicinal products and other forms of interaction :

Laboratory tests have suggested that, when used together, this product may cause damage to latex contraceptives. Consequently the effectiveness of such contraceptives may be reduced. Patients should be advised to use alternative precautions for at least five days after using this product.

Fertility, pregnancy and lactation :

Pregnancy:

There is a limited amount of data from the use of clotrimazole in pregnant women. Animal studies with clotrimazole have shown reproductive toxicity at high oral doses (see section 5.3). At the low systemic exposures of clotrimazole following topical treatment, harmful effects with respect to reproductive toxicity are not predicted. Clotrimazole can be used during pregnancy but only under the supervision of a physician or midwife.

Lactation:

Available pharmacodynamic/toxicological data in animals have shown excretion of clotrimazole/metabolites in milk after intravenous administration (see section 5.3). A risk to the suckling child cannot be excluded. A decision must be made whether to discontinue breast-feeding or to discontinue/abstain from clotrimazole therapy taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman.

Fertility:

No human studies of the effects of clotrimazole on fertility have been performed; however, animal studies have not demonstrated any effects of the drug on fertility.

Pharmacodynamic properties :

Pharmacotherapeutic group: Antifungals for topical use – imidazole and triazole derivatives

ATC code: D01A C01

Mechanism of Action

Clotrimazole acts against fungi by inhibiting ergosterol synthesis. Inhibition of ergosterol synthesis leads to structural and functional impairment of the cytoplasmic membrane.

Pharmacodynamic Effects

Clotrimazole has a broad antimycotic spectrum of action in vitro and in vivo, which includes dermatophytes, yeasts, moulds, etc. Under appropriate test conditions, the MIC values for these types of fungi are in the region of less than 0.062-8.0 µg/ml substrate.

The mode of action of clotrimazole is primarily fungistatic or fungicidal depending on the concentration of clotrimazole at the site of infection. In vitro activity is limited to proliferating fungal elements; fungal spores are only slightly sensitive.

In addition to its antimycotic action, clotrimazole also acts on gram-positive microorganisms (Streptococci / Staphylococci / Gardnerella vaginalis), and gram-negative microorganisms (Bacteroides).

In vitro clotrimazole inhibits the multiplication of Corynebacteria and gram-positive cocci - with the exception of Enterococci - in concentrations of 0.5-10 µg/ml substrate.

Primarily resistant variants of sensitive fungal species are very rare; the development of secondary resistance by sensitive fungi has so far only been observed in very isolated cases under therapeutic conditions.

Pharmacokinetic properties

Pharmacokinetic investigations after dermal application have shown that clotrimazole is minimally absorbed from the intact or inflamed skin into the human blood circulation. The resulting peak serum concentrations of clotrimazole were below the detection limit of 0.001 mcg/ml, suggesting that clotrimazole applied topically is unlikely to lead to measurable systemic effects or side effects.

PHARMACOLOGICAL PROPERTIES

Preclinical safety data

Non-clinical data reveal no special hazard for humans based on studies of repeated dose toxicity, genotoxicity and carcinogenicity.

Clotrimazole was not teratogenic in reproductive toxicity studies in mice, rats and rabbits. In rats high oral doses were associated with maternal toxicity, embryotoxicity, reduced fetal weights and decreased pup survival.

In rats clotrimazole and/or its metabolites were secreted into milk at levels higher than in plasma by a factor of 10 to 20 at 4 hrs after administration, followed by a decline to a factor of 0.4 by 24 hrs.