Usage
Clioquinol is prescribed for the topical treatment of superficial skin infections caused by bacteria and fungi. It is classified as an antimicrobial agent. Its mechanism of action involves inhibiting the growth of bacteria and fungi on the skin. It is often used in combination with corticosteroids like betamethasone or hydrocortisone for enhanced anti-inflammatory and antipruritic effects.
Alternate Names
Iodochlorhydroxyquin, Vioform. Brand names vary depending on the region and specific formulation.
How It Works
Pharmacodynamics: Clioquinol exhibits both antifungal and antibacterial properties. It inhibits the growth of fungi and bacteria, reducing infection and inflammation. It also possesses mild anti-inflammatory properties, which contribute to its effectiveness in treating skin irritations.
Pharmacokinetics: Primarily for topical use; systemic absorption is minimal. When used topically, very little clioquinol is absorbed into the bloodstream. Most of the drug remains on the skin surface where it exerts its antifungal and antibacterial actions. Less than 1% is excreted in urine, mostly as glucuronide and sulfate conjugates. Bile salts can enhance bioavailability through improved suspension and increased intestinal reabsorption. Repeated oral administrations show steady-state accumulation after approximately 5 days with high inter-subject variability.
Mode of Action: Clioquinol acts by inhibiting certain enzymes crucial for fungal and bacterial cell wall synthesis and function. This leads to disruption of the microbial cell wall, hindering growth and replication, and eventually causing cell death.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Clioquinol’s primary mode of action involves enzyme inhibition in microbial cells. Specifically, it inhibits enzymes involved in cell wall synthesis and maintenance in fungi and bacteria.
Dosage
Standard Dosage
Adults: Apply a thin layer of cream or ointment to the affected area two to four times daily for a maximum of 7-10 days (depending on the type of infection and product used) unless otherwise directed by a physician.
Children: For children 2 years of age and older, apply a thin layer to the affected area two to four times daily as directed by a physician. Use in children under 2 years of age is generally not recommended. The smaller the child, the less medication should be used. Treatment courses for children should generally not exceed 5 days unless specifically directed by a physician.
Special Cases:
- Elderly Patients: Use with caution due to potential increased risk of skin thinning. Close monitoring is recommended.
- Patients with Renal Impairment: While systemic absorption is minimal, caution is advised.
- Patients with Hepatic Dysfunction: While systemic absorption is minimal, caution is advised.
- Patients with Comorbid Conditions: No specific adjustments are routinely recommended; individual assessment is advisable.
Clinical Use Cases
Clioquinol is intended for topical use only and is not indicated for use in clinical scenarios requiring intubation, surgical procedures, mechanical ventilation, intensive care unit (ICU) use, or emergency situations.
Side Effects
Common Side Effects:
- Itching
- Burning or stinging sensation at the application site
- Redness
- Skin irritation
Rare but Serious Side Effects:
- Allergic contact dermatitis
Long-Term Effects:
Prolonged use may lead to skin atrophy, especially when used on the face or in combination with corticosteroids. Avoid long-term continuous use, particularly in infants and children, as it can lead to adrenal suppression, even without occlusion.
Contraindications
- Hypersensitivity to clioquinol, iodine, or any component of the formulation.
- Open wounds or mucous membranes.
- Perforated tympanic membrane (for ear drop formulations).
- Primary bacterial, viral (such as herpes simplex, chickenpox), or fungal infections of the outer ear.
- Children under 2 years old.
- Tuberculosis of the skin.
- Rosacea, acne vulgaris and perioral dermatitis.
Drug Interactions
- Other topical antifungals or corticosteroids (may increase the risk of side effects).
- Iodine-containing preparations.
- Drugs that weaken the immune system (such as cyclosporine).
- Topical use may interfere with thyroid function tests (such as PBI, radioactive iodine, and butanol-extractable iodine). These tests should not be performed within one month of using clioquinol.
Pregnancy and Breastfeeding
Pregnancy Safety Category: C (US FDA). While not extensively studied, animal studies have shown some adverse effects on the fetus. Use only if the potential benefits justify the risks. Breastfeeding: Caution is recommended. While data on breast milk excretion is limited, there’s a potential risk to the infant. Discuss with a physician if alternative treatments are available.
Drug Profile Summary
- Mechanism of Action: Inhibits fungal and bacterial growth; mild anti-inflammatory activity.
- Side Effects: Itching, burning, redness, irritation at the application site; rarely allergic contact dermatitis.
- Contraindications: Hypersensitivity; open wounds; perforated tympanic membrane (ear drops); primary infections (ear drops); use in children under two years.
- Drug Interactions: Other topical antifungals/corticosteroids; iodine-containing preparations; drugs affecting immune system.
- Pregnancy & Breastfeeding: Caution advised; discuss risks/benefits with a physician.
- Dosage: Topical application 2-4 times daily for up to 7-10 days; dose adjustments may be needed for children or specific formulations.
- Monitoring Parameters: Observe for skin irritation, signs of infection resolution, or any allergic reactions.
Popular Combinations
Clioquinol is commonly combined with corticosteroids like betamethasone or hydrocortisone to enhance anti-inflammatory and anti-itch effects.
Precautions
- Discontinue if irritation or sensitization occurs.
- Avoid contact with eyes.
- Avoid prolonged use.
- Not recommended for children under 2 years of age.
- Caution in patients with renal or hepatic impairment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Clioquinol?
A: Topical application 2-4 times a day, for up to 7-10 days, unless otherwise directed by a physician. Pediatric and specific product dosages may vary.
Q2: What is Clioquinol used for?
A: Topical treatment of superficial skin infections caused by bacteria and fungi.
Q3: What are the common side effects of Clioquinol?
A: Itching, burning, redness, and irritation at the application site.
Q4: Is Clioquinol safe to use during pregnancy or breastfeeding?
A: Caution is advised. Consult a physician to discuss the risks and benefits.
Q5: Are there any drug interactions I should be aware of with Clioquinol?
A: Yes. Clioquinol can interact with other topical antifungals or corticosteroids, iodine-containing preparations, and medications that affect the immune system. It can also interfere with certain thyroid function tests.
Q6: What should I do if I miss a dose of Clioquinol?
A: Apply the missed dose as soon as you remember, unless it is almost time for your next dose. Do not double the dose to catch up.
Q7: Can Clioquinol be used on open wounds?
A: No, Clioquinol is contraindicated for use on open wounds or mucous membranes.
Q8: How should Clioquinol be stored?
A: Store in a cool, dry place away from direct sunlight.
Q9: What is the mechanism of action of Clioquinol?
A: Clioquinol inhibits bacterial and fungal growth and has mild anti-inflammatory properties.
Q10: Are there any contraindications for using Clioquinol?
A: Yes. Contraindications include hypersensitivity to Clioquinol or iodine, open wounds, perforated tympanic membrane (for ear drops), primary infections of the outer ear (for ear drops), and children under 2 years of age. Specific formulations may have additional contraindications.
