Usage
This combination medication is prescribed for inflammatory skin conditions complicated by bacterial and/or fungal infections. These conditions include:
- Eczema
- Dermatitis (various types)
- Psoriasis
- Impetigo
- Diaper rash
- Lichen simplex chronicus
- Insect bites
- Burns
- Boils
- Otitis externa
- Other dermatoses with secondary infection.
Pharmacological Classification: This is a combination product containing a corticosteroid, an antifungal, and an antibiotic.
Mechanism of Action: Beclometasone is a corticosteroid that reduces inflammation and itching. Clotrimazole is an antifungal that disrupts the fungal cell membrane. Gentamicin is an aminoglycoside antibiotic that inhibits bacterial protein synthesis.
Alternate Names
This triple combination doesn’t have a universally recognized International Nonproprietary Name (INN). It’s often referred to by its constituent drugs.
Brand Names: Brand names vary by region. Examples include: Betnovate-GM, Triderm, Canesten HC, Lotriderm. Many other brand names exist.
How It Works
Pharmacodynamics:
- Beclometasone: Binds to glucocorticoid receptors, reducing inflammation by suppressing the immune response and inhibiting the production of inflammatory mediators.
- Clotrimazole: Alters fungal cell membrane permeability, leading to leakage of essential intracellular components and fungal cell death.
- Gentamicin: Binds to bacterial ribosomes, inhibiting protein synthesis and leading to bacterial cell death.
Pharmacokinetics:
- Primarily topical application. Systemic absorption is minimal under normal conditions.
- Beclometasone: Metabolized in the liver, excreted mainly in the urine and feces.
- Clotrimazole: Minimally absorbed through the skin. Hepatic metabolism.
- Gentamicin: Negligible systemic absorption when applied topically. Excreted primarily unchanged in the urine.
Receptor binding, enzyme inhibition, or neurotransmitter modulation: Beclometasone binds to glucocorticoid receptors. Clotrimazole interacts with fungal cell membrane components. Gentamicin binds to bacterial ribosomes.
Elimination pathways: Beclometasone is eliminated via hepatic metabolism and renal/fecal excretion. Clotrimazole is eliminated via hepatic metabolism. Topically applied gentamicin is mostly not absorbed. If absorbed, it is excreted renally.
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected area twice daily.
Special Cases:
- Elderly Patients: Use with caution and for limited periods.
- Patients with Renal Impairment: Caution is advised, especially with prolonged use, as small amounts of gentamicin can be absorbed systemically. Monitor renal function.
- Patients with Hepatic Dysfunction: Caution is advised.
- Patients with Comorbid Conditions: Caution in patients with diabetes (beclometasone can affect blood glucose).
Clinical Use Cases
The dosage for this combination medication remains the same across various clinical scenarios. It is typically not used for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its use is limited to topical skin infections.
Dosage Adjustments
Dosage adjustments are usually not necessary for topical use. However, individual patient factors should be considered.
Side Effects
Common Side Effects
- Burning sensation
- Itching
- Irritation
- Redness
- Dryness
Rare but Serious Side Effects
- Skin atrophy
- Telangiectasia
- Hypopigmentation
- Hypertrichosis
- Allergic contact dermatitis
- Secondary infection
Long-Term Effects
- Skin thinning
- Striae
- Cushing’s syndrome (with extensive use or occlusion)
Adverse Drug Reactions (ADR)
Severe allergic reactions (rare).
Contraindications
- Hypersensitivity to any of the components.
- Viral skin infections (herpes simplex, varicella, vaccinia).
- Tuberculosis of the skin.
- Untreated fungal infections not susceptible to clotrimazole.
- Rosacea, acne, perioral dermatitis.
Drug Interactions
- No significant drug interactions are expected with topical application. However, inform patients to disclose all medications, including topical products.
Pregnancy and Breastfeeding
Safety during pregnancy and breastfeeding has not been fully established. Use only if the potential benefit outweighs the potential risk to the fetus or infant.
Drug Profile Summary
- Mechanism of Action: Combines anti-inflammatory, antifungal, and antibacterial actions.
- Side Effects: Burning, itching, irritation, dryness, redness. Rarely: skin atrophy, allergic reactions.
- Contraindications: Hypersensitivity, viral skin infections, tuberculosis of the skin, rosacea, acne.
- Drug Interactions: No significant interactions expected with topical application.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: Topical application twice daily.
- Monitoring Parameters: Monitor for local skin reactions and signs of systemic absorption with prolonged use, especially in children.
Popular Combinations
This product is already a combination. No further combination is recommended.
Precautions
- Avoid contact with eyes.
- Do not use on broken skin or open wounds unless specifically directed by a physician.
- For external use only.
- Discontinue if irritation or sensitization occurs.
FAQs (Frequently Asked Questions)
A: Apply a thin layer to the affected skin area twice daily.
Q2: Can it be used on the face?
A: Use on the face with caution and for limited periods due to increased risk of skin atrophy.
Q3: Can it be used for diaper rash?
A: Yes, it can be used for diaper rash complicated by secondary infection. However, ensure proper hygiene practices.
Q4: How long should it be used?
A: Generally, not more than 2-4 weeks. Consult a doctor if the condition persists.
Q5: What if I accidentally get it in my eyes?
A: Rinse thoroughly with water. Seek medical advice if irritation persists.
Q6: Can I use it if I’m pregnant or breastfeeding?
A: Consult your doctor before use during pregnancy or breastfeeding.
Q7: Can it be used in children?
A: Use with extreme caution in children and under strict medical supervision due to higher systemic absorption risk. Limit application to the shortest period needed.
Q8: Can it be used with other topical medications?
A: Inform your doctor about all other medications you are using, including topical products, to avoid potential interactions or additive effects.
Q9: What if my skin condition worsens after using it?
A: Discontinue use and consult a doctor immediately.
Q10: Can I cover the treated area with a bandage?
A: Generally, avoid covering the treated area with a bandage or dressing, as this can enhance absorption and increase the risk of side effects.
