Usage
This combination cream is prescribed for inflammatory skin disorders complicated by bacterial and fungal infections. It is effective against dermatoses responsive to corticosteroids, such as eczema, psoriasis, and contact dermatitis, when these conditions are also infected. It is not effective against acne and may worsen the condition. This medication is for topical use only.
Pharmacological Classification: Combination product containing a corticosteroid, antibiotic, antifungal, and minerals. Specifically:
- Clobetasol: Corticosteroid
- Neomycin: Aminoglycoside antibiotic
- Miconazole: Imidazole antifungal
- Zinc Oxide & Borax: Protectants/minerals with mild antiseptic properties
Mechanism of Action:
- Clobetasol: Exerts anti-inflammatory, antipruritic, and vasoconstrictive effects by inhibiting the release of inflammatory mediators.
- Neomycin: Inhibits bacterial protein synthesis, leading to bacterial cell death.
- Miconazole: Alters fungal cell wall permeability, causing fungal cell death.
- Zinc Oxide & Borax: Provide a protective barrier and contribute to a slightly alkaline environment that is unfavorable to some microorganisms.
Alternate Names
Clobeta GM Cream (common brand name). Other brand names may exist regionally.
How It Works
Pharmacodynamics:
Clobetasol reduces inflammation and itching; neomycin inhibits bacterial protein synthesis; miconazole inhibits fungal growth. Zinc oxide and borax act as protectants and have mild antiseptic properties.
Pharmacokinetics:
Topical absorption is limited but increases with application to large areas, damaged skin, or use of occlusive dressings. Clobetasol is metabolized in the liver and excreted primarily in the urine. Neomycin and Miconazole are minimally absorbed topically when applied to intact skin.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area twice daily. Treatment duration should be limited to the minimum effective period due to the presence of a potent corticosteroid (generally no more than 1-2 weeks). The total dosage should not exceed 50 grams per week.
Children:
Use with caution in children older than 2 years. Prolonged use of topical corticosteroids in children should be avoided due to the risk of increased systemic absorption. A course of treatment for children should be limited to 5 days, and occlusive dressings should not be used. This medication is not recommended for neonates and infants (younger than 2 years).
Special Cases:
- Elderly Patients: Generally, no dosage adjustment is required, but greater sensitivity in some older individuals cannot be ruled out.
- Patients with Renal Impairment: Dosage should be reduced.
- Patients with Hepatic Dysfunction: Use with caution due to clobetasol’s hepatic metabolism.
- Patients with Comorbid Conditions: Pre-existing adrenal gland problems should be considered.
Clinical Use Cases
This combination is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. It is intended for topical treatment of dermatological conditions. In emergency situations, other medications are typically preferred.
Dosage Adjustments
Dosage adjustments are necessary for patients with renal/hepatic dysfunction.
Side Effects
Common Side Effects
- Burning sensation at the application site
- Dry skin
- Itching
- Redness
- Skin irritation
Rare but Serious Side Effects
- Severe allergic reactions
- Signs of systemic corticosteroid absorption (Cushingoid features)
- Nephrotoxicity or ototoxicity from neomycin (rare with topical use)
Long-Term Effects
Skin thinning (atrophy) can occur with prolonged use of topical corticosteroids. Hypopigmentation has also been reported.
Adverse Drug Reactions (ADR)
Severe allergic reactions and signs of systemic corticosteroid absorption necessitate immediate intervention.
Contraindications
- Hypersensitivity to any of the components
- Viral skin infections (e.g., herpes simplex, chickenpox)
- Rosacea
- Acne vulgaris
- Perioral dermatitis
Drug Interactions
While minimal with topical application, concomitant use of other topical medications on the same area should be avoided unless directed by a physician. Oral anticoagulants, anti-diabetic drugs, some antibiotics, and grapefruit juice may interact with this medication.
Pregnancy and Breastfeeding
Pregnancy: Clobetasol is a Category C drug. Use only if the potential benefit outweighs the risk to the fetus.
Breastfeeding: Exercise caution. It is unknown whether these components are excreted in human milk. Avoid applying to the breast area shortly before breastfeeding.
Drug Profile Summary
See above sections for detailed information.
Popular Combinations
This product is already a combination of active ingredients. Combining it with other topical agents is generally not recommended.
Precautions
- Avoid contact with eyes, nose, and mouth.
- Do not use on broken skin or open wounds.
- Do not use under occlusive dressings unless directed by a physician.
- Monitor for signs of skin atrophy and allergic reactions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Borax + Clobetasol + Miconazole + Neomycin + Zinc Oxide?
A: Apply a thin layer to the affected area twice daily for no more than 1-2 weeks in adults. See Dosage section for pediatric and special population dosing.
Q2: What skin conditions is this combination used for?
A: It is used for inflammatory skin conditions complicated by bacterial and fungal infections, like eczema, psoriasis and contact dermatitis when infected.
Q3: What are the main side effects?
A: Common side effects include burning, itching, dryness, and irritation at the application site.
Q4: Are there any serious side effects?
A: Rarely, allergic reactions or signs of systemic corticosteroid absorption can occur.
Q5: Can this be used during pregnancy or breastfeeding?
A: Use with caution. Consult a physician to assess the risks and benefits.
Q6: Are there any drug interactions I should be aware of?
A: Concomitant use of other topical medications, some oral medications and grapefruit juice can cause interactions. Consult a physician.
Q7: What should I do if I accidentally swallow the cream?
A: Contact a poison control center or seek medical attention immediately.
Q8: Can I use this cream on my face?
A: Generally avoid use on the face unless specifically directed by a physician.
Q9: How long can I use this cream?
A: Use for the shortest duration necessary, typically no longer than 1-2 weeks, unless advised by a physician.
Q10: Is this cream suitable for children?
A: Use cautiously in children older than 2 years under the guidance of a physician. Avoid prolonged use. Not recommended for children younger than 2.
