Usage
This combination medication is prescribed for inflammatory skin disorders complicated by secondary bacterial and/or fungal infections. These include conditions like eczema, psoriasis, dermatitis, and tinea infections where inflammation, bacterial infection, and fungal infection co-exist.
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Pharmacological Classification: This is a combination product containing a corticosteroid (clobetasol), an antifungal (miconazole), an antibiotic (neomycin), and an astringent/anti-inflammatory agent (zinc sulfate).
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Mechanism of Action: Clobetasol is a potent topical corticosteroid that reduces inflammation by suppressing the immune response and constricting blood vessels. Miconazole inhibits fungal growth by disrupting the synthesis of ergosterol, a crucial component of the fungal cell membrane. Neomycin is an aminoglycoside antibiotic that inhibits bacterial protein synthesis. Zinc sulfate exerts astringent and mild anti-inflammatory actions.
Alternate Names
No internationally recognized non-proprietary name exists for this combination. It may be referred to by the names of its individual components.
- Brand Names: Several brand names exist depending on the manufacturer and region. Some examples include “A TO Z Cream”, “Afderm Plus Cream”, and “Agiclob NM Cream.” Many other brand names also exist.
How It Works
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Pharmacodynamics: Clobetasol reduces inflammation, itching, and redness. Miconazole eliminates fungal infection. Neomycin eliminates bacterial infection. Zinc sulfate promotes drying and healing.
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Pharmacokinetics: Clobetasol is minimally absorbed systemically when applied topically. Systemic absorption of neomycin is also low with intact skin, but increases with broken skin. Miconazole and zinc sulfate have minimal systemic absorption. Metabolism and excretion data for the combination are limited, as studies usually focus on the individual components. Clobetasol is primarily metabolized in the liver. Neomycin is primarily excreted unchanged by the kidneys. Miconazole is metabolized in the liver. Zinc is primarily excreted in feces.
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Mode of Action: See “Mechanism of Action” in the “Usage” section.
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Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Clobetasol binds to glucocorticoid receptors. Miconazole inhibits fungal cytochrome P450 enzymes. Neomycin inhibits bacterial ribosomal protein synthesis.
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Elimination Pathways: See “Pharmacokinetics.”
Dosage
Standard Dosage
Adults: Apply a thin layer to the affected area twice daily.
Children: Apply a thin layer to the affected area of children over 2 years of age twice daily, under strict medical supervision. It’s essential to re-evaluate treatment weekly for pediatric patients.
Special Cases:
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Elderly Patients: Close monitoring is recommended due to increased susceptibility to adverse effects like skin thinning. Dose adjustments may be necessary based on individual patient response.
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Patients with Renal Impairment: Exercise caution due to the nephrotoxic potential of neomycin. Monitor renal function. Dose adjustment might be required.
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Patients with Hepatic Dysfunction: Clobetasol is metabolized in the liver. Caution is advised. Monitor liver function and consider dose adjustments.
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Patients with Comorbid Conditions: Monitor closely in patients with other conditions due to possible drug interactions or altered drug metabolism. Adjust dose as necessary.
Clinical Use Cases
This combination cream is not typically indicated for systemic medical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary use is limited to topical application on affected skin areas.
Dosage Adjustments
Adjustments are based on patient factors like age, renal function, hepatic function, and other medical conditions. Monitor patients for adverse effects and adjust the dose as necessary.
Side Effects
Common Side Effects:
- Burning sensation
- Itching
- Irritation
- Dryness
- Redness at the application site
Rare but Serious Side Effects:
- Skin atrophy (thinning)
- Telangiectasia (spider veins)
- Hypopigmentation
- Hypertrichosis (excessive hair growth)
- Allergic contact dermatitis
- Cushing’s syndrome (with prolonged or excessive use)
Long-Term Effects:
- Skin atrophy
- Striae (stretch marks)
- Telangiectasia
Adverse Drug Reactions (ADR):
- Severe allergic reactions (rare)
Contraindications
- Hypersensitivity to any component of the medication
- Primary cutaneous viral infections (e.g., herpes simplex, varicella)
- Rosacea
- Acne vulgaris
- Perioral dermatitis
- Neonates and infants
Drug Interactions
- Concurrent use with other topical corticosteroids may increase the risk of systemic side effects.
- Neomycin may interact with systemic aminoglycosides, increasing the risk of nephrotoxicity and ototoxicity.
Pregnancy and Breastfeeding
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Pregnancy: Safety during pregnancy has not been established. Use only if potential benefits outweigh potential risks to the fetus.
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Breastfeeding: Not known if excreted in breast milk. Avoid applying to the breast area if breastfeeding.
Drug Profile Summary
- Mechanism of Action: Corticosteroid, antifungal, antibiotic, and astringent/anti-inflammatory actions.
- Side Effects: See “Side Effects.”
- Contraindications: See “Contraindications.”
- Drug Interactions: See “Drug Interactions.”
- Pregnancy & Breastfeeding: See “Pregnancy and Breastfeeding.”
- Dosage: See “Dosage.”
- Monitoring Parameters: Monitor for local skin reactions and systemic side effects (if prolonged use). Monitor renal function in patients with renal impairment.
Popular Combinations
This combination itself is a commonly used mixture. Combining it with other medications is generally not recommended without specific clinical indication and careful monitoring.
Precautions
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General Precautions: Perform a patch test before widespread application, especially in patients with a history of allergies. Avoid contact with eyes and mucous membranes.
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Specific Populations: See “Dosage - Special Cases” and “Pregnancy and Breastfeeding.”
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Lifestyle Considerations: No specific lifestyle considerations. However, advise patients to avoid excessive sun exposure on treated areas.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Clobetasol + Miconazole + Neomycin + Zinc Sulphate Monohydrate?
A: Apply a thin layer to the affected area twice daily. See “Dosage” section for details about specific populations and adjustments.
Q2: Can this cream be used on the face?
A: Use on the face should be limited and under close medical supervision due to increased absorption and the risk of side effects like skin atrophy and telangiectasia.
Q3: Can I use this cream if I’m pregnant or breastfeeding?
A: Consult your doctor before using this cream during pregnancy or breastfeeding. See “Pregnancy and Breastfeeding.”
Q4: What are the signs of an allergic reaction to this cream?
A: Signs may include increased redness, itching, burning, swelling, or blistering at the application site. If these occur, discontinue use and consult a doctor.
Q5: How long can I use this cream continuously?
A: Do not use for more than 7 days without medical supervision. Prolonged use can increase the risk of side effects like skin thinning.
Q6: Can I use this cream on broken skin?
A: Use with caution on broken skin, as it can increase the systemic absorption of neomycin.
Q7: Should I cover the treated area with a bandage?
A: Generally, avoid covering the treated area unless specifically directed by your doctor. Covering the area can increase absorption and the risk of side effects.
Q8: Can I use other topical medications at the same time as this cream?
A: Avoid using other topical medications on the same area without consulting your doctor. Some medications may interact.
Q9: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember. However, if it’s almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply extra cream to make up for a missed dose.
