Usage
Fluocinolone acetonide + Gentamicin is prescribed for inflammatory skin disorders complicated by bacterial infection. This includes conditions like infected atopic dermatitis, eczema, neurodermatitis, seborrheic dermatitis, contact dermatitis, and anogenital pruritus.
This combination medication falls under two pharmacological classifications:
- Corticosteroid (Fluocinolone acetonide): Provides anti-inflammatory, antipruritic (anti-itch), and vasoconstrictive effects.
- Aminoglycoside Antibiotic (Gentamicin): Exhibits bactericidal action against a broad spectrum of gram-positive and gram-negative bacteria.
Alternate Names
Several brand names exist for this combination, including Gentasolon and Genolon. No widely used international nonproprietary names (INNs) exist for the combination product itself; the components are referred to by their respective INNs, fluocinolone acetonide and gentamicin sulfate.
How It Works
Fluocinolone acetonide exerts its anti-inflammatory action by binding to glucocorticoid receptors in the skin. This binding leads to decreased production of inflammatory mediators, reduced vascular permeability, and suppression of the immune response. It is metabolized primarily in the liver and excreted via the kidneys.
Gentamicin acts by irreversibly binding to the 30S subunit of bacterial ribosomes. This inhibits protein synthesis, leading to bacterial cell death. Gentamicin is primarily excreted unchanged by the kidneys.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area two to three times daily.
Children:
The safety and efficacy in children have not been fully established. Consultation with a pediatrician is crucial. Limit application to five days and avoid use on the face.
Special Cases:
- Elderly Patients: No specific dosage adjustments are generally recommended, but close monitoring for side effects is important.
- Patients with Renal Impairment: Caution should be used. Systemic absorption can occur with prolonged use over large areas, potentially affecting renal function.
- Patients with Hepatic Dysfunction: Use cautiously as Fluocinolone acetonide is metabolized by the liver.
- Patients with Comorbid Conditions: Consider comorbid conditions like diabetes and adrenal gland disorders as corticosteroids can affect glucose metabolism and adrenal function.
Clinical Use Cases
This topical medication is generally not indicated for use in systemic contexts such as intubation, surgical procedures, mechanical ventilation, ICU care, or emergency situations. Its use is limited to topical application on the skin.
Dosage Adjustments
Adjustments are typically made based on the patient’s response and tolerance to the medication. Consider renal and hepatic function when applying over large areas for prolonged periods.
Side Effects
Common Side Effects
- Burning
- Itching
- Irritation
- Dryness
- Redness at the application site.
Rare but Serious Side Effects
- Skin atrophy
- Telangiectasia (spider veins)
- Striae (stretch marks)
- Hypopigmentation
- Hypertrichosis (excessive hair growth)
- Secondary infections
- Allergic contact dermatitis.
Long-Term Effects
Prolonged use can lead to skin thinning, striae, and telangiectasia. Systemic absorption can cause adrenal suppression, particularly in children or when used over large areas.
Adverse Drug Reactions (ADR)
Severe allergic reactions are rare but possible. Hypersensitivity to gentamicin can manifest as local or systemic reactions.
Contraindications
- Vaccinia
- Varicella
- Tuberculosis of the skin
- Hypersensitivity to any component of the medication.
Drug Interactions
Limited information is available about specific drug interactions with topical Fluocinolone acetonide + Gentamicin. However, concurrent use of other topical medications on the same area should be avoided unless specifically directed by a physician.
Pregnancy and Breastfeeding
Safety during pregnancy and breastfeeding has not been fully established. Use only if the potential benefit outweighs the risk to the fetus or infant. For breastfeeding mothers, avoid applying the medication to areas where the infant might come into contact with it.
Drug Profile Summary
- Mechanism of Action: Fluocinolone acetonide: Binds to glucocorticoid receptors, reducing inflammation. Gentamicin: Inhibits bacterial protein synthesis.
- Side Effects: Burning, itching, irritation, dryness, skin atrophy, telangiectasia, striae.
- Contraindications: Vaccinia, varicella, cutaneous tuberculosis, hypersensitivity.
- Drug Interactions: Limited data available. Consult a healthcare professional.
- Pregnancy & Breastfeeding: Consult a physician, use cautiously.
- Dosage: Apply thinly 2-3 times daily.
- Monitoring Parameters: Monitor for local skin reactions and signs of systemic absorption.
Popular Combinations
No established combinations exist for enhancing the topical application of Fluocinolone acetonide + Gentamicin.
Precautions
- Avoid use on broken skin or open wounds.
- Avoid contact with eyes, nose, and mouth.
- Do not use under occlusive dressings unless directed by a physician.
- Use cautiously in patients with diabetes or impaired adrenal function.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Fluocinolone acetonide + Gentamicin?
A: Apply a thin layer to the affected skin area two to three times per day.
Q2: Can I use this medication on my face?
A: Use on the face should be limited to five days, and only under the close supervision of a physician.
Q3: Can I use this medication if I am pregnant?
A: Consult your doctor before using if you are pregnant or breastfeeding. The safety in these situations hasn’t been fully established.
Q4: What should I do if my symptoms don’t improve?
A: Consult your doctor if your condition doesn’t improve or worsens after a few days of treatment.
Q5: Can I use this cream with other topical medications?
A: Avoid using other topical medications concurrently on the same area unless advised by your physician.
Q6: Are there any long-term side effects I should be aware of?
A: Prolonged use can lead to skin thinning, stretch marks, and visible blood vessels (telangiectasia).
Q7: How should I store this medication?
A: Store in a cool, dry place below 25°C.
Q8: What if I accidentally ingest this medication?
A: This medication is for external use only. If ingested, seek medical advice immediately.
Q9: Can this medication be used on children?
A: The safety and efficacy in children have not been fully established. Pediatric use should be limited, and under strict supervision of a pediatrician.
