Usage
Fluticasone Propionate + Fusidic Acid is a combination medication prescribed for inflammatory skin disorders complicated by bacterial infection, such as infected eczema and atopic dermatitis.
Pharmacological Classification:
- Fluticasone Propionate: Corticosteroid, Anti-inflammatory
- Fusidic Acid: Antibiotic
Mechanism of Action:
This combination tackles both inflammation and infection. Fluticasone propionate reduces inflammation, itching, and redness by suppressing the immune response. Fusidic acid inhibits bacterial protein synthesis, preventing bacterial growth and spread of the infection.
Alternate Names
While there isn’t a universally recognized alternate name for this specific drug combination, the individual components are sometimes referred to as:
- Fluticasone Propionate: Fluticasone
- Fusidic Acid: Sodium Fusidate
Brand Names:
Flutoson-F, Fexin F, Flute F are among the brand names under which this combination is marketed. Brand names may vary regionally.
How It Works
Pharmacodynamics:
Fluticasone Propionate exerts its anti-inflammatory action by binding to glucocorticoid receptors in the skin cells. This leads to decreased production of inflammatory mediators, reducing swelling, redness, and itching. Fusidic Acid acts on bacterial ribosomes, inhibiting protein synthesis and thereby halting bacterial growth.
Pharmacokinetics:
- Absorption: Both drugs are absorbed percutaneously (through the skin) following topical application, with minimal systemic absorption. Occlusive dressings increase absorption.
- Metabolism: Fluticasone propionate is primarily metabolized in the liver by CYP3A4 enzymes. Fusidic acid undergoes minimal metabolism.
- Elimination: Fluticasone propionate is primarily eliminated in the feces, with a small amount excreted in urine. Fusidic acid is mainly excreted in bile.
Mode of Action:
Fluticasone propionate modulates gene expression to reduce inflammation. Fusidic acid inhibits bacterial protein synthesis by interfering with translocation on the ribosome.
Receptor binding, enzyme inhibition, or neurotransmitter modulation: Fluticasone propionate binds to glucocorticoid receptors. Fusidic acid does not bind to receptors but inhibits bacterial elongation factor G.
Dosage
Standard Dosage
Adults:
Apply a thin layer of the cream to the affected area two to three times daily. The duration of treatment should be limited to the minimum time necessary to control the infection and inflammation. Typically, this is one to two weeks.
Children:
Similar to adults, apply a thin layer two to three times a day. Monitor for side effects, especially with prolonged use or application over large areas.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically required. However, close monitoring for systemic effects is recommended with extensive application or prolonged use.
- Patients with Renal Impairment: No specific dosage adjustments needed as systemic absorption is minimal.
- Patients with Hepatic Dysfunction: Use cautiously in patients with severe hepatic impairment due to potential increased systemic availability of fluticasone propionate. Monitor for systemic side effects.
- Patients with Comorbid Conditions: Consider coexisting conditions that might be exacerbated by corticosteroids or antibiotics.
Clinical Use Cases
The combination is generally not indicated for systemic use and hence has no dosage recommendations for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. It is exclusively for topical use on the skin.
Side Effects
Common Side Effects:
Burning, stinging, itching, dryness, irritation, skin thinning, redness, swelling, acne, excessive hair growth, folliculitis (inflammation of hair follicles).
Rare but Serious Side Effects:
Allergic contact dermatitis, skin atrophy, striae (stretch marks), secondary infections, hypopigmentation. Systemic effects with extensive application, especially in children, can include adrenal suppression, growth retardation, Cushing’s syndrome.
Long-Term Effects:
Skin thinning, telangiectasia (spider veins), hypopigmentation, striae. Prolonged use, especially under occlusion, increases the risk of systemic side effects.
Contraindications
Hypersensitivity to either fluticasone propionate or fusidic acid. Avoid application to open wounds, viral, fungal, or tuberculous skin lesions, rosacea, perioral dermatitis. Use with caution in patients with a history of skin atrophy.
Drug Interactions
Clinically significant interactions with topical application are rare due to limited systemic absorption. Inform patients to report all concomitant medications, including topical and systemic drugs. Monitor for any unusual skin reactions.
Pregnancy and Breastfeeding
Pregnancy: Use with caution during pregnancy only if the potential benefit outweighs the risk to the fetus. Topical corticosteroids should not be used extensively in large amounts or for prolonged periods during pregnancy.
Breastfeeding: Exercise caution as it is unknown whether topical fluticasone propionate is excreted in breast milk. It is likely safe when used sparingly. Advise avoiding application directly to the breast area before nursing.
Drug Profile Summary
- Mechanism of Action: Reduces inflammation (fluticasone) and inhibits bacterial growth (fusidic acid).
- Side Effects: Local: burning, itching, dryness. Systemic (rare): adrenal suppression.
- Contraindications: Hypersensitivity, viral/fungal/tuberculous lesions.
- Drug Interactions: Limited with topical use.
- Pregnancy & Breastfeeding: Use cautiously if benefits outweigh risks.
- Dosage: Apply thinly 2–3 times daily.
- Monitoring Parameters: Observe skin for local reactions and systemic effects.
Popular Combinations
This combination itself is a popular pairing in dermatology for treating infected inflammatory skin conditions.
Precautions
Avoid contact with eyes, mouth, or open wounds. Discontinue use if irritation develops. Do not use occlusive dressings unless directed by a physician. Wash hands thoroughly after application. Avoid prolonged use, especially in children.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Fluticasone Propionate + Fusidic Acid?
A: Apply a thin layer to affected areas 2-3 times/day. Duration depends on the condition and response, usually 1-2 weeks.
Q2: What are the common side effects?
A: Common side effects include burning, itching, dryness, skin thinning, redness, and folliculitis.
Q3: Can this cream be used on the face?
A: Use with caution on the face due to the risk of skin atrophy and telangiectasia. Avoid prolonged use.
Q4: Is it safe to use during pregnancy?
A: Use cautiously during pregnancy only if the benefits outweigh the potential risks to the fetus. Consult a specialist.
Q5: Can I use this cream if I am breastfeeding?
A: Exercise caution while breastfeeding. Avoid applying directly to the nipples before nursing. Consult a doctor.
Q6: How long does it take to see improvement?
A: Improvement can be seen within a few days, but complete resolution may take 1-2 weeks or longer.
Q7: What should I do if I miss a dose?
A: Apply the missed dose as soon as remembered unless it’s close to the next scheduled dose. Do not apply a double dose.
Q8: What should I do if I experience severe side effects?
A: Discontinue use and consult a doctor immediately.
Q9: Can this cream be used with other topical medications?
A: Inform your doctor about all other medications, including topical treatments, to avoid potential interactions.
