Fluticasone Propionate + Terbinafine

Usage

Fluticasone propionate + terbinafine is prescribed for inflammatory fungal skin infections, such as ringworm (tinea corporis), athlete’s foot (tinea pedis), jock itch (tinea cruris), and other dermatomycoses where inflammation is a prominent feature.

• Pharmacological Classification: This is a combination product containing a corticosteroid (fluticasone propionate) and an antifungal (terbinafine hydrochloride).

• Mechanism of Action: Fluticasone reduces inflammation by binding to glucocorticoid receptors, suppressing the immune response, and inhibiting the release of inflammatory mediators. Terbinafine inhibits squalene epoxidase, a key enzyme in fungal ergosterol biosynthesis, leading to fungal cell membrane disruption and death.

Alternate Names

There are no officially recognized alternate names for this combination product. However, it may be referred to simply as “fluticasone/terbinafine.”

• Brand Names: This combination is marketed under various brand names depending on the region. Some examples include Corifung Plus Cream, Panderm Plus cream.

How It Works

• Pharmacodynamics: Fluticasone exerts its anti-inflammatory action by binding to intracellular glucocorticoid receptors. This complex modulates gene expression, decreasing the production of inflammatory cytokines and inhibiting the activity of inflammatory cells. Terbinafine specifically targets fungal cells by inhibiting squalene epoxidase. This leads to a deficiency of ergosterol, a vital component of fungal cell membranes, and an accumulation of squalene, resulting in fungal cell death.

• Pharmacokinetics:

  • Fluticasone Propionate: Topically applied fluticasone propionate is minimally absorbed systemically. The absorbed drug is rapidly metabolized, primarily by CYP3A4 enzymes in the liver. It is mainly excreted in the feces and to a lesser extent in the urine.
  • Terbinafine Hydrochloride: Terbinafine applied topically achieves high concentrations in the stratum corneum, hair follicles, and sebaceous glands, where fungal infections commonly reside. A small amount is absorbed systemically and is metabolized in the liver, mainly by CYP enzymes. It is primarily excreted in the urine, with some excretion in feces and sweat.

• Mode of Action: Fluticasone binds to glucocorticoid receptors, affecting gene transcription and reducing inflammatory mediators. Terbinafine inhibits squalene epoxidase, disrupting fungal ergosterol biosynthesis and causing cell death.

• Elimination Pathways: Fluticasone propionate is eliminated primarily through hepatic metabolism, with excretion in feces and urine. Terbinafine is mainly eliminated through hepatic metabolism with urinary excretion and some elimination in feces.

Dosage

Standard Dosage

Adults: Apply a thin layer to the affected skin areas once or twice daily. Treatment duration typically ranges from 2 to 4 weeks, depending on the infection and its severity.

Children: Use in children under 12 years of age is generally not recommended unless under the guidance of a pediatrician.

Special Cases:

• Elderly Patients: No specific dose adjustments are typically necessary. However, close monitoring for adverse effects is advised.
• Patients with Renal Impairment: No specific dose adjustments are necessary for topical application.
• Patients with Hepatic Dysfunction: Caution is advised, especially with extensive application or prolonged use.
• Patients with Comorbid Conditions: No specific dosage adjustments for topical preparations of Fluticasone Propionate + Terbinafine are mentioned.

Clinical Use Cases

The combination is intended for topical use on the skin. It’s not used in settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.

Dosage Adjustments

Dose adjustments are based on response to therapy and potential adverse events. No specific adjustments are routinely made based on renal/hepatic function, or metabolic disorders.

Side Effects

Common Side Effects:

• Application site reactions (burning, itching, irritation, dryness, redness).

Rare but Serious Side Effects:

• Allergic contact dermatitis
• Skin atrophy (with prolonged use)
• Worsening of underlying skin conditions

Long-Term Effects:

• Skin atrophy, telangiectasia, striae (with prolonged or high-potency corticosteroid use).

Adverse Drug Reactions (ADR)

• Angioedema, urticaria (rare).

Contraindications

• Hypersensitivity to fluticasone, terbinafine, or any component of the formulation.
• Viral skin infections (e.g., herpes simplex, chickenpox).
• Rosacea, acne, perioral dermatitis.

Drug Interactions

• Terbinafine: May interact with CYP2D6 inhibitors (e.g., fluoxetine, paroxetine) and inducers (e.g., rifampin).
• Fluticasone: May interact with strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir).

Pregnancy and Breastfeeding

• Pregnancy: Use only if clearly needed and the potential benefits outweigh the risks to the fetus. Topical use is generally preferred over oral terbinafine if antifungal therapy is necessary.
• Breastfeeding: Consult a physician before use. Topical application to limited areas is generally considered low risk, but avoid applying to the breast area.

Drug Profile Summary

• Mechanism of Action: Terbinafine: inhibits fungal squalene epoxidase; Fluticasone propionate: binds to glucocorticoid receptors, exerting anti-inflammatory effects.
• Side Effects: Application site reactions, allergic reactions, skin atrophy (long-term).
• Contraindications: Hypersensitivity, viral skin infections, rosacea, acne.
• Drug Interactions: Potential interactions with CYP450 modulators (Terbinafine), QT prolonging drugs (Fluticasone).
• Pregnancy & Breastfeeding: Use with caution; consult a physician.
• Dosage: Topical application once or twice daily for 2-4 weeks.
• Monitoring Parameters: Monitor for treatment response, adverse reactions, and signs of adrenal suppression with extensive or prolonged use.

Popular Combinations

This combination itself represents a popular therapeutic approach.

Precautions

• Avoid application on open wounds, broken skin, or mucous membranes.
• Do not use occlusive dressings unless specifically directed by a physician.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Fluticasone Propionate + Terbinafine?

A: Apply a thin layer to the affected skin once or twice daily for 2-4 weeks.

Q2: Can this combination be used on the face?

A: It should be used cautiously on the face and avoided in areas like the eyelids or near the eyes due to the risk of skin thinning and other adverse effects.

Q3: What are the common side effects?

A: Burning, itching, irritation, dryness, and redness at the application site are common.

Q4: What should be done if side effects occur?

A: Discontinue use and consult a physician. Mild side effects often resolve on their own.

Q5: Can this be used during pregnancy or breastfeeding?

A: Consult a physician before using during pregnancy or breastfeeding. Topical application is generally preferred if antifungal therapy is essential.

Q6: What are the contraindications for this medication?

A: Hypersensitivity, viral skin infections, rosacea, acne, and perioral dermatitis are contraindications.

Q7: How does this medication interact with other drugs?

A: Terbinafine can interact with certain medications metabolized by the liver. Fluticasone may interact with drugs that prolong the QT interval. Provide a complete medication history to your physician.

Q8: What is the duration of treatment?

A: The usual treatment duration is 2 to 4 weeks, depending on the infection and its severity. Your physician will determine the appropriate duration based on your specific condition.

Q9: How should this medication be stored?

A: Store at room temperature away from excessive heat and moisture. Keep out of reach of children.