Usage
Hydrocortisone + Miconazole is prescribed for inflammatory skin infections where fungal or bacterial infection is present with inflammation. It is indicated for infected eczema, candidal intertrigo, and tinea pedis.
Pharmacological Classification: This is a combination product containing a corticosteroid (hydrocortisone) and an antifungal (miconazole). Thus, it can be classified as a combination topical anti-inflammatory and antifungal agent.
Mechanism of Action: Hydrocortisone reduces inflammation by decreasing vascular permeability, suppressing leukocyte migration, and causing vasoconstriction. Miconazole inhibits ergosterol synthesis, a vital component of fungal cell membranes, leading to fungal cell death. It also demonstrates activity against some gram-positive bacteria.
Alternate Names
No alternate generic names found.
Brand Names: Daktacort, Resolve Plus, others.
How It Works
Pharmacodynamics: Hydrocortisone exerts its anti-inflammatory effect through binding to glucocorticoid receptors, which modulates gene expression related to inflammation. Miconazole works by inhibiting the fungal cytochrome P450 enzyme lanosterol 14α-demethylase, thereby blocking ergosterol synthesis. This disrupts the fungal cell membrane, leading to cell death.
Pharmacokinetics:
- Absorption: Hydrocortisone has approximately 3% cutaneous absorption. Miconazole is minimally absorbed systemically (<1% bioavailability) but persists in the skin for several days after application.
- Metabolism: Hydrocortisone is metabolized primarily in the liver to inactive metabolites. Miconazole metabolism is not fully understood but is thought to be primarily hepatic.
- Elimination: Hydrocortisone metabolites, mainly glucuronides, are excreted in the urine, along with a small amount of unchanged drug. Miconazole is predominantly eliminated in feces, with minor urinary excretion.
Dosage
Standard Dosage
Children: Similar dosing as adults. Some sources suggest use is not recommended under 2 years of age. Use with caution in children due to increased risk of systemic absorption.
Special Cases:
- Elderly Patients: Use sparingly and for shorter durations due to age-related skin thinning.
- Patients with Renal Impairment: No specific dose adjustment required due to limited systemic absorption. However, caution is advised.
- Patients with Hepatic Dysfunction: No specific dose adjustment recommended, but caution is warranted.
- Patients with Comorbid Conditions: No specific adjustments indicated, but monitor patients with conditions such as diabetes or those receiving oral anticoagulants for potential interactions or exacerbations.
Clinical Use Cases
The combination is not typically used in settings such as intubation, surgical procedures, mechanical ventilation, or emergency situations like cardiac arrest. Its use is mainly limited to topical dermatological conditions.
Dosage Adjustments
No specific dosage adjustments are generally required based on renal or hepatic dysfunction. However, caution should be exercised in these populations.
Side Effects
Common Side Effects:
Local skin irritation, burning, pruritus, rash, contact dermatitis, erythema, hypopigmentation.
Rare but Serious Side Effects:
Severe hypersensitivity reactions, including anaphylaxis and angioedema; adrenal suppression (with prolonged use or use over large areas), irritability.
Long-Term Effects: Skin atrophy, telangiectasia, striae, skin fragility.
Adverse Drug Reactions (ADR): Anaphylaxis, angioedema, adrenal suppression.
Contraindications
Hypersensitivity to hydrocortisone, miconazole, or any component of the formulation; tubercular, viral (e.g. herpes, chicken pox), or gram-negative bacterial skin infections; acne, rosacea, perioral dermatitis, ulcerative skin conditions.
Drug Interactions
May increase the effect of oral anticoagulants (e.g., warfarin); Miconazole may inhibit the metabolism of hydrocortisone. Latex contraceptive agents can be damaged.
Pregnancy and Breastfeeding
No absolute contraindication, but use cautiously during pregnancy and breastfeeding, especially during the first trimester and on large areas. Avoid applying to breasts if breastfeeding.
Drug Profile Summary
- Mechanism of Action: Hydrocortisone: Anti-inflammatory via glucocorticoid receptor binding. Miconazole: Antifungal via ergosterol synthesis inhibition.
- Side Effects: Local skin reactions, hypersensitivity, adrenal suppression (rarely).
- Contraindications: Hypersensitivity, specific skin infections.
- Drug Interactions: Oral anticoagulants, latex contraceptives.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: Apply thinly 2-3 times daily for up to 7 days.
- Monitoring Parameters: Monitor for local skin reactions, signs of infection worsening, and (with prolonged use) signs of adrenal suppression.
Popular Combinations
This is already a combination product. No other combination is mentioned in the sources.
Precautions
Avoid contact with eyes. Discontinue if hypersensitivity occurs. Prolonged use can lead to skin atrophy, telangiectasia, and striae. Pre-screening is advisable for patients with allergies or pre-existing skin conditions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Hydrocortisone + Miconazole?
A: Apply a thin layer to the affected area 2-3 times daily for up to 7 days for most adults and children. For ointment formulations, apply until inflammation resolves and then switch to an antifungal alone. Use cautiously in children under 2.
Q2: How long does it take for Hydrocortisone + Miconazole to work?
A: Improvement may be seen within a few days, but the full course of treatment should be completed even if symptoms resolve earlier.
Q3: Can I use Hydrocortisone + Miconazole on my face?
A: Use cautiously on the face, as it can cause skin thinning and other adverse effects with prolonged use. Consult a doctor if symptoms don’t improve or worsen.
Q4: Can I use this medication if I am pregnant or breastfeeding?
A: Consult your doctor before using this medication during pregnancy or breastfeeding. While not absolutely contraindicated, caution is advised, especially in the first trimester and during breastfeeding. Avoid applying to the breasts if breastfeeding.
Q5: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember, unless it is almost time for the next dose. Do not apply a double dose to catch up.
Q6: Can I use this cream with condoms or diaphragms?
A: No. The cream can damage latex contraceptives, potentially making them less effective.
Q7: What are the signs of an allergic reaction to this medication?
A: Signs may include hives, difficulty breathing, swelling of the face, lips, tongue, or throat. Seek immediate medical attention if these occur.
Q8: Can I use this medication for any type of skin infection?
A: No. This medication is not suitable for all skin infections. It is contraindicated in tubercular, viral (e.g., herpes, chickenpox), or gram-negative bacterial infections, among other conditions. Consult a doctor for an accurate diagnosis and appropriate treatment.
Q9: What are the long-term side effects of this medication?
A: Prolonged use, especially on the face and skin folds, can lead to skin thinning (atrophy), dilated blood vessels (telangiectasia), and stretch marks. It’s crucial to use the medication only as directed and for the prescribed duration.
Q10: What should I do if my symptoms don’t improve after using this cream?
A: Consult your doctor. They may need to reassess your diagnosis and recommend an alternative treatment.
