Usage
Mometasone + Nadifloxacin + Terbinafine is a topical combination medication prescribed for mixed superficial bacterial and fungal skin infections, particularly where inflammation is a prominent feature. It is indicated for conditions such as:
- Athlete’s foot (tinea pedis)
- Jock itch (tinea cruris)
- Ringworm (tinea corporis)
- Infected eczema
- Infected dermatitis
Pharmacological Classification:
- Mometasone: Corticosteroid
- Nadifloxacin: Fluoroquinolone antibiotic
- Terbinafine: Allylamine antifungal
Mechanism of Action: This triple-combination cream tackles skin infections through three distinct mechanisms:
- Mometasone: Reduces inflammation, redness, and itching.
- Nadifloxacin: Eliminates bacterial infections.
- Terbinafine: Eradicates fungal infections.
Alternate Names
While the generic name is Mometasone + Nadifloxacin + Terbinafine, it’s marketed under various brand names, including Nadoxin Plus. There are no widely recognized international or regional variations for the generic name.
How It Works
Pharmacodynamics:
- Mometasone: Binds to glucocorticoid receptors, suppressing inflammatory mediators.
- Nadifloxacin: Inhibits bacterial DNA gyrase and topoisomerase IV, essential for bacterial DNA replication and repair.
- Terbinafine: Inhibits squalene epoxidase, disrupting fungal ergosterol biosynthesis and causing fungal cell death.
Pharmacokinetics:
Topical application leads to limited systemic absorption.
- Mometasone: Primarily metabolized in the liver.
- Nadifloxacin: Excreted mainly in urine.
- Terbinafine: Metabolized in the liver and excreted in urine and feces.
Dosage
Standard Dosage
Adults:
Apply a thin layer to the affected area once or twice daily for 1-2 weeks. Treatment duration can be adjusted based on severity and response. Avoid prolonged use, especially on sensitive areas (face, groin, axillae), without medical supervision.
Children:
Not recommended for children under 14 years old due to limited safety data. If use is deemed necessary, administer under strict medical supervision with appropriate dose adjustments.
Special Cases:
- Elderly Patients: No specific adjustments are typically required unless significant renal or hepatic impairment exists.
- Patients with Renal Impairment: Caution is advised; dose adjustment may be necessary.
- Patients with Hepatic Dysfunction: Caution is advised; dose adjustment may be necessary.
- Patients with Comorbid Conditions: Consider individual patient factors and concomitant medications.
Clinical Use Cases
The provided sources focus on the topical application of Mometasone + Nadifloxacin + Terbinafine for dermatological conditions. They do not offer dosage recommendations for systemic use cases such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Adjustments may be required based on:
- Severity and location of infection
- Patient response to treatment
- Renal or hepatic impairment
- Concomitant medications
Side Effects
Common Side Effects:
- Application site reactions (burning, stinging, itching, redness, dryness, irritation, peeling)
- Hypopigmentation
Rare but Serious Side Effects:
- Allergic contact dermatitis
- Skin atrophy
- Telangiectasia
- Striae
- Hypertrichosis
- Secondary infections (bacterial or fungal)
Long-Term Effects:
- Skin thinning
- Increased risk of skin infections with prolonged use
- Systemic absorption of corticosteroids with potential for adrenal suppression (rare with topical use)
Adverse Drug Reactions (ADR):
- Severe allergic reactions (angioedema, urticaria, difficulty breathing) – requires immediate medical attention.
Contraindications
- Hypersensitivity to any of the components
- Rosacea
- Perioral dermatitis
- Viral skin infections (e.g., herpes simplex, varicella)
- Tuberculosis, syphilis
- Open wounds
Drug Interactions
Limited systemic absorption reduces the likelihood of significant drug interactions. However, inform patients about potential interactions with other topical medications applied to the same area. Consult drug databases for specific interactions with Terbinafine, Nadifloxacin, or Mometasone if systemic use is anticipated.
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding. Consult a specialist to assess the benefit-risk ratio. Safety profiles in these populations are not fully established. Consider alternative treatments if deemed safer.
Drug Profile Summary
- Mechanism of Action: Mometasone: Anti-inflammatory; Nadifloxacin: Antibacterial; Terbinafine: Antifungal.
- Side Effects: Common: Local skin reactions; Rare: Allergic reactions, skin atrophy.
- Contraindications: Hypersensitivity, rosacea, viral infections, open wounds.
- Drug Interactions: Limited systemic absorption; potential interactions with other topical medications.
- Pregnancy & Breastfeeding: Use with caution; consult a specialist.
- Dosage: Apply a thin layer once or twice daily for 1-2 weeks, adjustable as needed.
- Monitoring Parameters: Treatment response, local skin reactions, infection resolution.
Popular Combinations
The combination of mometasone, nadifloxacin, and terbinafine is itself a popular and effective therapy. No additional drug combinations are routinely recommended within the provided sources.
Precautions
- General Precautions: Screen for allergies and pre-existing skin conditions. Avoid contact with eyes, nose, and mouth.
- Specific Populations: Consult a specialist for pregnancy, breastfeeding, and pediatric use.
- Lifestyle Considerations: No specific lifestyle restrictions are mentioned, but advise against covering the treated area with airtight dressings unless directed by a physician.
FAQs (Frequently Asked Questions)
A: Adults: Apply a thin layer to the affected area once or twice daily for 1-2 weeks, adjustable as needed. Not recommended for children under 14.
Q2: What skin conditions is this cream used for?
A: It’s effective against mixed bacterial and fungal skin infections like athlete’s foot, jock itch, ringworm, and infected eczema or dermatitis.
Q3: Can I use this cream during pregnancy or while breastfeeding?
A: Consult a specialist before using during pregnancy or breastfeeding. Safety in these populations isn’t fully established.
Q4: Are there any common side effects?
A: Yes, common side effects include local skin reactions like burning, itching, redness, and peeling at the application site.
Q5: What should I do if the infection doesn’t improve?
A: Consult your doctor if the infection doesn’t improve after 2 weeks of treatment or if symptoms worsen.
Q6: Can this cream be used on open wounds?
A: No, do not apply this cream to open wounds.
Q7: How does each ingredient in this cream work?
A: Mometasone reduces inflammation, nadifloxacin kills bacteria, and terbinafine eliminates fungi.
Q8: Are there any serious side effects I should be aware of?
A: While rare, serious side effects can include allergic contact dermatitis, skin atrophy, and secondary infections. Seek immediate medical attention if severe allergic reactions such as angioedema or difficulty breathing occur.
Q9: Can I cover the treated area with a bandage?
A: Unless specifically advised by your doctor, avoid covering the treated area with airtight dressings.
Q10: How is this cream absorbed by the body?
A: It has limited systemic absorption when applied topically.
