Usage
Mometasone + Tazarotene is prescribed for the topical treatment of plaque psoriasis. It is classified as an antipsoriatic agent, specifically a combination of a retinoid (tazarotene) and a corticosteroid (mometasone). The combination of these two medications works synergistically to treat psoriasis more effectively than either drug alone. Tazarotene normalizes skin cell turnover, reducing hyperproliferation and inflammation. Mometasone provides anti-inflammatory, antipruritic, and vasoconstrictive actions.
Alternate Names
This combination is often marketed under brand names like Momate-T Cream. Tazarotene, when used alone, is marketed under the brand name Zorac among others.
How It Works
Pharmacodynamics: Tazarotene, a retinoid, binds to retinoic acid receptors, modifying gene expression to normalize the differentiation of keratinocytes (skin cells) and reduce inflammation. Mometasone, a corticosteroid, binds to glucocorticoid receptors, thereby inhibiting inflammatory pathways.
Pharmacokinetics: Both mometasone and tazarotene are minimally absorbed systemically after topical application, limiting their potential for systemic side effects.
Mode of Action/Receptor Binding/Enzyme Inhibition: Tazarotene is a prodrug converted into its active metabolite, tazarotenic acid. Tazarotenic acid specifically binds to retinoic acid receptors (RARs), particularly RAR-beta and RAR-gamma subtypes, located in the nucleus of keratinocytes. This interaction modulates gene transcription related to cell differentiation, proliferation, and inflammation. As a topical corticosteroid, mometasone binds to glucocorticoid receptors in the cytoplasm of cells. This binding leads to the inhibition of inflammatory mediators, such as cytokines and prostaglandins.
Elimination Pathways: Primarily metabolized in the liver and excreted in bile and urine.
Dosage
Standard Dosage
Adults: Apply a thin layer of Mometasone + Tazarotene cream once daily to the affected areas, preferably in the evening. Limit treatment to a maximum of 10% of body surface area.
Children: Safety and efficacy in children have not been established, and use is generally not recommended.
Special Cases:
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Elderly Patients: No specific dosage adjustments are typically required.
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Patients with Renal Impairment: No specific dosage adjustments are typically necessary due to minimal systemic absorption. However, caution is advised.
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Patients with Hepatic Dysfunction: No specific dosage adjustments are typically necessary due to minimal systemic absorption. However, caution is advised.
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Patients with Comorbid Conditions: Use with caution in patients with eczema or sunburn. Close monitoring is recommended.
Clinical Use Cases
Mometasone + Tazarotene is not intended for systemic use and therefore is not relevant in scenarios like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage adjustments are not generally required for renal or hepatic dysfunction, but caution is warranted. If significant irritation occurs, reduce application frequency or use a lower tazarotene concentration.
Side Effects
Common Side Effects
Itching, burning, stinging, redness, irritation, dryness, and peeling at the application site.
Rare but Serious Side Effects
Allergic reactions (skin rash, hives, swelling), skin cracking or discoloration, and bleeding of the skin.
Long-Term Effects
With long-term use of topical corticosteroids like mometasone, there is a very small risk of systemic absorption and complications such as adrenal gland problems, hyperglycemia, and vision changes.
Adverse Drug Reactions (ADR)
Severe allergic reactions, worsening of psoriasis, skin infections.
Contraindications
Hypersensitivity to mometasone, tazarotene, or any components of the formulation. Pregnancy (tazarotene is teratogenic). Breastfeeding (potential for adverse effects on the infant). Active eczema or sunburn.
Drug Interactions
Concomitant use with other topical medications, especially those with drying effects (like adapalene), may increase irritation. Photosensitizing agents may increase sensitivity to sunlight. Some medications (aminolevulinic acid, benzoyl peroxide, isotretinoin, methoxsalen, resorcinol, salicylic acid, sulfur, verteporfin) are known to interact with tazarotene and should be used with caution. Though tazarotene is minimally absorbed systemically, drugs that affect CYP enzymes may theoretically impact its metabolism.
Pregnancy and Breastfeeding
Pregnancy Safety Category: X (Tazarotene is contraindicated in pregnancy). Tazarotene is a known teratogen and can cause serious birth defects.
Breastfeeding: Tazarotene and mometasone may be excreted in breast milk and potentially harm the infant. Use is contraindicated.
Drug Profile Summary
- Mechanism of Action: Tazarotene (retinoid): Normalizes keratinocyte differentiation and reduces inflammation. Mometasone (corticosteroid): Exerts anti-inflammatory and antipruritic effects.
- Side Effects: Itching, burning, redness, irritation, dryness, peeling. Rarely, allergic reactions.
- Contraindications: Hypersensitivity, pregnancy, breastfeeding, active eczema/sunburn.
- Drug Interactions: Other topical medications, photosensitizing agents.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Apply a thin layer once daily to affected areas.
- Monitoring Parameters: Monitor for local skin reactions, signs of infection, and with prolonged use, signs of systemic corticosteroid effects.
Popular Combinations
Mometasone + Tazarotene is itself a commonly used and effective combination.
Precautions
- General Precautions: Screen for allergies, metabolic disorders, organ dysfunction.
- Specific Populations: See contraindications for pregnant/breastfeeding women. Use with caution in children and the elderly.
- Lifestyle Considerations: Advise patients to avoid excessive sun exposure, use sunscreen, and limit alcohol consumption as it may worsen psoriasis.
FAQs (Frequently Asked Questions)
A: Apply a thin layer of the cream to affected areas once daily, usually in the evening. Do not exceed 10% of body surface area.
Q2: Can this combination be used during pregnancy or breastfeeding?
A: No, it is contraindicated in both pregnancy and breastfeeding due to the teratogenic effects of tazarotene.
Q3: What are the common side effects?
A: Common side effects include local skin reactions like itching, burning, redness, dryness, and peeling.
A: The combination therapy demonstrates enhanced efficacy and better tolerability compared to either drug used as monotherapy.
Q5: Are there any drug interactions I should be aware of?
A: Concomitant use of other topical medications, particularly those with drying effects, may exacerbate irritation. Photosensitizing medications may increase the risk of sunburn. Some medications are known to interact with tazarotene and should be used cautiously.
Q6: What should I do if my patient experiences significant skin irritation?
A: Reduce the application frequency or consider switching to a lower concentration of tazarotene.
Q7: Can this cream be used on the face?
A: Yes, but use with caution and avoid the eyes and mucous membranes.
Q8: How long can patients use this medication?
A: Patients should use it for the shortest duration necessary to achieve desired results, as long-term continuous use of topical corticosteroids carries a small risk of systemic side effects.
Q9: Is this medication safe for elderly patients?
A: Yes, typically no dose adjustments are required for elderly patients. However, monitor for local skin reactions.
