Mometasone + Terbinafine

Usage

Mometasone + Terbinafine is a combination medication prescribed for the topical treatment of superficial fungal skin infections, especially where inflammatory skin conditions like eczema or psoriasis coexist with the fungal infection. It is effective against dermatophytes (ringworm, athlete’s foot, jock itch), Tinea versicolor, and cutaneous candidiasis.

• Pharmacological Classification: This drug combines a corticosteroid (Mometasone) with an antifungal (Terbinafine).

• Mechanism of Action: Mometasone furoate, a potent corticosteroid, provides anti-inflammatory, antipruritic (anti-itch), and vasoconstrictive effects by binding to glucocorticoid receptors. This reduces inflammation, redness, and itching associated with the infection. Terbinafine hydrochloride, an allylamine antifungal, inhibits squalene epoxidase, an enzyme essential for fungal cell membrane synthesis. This leads to fungal cell death and clearance of the infection.

Alternate Names

No widely recognized alternate names exist. Several brand names may be used in different regions; one mentioned is Cutizone-T.

How It Works

• Pharmacodynamics: Mometasone produces its anti-inflammatory, antipruritic, and vasoconstrictive effects by binding to glucocorticoid receptors in the skin cells, thereby inhibiting the release of inflammatory mediators like prostaglandins and leukotrienes. Terbinafine inhibits squalene epoxidase, disrupting ergosterol synthesis, a critical component of the fungal cell membrane, eventually leading to cell death.

• Pharmacokinetics: When applied topically, Mometasone has limited systemic absorption. Terbinafine is minimally absorbed through the skin, with peak plasma concentrations achieved within 2 hours. Terbinafine is metabolized in the liver via CYP enzymes, primarily CYP2D6, 3A4, 1A2, and 2C9 and is excreted mostly in the urine. Mometasone, when absorbed, is metabolized via hepatic pathways and excreted in the urine and bile.

• Mode of Action: Mometasone’s mode of action involves receptor binding (glucocorticoid receptors). Terbinafine’s mode of action is enzyme inhibition (squalene epoxidase).

• Elimination Pathways: Both drugs are primarily eliminated through hepatic metabolism and renal excretion.

Dosage

Standard Dosage

Adults: Apply a thin layer to the affected area once or twice daily for 2-6 weeks depending on the infection.

Children: Not recommended for children under 12 years old. For adolescents (12 years and above), the dosage is the same as for adults.

Special Cases:

• Elderly Patients: No specific dosage adjustments are typically required. However, caution is advised in patients with pre-existing skin atrophy.
• Patients with Renal Impairment: Caution is recommended, and monitoring may be necessary.
• Patients with Hepatic Dysfunction: Caution is recommended, and monitoring may be necessary.
• Patients with Comorbid Conditions: Use with caution in patients with diabetes, Cushing’s syndrome, compromised immune systems, or other systemic conditions.

Clinical Use Cases

The combination of Mometasone + Terbinafine is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. It is solely indicated for topical dermatological application.

Dosage Adjustments

Dosage adjustments should be made based on the patient’s specific medical condition, the severity of the infection, and response to treatment.

Side Effects

Common Side Effects:

Itching, irritation, burning, stinging, dryness, redness, skin peeling, or hypopigmentation at the application site. These are usually mild and transient.

Rare but Serious Side Effects:

Allergic contact dermatitis, skin atrophy, telangiectasia, striae, folliculitis, acneiform eruptions.

Long-Term Effects:

Prolonged use of topical corticosteroids can lead to skin thinning, striae, telangiectasia, and other skin changes.

Adverse Drug Reactions (ADR):

Although rare, serious allergic reactions may occur.

Contraindications

Hypersensitivity to Mometasone, Terbinafine, or any other component of the formulation. Not recommended for use in patients with perforated eardrums (when applied for otitis externa) or generalized demodicosis. Contraindicated in pregnancy and breastfeeding.

Drug Interactions

No significant drug interactions have been documented with topical application. However, advise patients to inform their doctor about any other medications they are taking. Rifampicin and cimetidine can decrease terbinafine levels, while fluconazole and ketoconazole may increase them.

Pregnancy and Breastfeeding

Contraindicated in pregnancy and breastfeeding.

Drug Profile Summary

• Mechanism of Action: Mometasone: Binds to glucocorticoid receptors, inhibiting inflammatory responses. Terbinafine: Inhibits squalene epoxidase, disrupting fungal cell membrane synthesis.
• Side Effects: Common: Itching, burning, dryness. Serious: Allergic reactions, skin atrophy.
• Contraindications: Hypersensitivity, pregnancy, breastfeeding.
• Drug Interactions: Limited with topical use. Some interactions are possible if absorbed.
• Pregnancy & Breastfeeding: Contraindicated.
• Dosage: Apply a thin layer once or twice daily for 2–6 weeks.
• Monitoring Parameters: Observe for treatment response and adverse effects.

Popular Combinations

This product is itself a combination and is not typically combined with other drugs.

Precautions

• General Precautions: Avoid application near the eyes, nose, or mouth. Use cautiously in patients with pre-existing skin conditions.
• Specific Populations: Contraindicated in pregnancy, breastfeeding, and children under 12.
• Lifestyle Considerations: Avoid alcohol consumption during treatment.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Mometasone + Terbinafine?

A: Apply a thin layer to the affected skin once or twice daily for 2 to 6 weeks, depending on the infection.

Q2: Can this cream be used on the face?

A: Use with caution on the face, as it can cause skin thinning and other adverse effects.

Q3: What if I miss a dose?

A: Apply the missed dose as soon as you remember, unless it’s almost time for the next dose. Do not double the dose.

Q4: Can I use this cream during pregnancy or breastfeeding?

A: No, it’s contraindicated. Consult your doctor for alternative treatments.

Q5: How long does it take to see improvement?

A: Improvement may be seen within a few days, but complete resolution can take several weeks.

Q6: What are the potential side effects?

A: Common side effects include itching, burning, and dryness at the application site.

Q7: Can I use this cream on open wounds?

A: No, avoid applying to open wounds or broken skin.

Q8: What should I do if my symptoms worsen or don’t improve?

A: Consult your doctor, who may adjust the dosage or prescribe a different medication.

Q9: Can I cover the treated area with a bandage?

A: Generally, it’s not necessary to cover the treated area unless directed by a doctor. Occlusive dressings may increase the risk of side effects from the corticosteroid component.