Usage
Prednicarbate is prescribed for the relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. This includes conditions like eczema, atopic dermatitis, contact dermatitis, psoriasis, and seborrheic dermatitis.
It is classified as a medium-potency topical corticosteroid.
Prednicarbate works by reducing inflammation, itching, and redness by mimicking the action of cortisol, a natural hormone produced by the adrenal glands. It binds to glucocorticoid receptors in the skin cells, altering gene expression and reducing the production of inflammatory mediators.
Alternate Names
Prednicarbate is the generic name. Some brand names include Dermatop, Prednitop, and Peitel.
How It Works
Pharmacodynamics: Prednicarbate exerts its effects by binding to glucocorticoid receptors located inside skin cells. This interaction modifies gene transcription, reducing the synthesis of inflammatory mediators like prostaglandins, leukotrienes, and cytokines. It also inhibits the infiltration of inflammatory cells into the skin, further reducing inflammation and its associated symptoms.
Pharmacokinetics:
- Absorption: Prednicarbate is absorbed percutaneously. The extent of absorption depends on factors like skin integrity, the vehicle used (cream or ointment), application site, and the use of occlusive dressings. Thin skin areas like the face, groin, and axillae absorb the drug more readily. Occlusive dressings enhance penetration.
- Metabolism: Prednicarbate is primarily metabolized in the skin and to a lesser extent in the liver via first-pass metabolism. The metabolites generated are less active than the parent drug.
- Elimination: The metabolites are primarily excreted renally, with some biliary excretion.
Mode of Action: Prednicarbate exerts its action intracellularly by binding to specific glucocorticoid receptors. Upon binding, the drug-receptor complex translocates to the nucleus, where it interacts with DNA, influencing gene expression. This inhibits the production of inflammatory mediators like prostaglandins, leukotrienes, and cytokines, thereby reducing inflammation and associated symptoms.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Prednicarbate acts primarily via glucocorticoid receptor binding, modulating gene expression.
Dosage
Standard Dosage
Adults:
Apply a thin film to the affected area twice daily.
Children:
- Cream: ≥1 year: Apply a thin film to the affected area twice daily. Maximum treatment duration: 3 weeks.
- Ointment: ≥10 years: Apply a thin film to the affected area twice daily.
Special Cases:
- Elderly Patients: Use with caution due to potential for increased systemic absorption and side effects.
- Patients with Renal Impairment: No specific dosage adjustments are typically necessary.
- Patients with Hepatic Dysfunction: No specific dosage adjustments are typically necessary.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, as topical corticosteroids can elevate blood glucose levels. Consider the potential for drug interactions with other medications.
Clinical Use Cases
Prednicarbate is not indicated for use in intubation, surgical procedures, mechanical ventilation, intensive care unit (ICU) use, or emergency situations. It is exclusively for topical dermatological applications.
Dosage Adjustments
No specific dosage adjustments are indicated for renal or hepatic dysfunction. However, caution is advised in patients with these conditions.
Side Effects
Common Side Effects:
Burning, itching, dryness, irritation, skin atrophy, acne, folliculitis, hypopigmentation, telangiectasia.
Rare but Serious Side Effects:
Allergic contact dermatitis, Cushing’s syndrome (with prolonged use or high doses), HPA axis suppression, hyperglycemia, secondary infections.
Long-Term Effects:
Skin atrophy, striae, telangiectasia, hypopigmentation.
Adverse Drug Reactions (ADR):
Severe allergic reactions, skin infections, signs of Cushing’s syndrome.
Contraindications
Hypersensitivity to prednicarbate, rosacea, perioral dermatitis, untreated skin infections (bacterial, fungal, viral), open wounds.
Drug Interactions
Prednicarbate can interact with other medications, particularly those metabolized by CYP450 enzymes. Some examples include oral corticosteroids like prednisone, drugs that lower the immune system such as cyclosporine, and some medications for diabetes. Consult drug interaction databases for a comprehensive list.
Pregnancy and Breastfeeding
Pregnancy Safety Category: C. Use with caution during pregnancy, weighing the potential benefits against risks to the fetus. Topical corticosteroids are generally considered compatible with breastfeeding, but avoid applying to areas where the infant could ingest the drug.
Drug Profile Summary
- Mechanism of Action: Binds to glucocorticoid receptors, modulating gene expression and suppressing inflammatory responses.
- Side Effects: Burning, itching, dryness, skin atrophy, risk of HPA axis suppression and Cushing’s syndrome.
- Contraindications: Hypersensitivity, untreated skin infections, rosacea, perioral dermatitis.
- Drug Interactions: Can interact with other drugs, particularly CYP450 substrates.
- Pregnancy & Breastfeeding: Category C; caution advised; generally compatible with breastfeeding.
- Dosage: Apply thinly twice daily.
- Monitoring Parameters: Blood glucose (in diabetic patients), signs of HPA axis suppression with prolonged use.
Popular Combinations
Prednicarbate is typically used as monotherapy. Combination therapy with other topical agents may be considered for specific conditions, but consult with a dermatologist for appropriate recommendations.
Precautions
- General Precautions: Avoid prolonged use, especially on the face, groin, and axillae. Use caution in patients with diabetes.
- Specific Populations: As outlined above.
- Lifestyle Considerations: Avoid contact with eyes. Limit alcohol consumption if experiencing side effects like skin thinning.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Prednicarbate?
A: Adults and children ≥10 years (ointment) or ≥1 year (cream): Apply a thin film to the affected skin twice daily.
Q2: What skin conditions is Prednicarbate used for?
A: It is used for various inflammatory and itchy skin conditions, including eczema, dermatitis, and psoriasis.
Q3: What are the common side effects of Prednicarbate?
A: Common side effects include burning, itching, dryness, and skin thinning at the application site.
Q4: Can I use Prednicarbate on my face?
A: Use on the face should be limited to short durations due to the risk of increased absorption and side effects like skin thinning and telangiectasia. Consult a dermatologist for guidance.
Q5: Is Prednicarbate safe to use during pregnancy?
A: It’s a Pregnancy Category C drug, meaning its safety hasn’t been definitively established. Use only if the potential benefits outweigh the risks, and consult with a doctor.
Q6: Can I use Prednicarbate if I have an infection on my skin?
A: No. Prednicarbate should not be used on skin with active infections. Treat the infection first.
Q7: How long can I use Prednicarbate?
A: Generally, treatment should be limited to 2 weeks, unless otherwise directed by a doctor. Prolonged use increases the risk of side effects.
Q8: What should I do if I miss a dose of Prednicarbate?
A: Apply the missed dose as soon as you remember, unless it’s close to the time for your next dose. Don’t apply extra to make up for the missed dose.
Q9: Can I use Prednicarbate with other topical medications?
A: Consult a dermatologist before combining Prednicarbate with other topical medications, as interactions may occur.
