pimecrolimus

pimecrolimus

an immunosuppressive agent similar to tacrolimus.

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pimecrolimus

Elidel

Pharmacologic class: Dermatologic agent

Therapeutic class: Immunomodulator

Pregnancy risk category C

FDA Boxed Warning

• Drug's long-term safety hasn't been established.
• Rare cases of lymphoma and skin cancer have occurred in patients who used drug. Avoid continuous long-term use in any age-group and limit application to areas of atopic dermatitis.
• Drug isn't indicated for use in children younger than age 2.

Action

Unknown. Thought to inhibit T-cell activation by blocking transcription of early cytokines. Also blocks release of inflammatory cytokines and mediators from mast cells after stimulation by antigen/immunoglobin E.

Availability

Cream: 1%

⊘Indications and dosages

➣ Mild to moderate atopic dermatitis

Adults and children ages 2 and older: Apply 1% cream topically b.i.d. to clean, dry, affected area.

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• eczema herpeticum (Kaposi's varicelliform eruption), varicella zoster (chickenpox or shingles), herpes simplex infection, lymphadenopathy, mononucleosis, acute infectious Netherton's syndrome, skin infections or papilloma, warts, immunocompromised state
• concurrent use of CYP3A inhibitors
• pregnant or breastfeeding patients
• children younger than age 2 (safety not established).

Administration

• Apply thin layer to affected area.
• Don't use with occlusive dressing (may increase systemic absorption).

Route	Onset	Peak	Duration
Topical	Not systemically absorbed	Not systemically absorbed	Not systemically absorbed

Adverse reactions

CNS: headache

EENT: sinus congestion, rhinorrhea

GI: nausea, vomiting, diarrhea, gastritis

Respiratory: upper respiratory tract infection

Skin: pruritus, application-site reaction or discomfort

Other: pyrexia, increased risk of viral or bacterial infections

Interactions

Drug-drug. CYP3A inhibitors (such as calcium channel blockers, cimetidine, erythromycin): inhibition of action by hepatic enzymes that eliminate pimecrolimus

Drug-behaviors. Sunbathing: possible increased risk of skin cancer

Patient monitoring

• Reevaluate at 6 weeks if lesions haven't healed.
• Discontinue therapy, as prescribed, if disease resolves.

Patient teaching

• Tell patient to apply to clean, dry skin and to wash hands afterward (unless hands are being treated).
• Caution patient not to use occlusive dressings.
• Tell patient drug may cause local reaction, such as a feeling of warmth or burning sensation. Advise him to contact prescriber if reaction is severe or lasts more than 1 week.
• Advise patient to apply missed dose as soon as possible. If it's almost time for next dose, tell him to skip missed dose and resume regular schedule.
• Tell patient to avoid natural or artificial sunlight and to use adequate sunblock on skin and lips.
• Instruct patient to contact prescriber if no improvement occurs after 6 weeks or if condition worsens.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.