ciclopirox


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Related to ciclopirox: ciclopirox olamine

ciclopirox

 [si″klo-pir´oks]
a broad-spectrum antifungal agent with activity similar to that of the imidazoles, used topically as the olamine salt against skin infections.

ciclopirox

(sye-kloe-peer-ox) ,

Loprox

(trade name),

Penlac

(trade name),

Stieprox

(trade name)

Classification

Therapeutic: antifungals
Pregnancy Category: B

Indications

Treatment of cutaneous fungal infections including cutaneous candidiasis (lotion and cream only), tinea pedis (athlete’s foot) (gel, lotion, and cream only), tinea cruris (jock itch) (lotion and cream only), tinea corporis (ringworm) (gel, lotion, and cream only), tinea versicolor (lotion and cream only), seborrheic dermatitis (shampoo and gel only), and onychomycosis of fingernails and toenails (nail lacquer only).

Action

Inhibits the transport of essential elements in fungal cell, disrupting the synthesis of DNA, RNA, and protein.

Therapeutic effects

Decrease in symptoms of fungal infection.

Pharmacokinetics

Absorption: Absorption through intact skin is minimal (<5%).
Distribution: Distribution after topical administration is primarily local.
Metabolism and Excretion: Eliminated by kidneys (3–10% for gel).
Half-life: 5.5 hr (gel).

Time/action profile

ROUTEONSETPEAKDURATION
Topunknownunknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to active ingredients, additives, preservatives, or bases; Some products contain alcohol (nail lacquer) and should be avoided in patients with known intolerance;.
Use Cautiously in: Obstetric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Local

  • burning
  • itching
  • local hypersensitivity reactions
  • redness
  • stinging

Interactions

Drug-Drug interaction

Not known.

Route/Dosage

Topical (Adults and Children >10 yr) Shampoo:Apply 5 mL (10 mL may be used for long hair) to scalp and leave on for 3 min before rinsing off. Use twice weekly (wait at least 3 days between treatments) for 4 wk. Cream/lotion: Apply twice daily for 2–4 wk. Gel: Apply twice daily for 4 wk. Topical solution (nail lacquer): Apply to nails once daily (at bedtime or 8 hr before bathing) for up to 48 wk. Each daily application should be made over the previous coat and then removed with alcohol every 7 days.

Availability (generic available)

Cream: 0.77%
Gel: 0.77%
Lotion: 0.77%
Nail Lacquer Solution: 8%
Shampoo: 1%, 1.5%

Nursing implications

Nursing assessment

  • Inspect involved areas of skin and mucous membranes before and frequently during therapy. Increased skin irritation may indicate need to discontinue medication.

Potential Nursing Diagnoses

Risk for impaired skin integrity (Indications)
Risk for infection (Indications)

Implementation

  • Consult physician or other health care professional for proper cleansing technique before applying medication.
  • Topical: Apply small amount to cover affected area completely. Avoid the use of occlusive wrappings or dressings unless directed by physician or other health care professional.
  • Nail lacquer: Avoid contact with skin other than skin immediately surrounding treated nail. Avoid contact with eyes or mucous membranes. Removal of unattached, infected nail, as frequently as monthly, by health care professional is needed with use of this medication. Up to 48 wk of daily application and professional removal may be required to achieve clear or almost clear nail. 6 mo of treatment may be required before results are noticed.

Patient/Family Teaching

  • Instruct patient to apply medication as directed for full course of therapy, even if feeling better. Emphasize the importance of avoiding the eyes.
  • Caution patient that some products may stain fabric, skin, or hair. Check label information. Fabrics stained from cream or lotion can usually be cleaned by handwashing with soap and warm water.
  • Patients with athlete’s foot should be taught to wear well-fitting, ventilated shoes, to wash affected areas thoroughly, and to change shoes and socks at least once a day.
  • Advise patient to report increased skin irritation or lack of response to therapy to health care professional.
  • Nail lacquer: File away loose nail and trim nails every 7 days after solution is removed with alcohol. Do not use nail polish on treated nails. Inform health care professional if have diabetes mellitus before using.
  • Inform patient that early relief of symptoms may be seen in 2–3 days but that full therapeutic response may take 3–4 wk. Recurrent fungal infections may be a sign of systemic illness.

Evaluation/Desired Outcomes

  • Decrease in skin irritation.
  • Resolution of infection.
References in periodicals archive ?
This is the first study to assess the efficacy of 40% urea gel in combination with 8% ciclopirox lacquer.
Ciclopirox 8% solution is a lacquer formulation indicated for use in immunocompetent patients with mild to moderate onychomycosis without involvement of the lunula and due to T.
Weeks and his associates hypothesized that pretreatment with urea might thin and debulk thick, hyperkeratotic nails and thereby improve ciclopirox penetration into the nail plate.
These investigators tested free-drug concentrations--in suspensions prepared from keratin samples--of efinaconazole, ciclopirox, and amorolfine (similar to ciclopirox, amorolfine is an agent in a lacquer formulation; amorolfine is not FDA-approved).
Topical antifungal treatment with amorolfine 5% nail lacquer and ciclopirox 8% nail lacquer--which are not currently available in the United States but are available in most European countries--is effective as monotherapy in the treatment of white superficial onychomycosis and of distal subungual onychomycosis limited to the distal nail of a few digits.
MUNCICH -- Ciclopirox nail lacquer is a safe and effective therapy in diabetic patients with onychomycosis, Dr.
Patients with diabetes were not excluded from the pivotal trials of efinaconazole and tavaborole, but the disease was a cause for exclusion in the pivotal clinical studies of ciclopirox. In addition, the use of ciclopirox requires that patients keep their nails trimmed and that they follow up with their clinicians for regular removal of unattached, infected nails and debris; these activities potentially increase the risk for trauma and secondary infection, particularly in patients with diabetic neuropathy.
has won tentative approval for its ANDA for ciclopirox topical solution 8% (nail lacquer).
Drug Dosage Cost/Tube(*) Ciclopirox twice a day $31.83 (Loprox) clotrimazole twice a day $14.87 econazole once or $31.78 (Spectazole) twice a day ketoconazol once or $31.78 twice a day naftifine twice a day $31.73 (20g) (Naftin) $54.40(40g) terbinafine twice a day $58.40 (Lamisil) SYSTEMIC AGENTS Drug Dosage Cost/Tube(*) Terbinafine 250 mg/day $8.68 (Lamisil) itraconazole 200-400 mg/day $15.56 (200 mg) (Sporanox) TROPICAL AGENTS Drug [dagger]Comment Ciclopirox Pyradone, formulated as cream, gel, lotion, and topical (Loprox) suspension.
Maintenance with topical ciclopirox (Penlac) 2 days per week helps prevent relapse.
The specialty pharmaceutical manufacturer received clearance for ciclopirox cream 0.77%.
Among the first approvals the company has received this year are fluticasone cream and ointment, the generic equivalents of GlaxoSmithKline PLC's Cutivate; metronidazole cream, a generic version of Galderma Laboratories LP's MetroCream; and ciclopirox lotion, a generic equivalent to Medicis Pharmaceutical Corp.'s Loprox topical suspension.