calcitriol (topical)

Therapeutic Classification: antipsoriatics

Pharmacologic Classification: vitamin d analogues

Indications ⬆ ⬇

REMS

Mild to moderate plaque psoriasis.

Action ⬆ ⬇

Exact mechanism is unknown, but may affect keratinocyte proliferation and differentiation, and decrease the action of proinflammatory cytokines.

Therapeutic effects:

Decreased severity of plaque psoriasis.

Pharmacokinetics ⬆ ⬇

Absorption: Although intended action is skin, some systemic absorption follows topical use.

Distribution: Unknown.

Metabolism/Excretion: Absorbed calcitriol undergoes enterohepatic recycling and is excreted in bile.

Half-Life: 5–8 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
Topical	unknown	within 8 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

None.

Use Cautiously in:

Exposure of the treated areas to natural or artificial sunlight, including tanning booths, sunlamps, or phototherapy; use should be limited or avoided;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children <2 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: pruritus, skin discomfort

GU: hypercalciuria

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with medications known to serum calcium levels including thiazide diuretics, calcium supplements, or high doses of vitamin D may ↑ serum calcium levels; use cautiously.

Route/Dosage ⬆ ⬇

(Adults and Children ≥7 yr): Apply twice daily (not to exceed 200 g/wk).
(Children 2–6 yr): Apply twice daily (not to exceed 100 g/wk).

Availability ⬆ ⬇

Ointment: 3 mcg/g

Assessment ⬆ ⬇

Assess psoriatic lesions periodically during therapy.

Lab Test Considerations:

May cause hypercalcemia and hypercalciuria.

Implementation ⬆ ⬇

Topical Apply ointment to affected areas twice daily, morning and evening. Rub gently into skin so no medication remains visible. Do not apply to eyes, lips, or facial skin.

Patient/Family Teaching ⬆ ⬇

Instruct patient to apply calcitriol ointment as directed. Do not use more than 200 g/wk in patients ≥7 yr or 100 g/wk in patient 2–6 yr of age.
Caution patient to avoid excessive exposure of treated areas to natural or artificial sunlight, including tanning booths and sunlamps; may increase risk of skin tumors.
Advise patient to report any signs of adverse reactions to health care professional.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise breastfeeding patient to avoid applying ointment directly to nipple and areola.

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Pronunciation ⬇

Classifications ⬆ ⬇