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/Excretion: Eliminated by kidneys (3–10% for gel).
Half-Life: 5.5 hr (gel).
Time/Action Profile⬆⬇
ROUTE
ONSET
PEAK
DURATION
Top
unknown
unknown
unknown
Contraind./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:
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children <16 yr (gel and shampoo), <12 yr (topical solution), or <10 yr (cream and lotion).
Adv. Reactions/Side Effects⬆⬇
Local: burning, itching, local hypersensitivity reactions, redness, stinging
Interactions⬆⬇
Drug-drug:
Not known.
Route/Dosage⬆⬇
(Adults and Children ≥16 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. Gel: Apply twice daily for 4 wk.
(Adults and Children ≥12 yr): 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.
(Adults and Children ≥10 yr): Cream/lotion: Apply twice daily for 2–4 wk.
Availability⬆⬇
(Generic available)
Cream: 0.77%; 1%
Gel: 0.77%
Lotion: 1%
Nail lacquer: 8%
Shampoo: 1%; 1.5%
Suspension: 0.77%
Assessment⬆⬇
Inspect involved areas of skin and mucous membranes before and frequently during therapy. Increased skin irritation may indicate need to discontinue medication.
Implementation⬆⬇
Consult 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 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.
