Adult: Available preparation:
Each 1 g of oint/cream contains betamethasone 1.22 mg and clioquinol 30 mg
Apply thinly and rub gently onto affected area(s) bid or tid, may reduce to once daily if condition improves. Child: Same as adult dose. Max duration of therapy: 5 days.
Patient w/ psoriasis. Childn. Pregnancy and lactation.
Adverse Reactions
Significant: Local hypersensitivity reactions; HPA axis suppression (e.g. Cushing’s syndrome), adrenal insufficiency, facial atrophic changes (long-term use); cataract, glaucoma; psoriasis relapse and tolerance, pustular psoriasis and systemic toxicity; prolonged local infection, risk of neurotoxicity (clioquinol). Dermatologic: Burning, pruritus, pain, pigmentation changes, allergic contact dermatitis, hypertrichosis.
Patient Counseling Information
This drug may cause discolouration of skin, hair and cloth. Avoid long term use and abrupt withdrawal. Avoid use of occlusive dressing. Avoid application to the eyes.
Monitoring Parameters
Monitor for hypothalamic-pituitary adrenal (HPA) axis and adrenal insufficiency.
Lab Interference
Betamethasone: May suppress the wheal and flare reaction to skin antigens.Clioquinol: May interfere w/ thyroid function tests [e.g. radioactive iodine and butanol extractable iodine, protein-bound iodine (PBI)]. May cause false-positive ferric chloride test for phenylketonuria.
Action
Description: Mechanism of Action: Betamethasone is a corticosteroid w/ mainly glucocorticoid activity. It has anti-inflammatory, antipruritic and vasoconstrictive properties. It depresses the formation, release and activity of inflammatory mediators (e.g. kinins, histamine, prostaglandins) by induction of phospholipase A2 inhibitory proteins (e.g. lipocortins) and inhibition of arachidonic acid release.
Clioquinol is a halogenated hydroxyquinoline derivative. It has a broad spectrum of activity against fungi (e.g. candida, microsporum, trichophyton); and bacteriostatic against gm+ve bacteria (e.g. staphylococci) but has limited activity against gm-ve bacterias. Pharmacokinetics: Absorption: Betamethasone: Readily absorbed from the intact skin.
Clioquinol: Approx 1.5-4% is absorbed. Distribution: Betamethasone: Rapidly distributed to all body tissues. Crosses the placenta and enters breast milk (small amounts). Plasma protein binding: Extensively bound mainly to globulin. Metabolism: Betamethasone: Metabolised in the liver. Excretion: Betamethasone: Via urine and faeces.
Clioquinol: Via urine mainly as glucuronide, and as sulphate metabolites (small amounts).
Chemical Structure
Betamethasone Source: National Center for Biotechnology Information. PubChem Database. Betamethasone, CID=9782, https://pubchem.ncbi.nlm.nih.gov/compound/Betamethasone (accessed on Jan. 21, 2020)
Clioquinol Source: National Center for Biotechnology Information. PubChem Database. Clioquinol, CID=2788, https://pubchem.ncbi.nlm.nih.gov/compound/Clioquinol (accessed on Jan. 21, 2020)
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