Consists of betamethasone valerate, Gentamicin sulfate, miconazole nitrate
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Betamethasone valerate/Gentamicin sulfate/miconazole nitrate Dosage |
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Consists of betamethasone valerate, Gentamicin sulfate, miconazole nitrate
Betamethasone valerate Cream/Betamethasone valerate RD Cream: A small quantity should be applied to the affected area 2 or 3 times daily until improvement occurs. It may then be possible to maintain improvement by applying once a day or even less often or by using the appropriate ready-diluted (1 in 4) preparation Betamethasone valerate RD Cream.
Betamethasone valerate Cream: Betamethasone valerate creams are especially appropriate for moist or weeping surfaces.
In the more resistant lesions eg, the thickened plaques of psoriasis on elbows and knees, the effect of Betamethasone valerate can be enhanced, if necessary, by occluding the treatment area with polythene film. Overnight occlusion only is usually adequate to bring about a satisfactory response in such lesions thereafter, improvement can usually be maintained by regular application without occlusion.
Betamethasone valerate RD Cream: A small amount of Betamethasone valerate RD Cream may be applied up to 3 times daily. Betamethasone valerate RD Cream is especially appropriate for moist or weeping surfaces.
Betamethasone valerate Scalp Application: A small quantity of Betamethasone valerate Scalp Application should be applied to the scalp night and morning until improvement is noticeable. It may then be possible to sustain improvement by applying once a day or less frequently.
Due to the flammable nature of Betamethasone valerate Scalp Application, patients should avoid smoking, heat including the use of hair dryer or being near an open flame during application and immediately after use.
Children: Betamethasone valerate valerate is contraindicated in children <1 year.
Children are more likely to develop local and systemic side effects of topical corticosteroids and in general, require shorter courses and less potent agents than adults.
Care should be taken when using Betamethasone valerate valerate to ensure the amount applied is the minimum that provides therapeutic benefit.
Elderly: The greater frequency of decreased hepatic or renal function in the elderly may delay elimination if systemic absorption occurs. Therefore, the minimum quantity should be used for the shortest duration to achieve the desired clinical benefit.
Renal/Hepatic Impairment: In case of systemic absorption (when application is over a large surface area for a prolonged period), metabolism and elimination may be delayed therefore increasing the risk of systemic toxicity. Therefore, the minimum quantity should be used for the shortest duration to achieve the desired clinical benefit.
Many drugs can affect Betamethasone valerate. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.
Betamethasone valerate drug interactions (in more detail)
Concurrent use of barbiturates, carbamazepine, phenytoin, primidone or rifampicin may enhance the metabolism and reduce the effects of systemic corticosteroids. Conversely, oral contraceptives or ritonavir may increase plasma concentrations of corticosteroids.
Use of corticosteroids with potassium-depleting diuretics eg, thiazides or furosemide may cause excessive potassium loss. There is also an increased risk of hypokalemia with concurrent amphotericin B or bronchodilator therapy with xanthines or β2 agonist.
There may be an increased incidence of gastrointestinal bleeding and ulceration when corticosteroids are given with NSAIDs. Corticosteroids may alter response to anticoagulants increasing requirements of antidiabetic drugs and antihypertensives.
Corticosteroids may decrease serum concentrations of salicylates and may decrease the effect of antimuscarinics in myasthenia gravis.
Gentamicin sulfate Sulfate Injection, USP is administered by intravenous infusion only after dilution in a 50 or 100 mL ADD-Vantage Flexible Diluent Container of 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP.
The patient’s pretreatment body weight should be obtained for calculation of correct dosage. The dosage of aminoglycosides in obese patients should be based on an estimate of the lean body mass. It is desirable to limit the duration of treatment with aminoglycosides to short term.
Patients with Normal Renal Function
Adults: The recommended dosage of Gentamicin sulfate sulfate for patients with serious infections and normal renal function is 3 mg/kg/day, administered in three equal doses every eight hours (Table 3).
For patients with life-threatening infections, dosages up to 5 mg/kg/day may be administered in three or four equal doses. The dosage should be reduced to 3 mg/kg/day as soon as clinically indicated (Table 3).
It is desirable to measure both peak and trough serum concentrations of Gentamicin sulfate to determine the adequacy and safety of the dosage. When such measurements are feasible, they should be carried out periodically during therapy to assure adequate but not excessive drug levels. When monitoring peak concentrations after intravenous administration, dosage should be adjusted so that prolonged levels above 12 mcg/mL are avoided. When monitoring trough concentrations (just prior to the next dose), dosage should be adjusted so that levels above 2 mcg/mL are avoided. Determination of the adequacy of a serum level for a particular patient must take into consideration the susceptibility of the causative organism, the severity of the infection, and the status of the patient’s host-defense mechanisms. In patients with extensive burns, altered pharmacokinetics may result in reduced serum concentrations of aminoglycosides. In such patients treated with Gentamicin sulfate, measurement of serum concentrations is recommended as a basis for dosage adjustment.
* The dosage of aminoglycosides in obese patients should be based on an estimate of the lean body mass. ** For q6h schedules, dosage should be recalculated. | |||
(Dosage at Eight-Hour Intervals) | |||
Patient’s Weight* | Usual Dose for Serious Infections | Dose for Life-Threatening Infections (Reduce as Soon as Clinically Indicated) | |
kg | (lb) | 1 mg/kg q8h (3 mg/kg/day) | 1.7 mg/kg q8h** (5 mg/kg/day) |
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| mg/dose q8h | mg/dose q8h |
40 | (88) | 40 | 66 |
45 | (99) | 45 | 75 |
50 | (110) | 50 | 83 |
55 | (121) | 55 | 91 |
60 | (132) | 60 | 100 |
65 | (143) | 65 | 108 |
70 | (154) | 70 | 116 |
75 | (165) | 75 | 125 |
80 | (176) | 80 | 133 |
85 | (187) | 85 | 141 |
90 | (198) | 90 | 150 |
95 | (209) | 95 | 158 |
100 | (220) | 100 | 166 |
NOTE: For further information concerning the use of Gentamicin sulfate in infants and children, see pediatric Gentamicin sulfate sulfate injection product information.
The usual duration of treatment for all patients is seven to ten days. In difficult and complicated infections, a longer course of therapy may be necessary. In such cases monitoring of renal, auditory, and vestibular functions is recommended, since toxicity is more apt to occur with treatment extended for more than ten days. Dosage should be reduced if clinically indicated.
For
The intravenous administration of Gentamicin sulfate may be particularly useful for treating patients with bacterial septicemia or those in shock. It may also be the preferred route of administration for some patients with congestive heart failure, hematologic disorders, severe burns, or those with reduced muscle mass. For intermittent intravenous administration in adults, a single dose of Gentamicin sulfate sulfate may be diluted in 50 or 100 mL of sterile 0.9% Sodium Chloride Injection, USP or in a sterile solution of 5% Dextrose Injection, USP. The solution may be infused over a period of one-half to two hours.
Gentamicin sulfate sulfate should not be physically premixed with other drugs, but should be administered separately in accordance with the recommended route of administration and dosage schedule.
Patients with Impaired Renal Function
Dosage must be adjusted in patients with impaired renal function to assure therapeutically adequate, but not excessive blood levels. Whenever possible, serum concentrations of Gentamicin sulfate should be monitored. One method of dosage adjustment is to increase the interval between administration of the usual doses. Since the serum creatinine concentration has a high correlation with the serum half-life of Gentamicin sulfate, this laboratory test may provide guidance for adjustment of the interval between doses. The interval between doses (in hours) may be approximated by multiplying the serum creatinine level (mg/100 mL) by 8. For example, a patient weighing 60 kg with a serum creatinine level of 2.0 mg/100 mL could be given 60 mg (1 mg/kg) every 16 hours (2x8).
In patients with serious systemic infections and renal impairment, it may be desirable to administer the antibiotic more frequently but in reduced dosage. In such patients, serum concentrations of Gentamicin sulfate should be measured so that adequate, but not excessive levels result. A peak and trough concentration measured intermittently during therapy will provide optimal guidance for adjusting dosage. After the usual initial dose, a rough guide for determining reduced dosage at eight-hour intervals is to divide the normally recommended dose by the serum creatinine level (Table 4). For example, after an initial dose of 60 mg (1 mg/kg), a patient weighing 60 kg with a serum creatinine level of 2.0 mg/100 mL could be given 30 mg every eight hours (60 ÷ 2). It should be noted that the status of renal function may be changing over the course of the infectious process.
It is important to recognize that deteriorating renal function may require a greater reduction in dosage than that specified in the above guidelines for patients with stable renal impairment.
(Dosage at Eight-Hour Intervals After the Usual Initial Dose) | ||
Serum Creatinine (mg%) | Approximate Creatinine Clearance Rate (mL/min/1.73M2) | Percent of Usual Doses Shown in Table 3 |
≤1.0 | >100 | 100 |
1.1 — 1.3 | 70 —100 | 80 |
1.4 — 1.6 | 55 — 70 | 65 |
1.7 — 1.9 | 45 — 55 | 55 |
2.0 — 2.2 | 40 — 45 | 50 |
2.3 — 2.5 | 35 — 40 | 40 |
2.6 — 3.0 | 30 — 35 | 35 |
3.1 — 3.5 | 25 — 30 | 30 |
3.6 — 4.0 | 20 — 25 | 25 |
4.1 — 5.1 | 15 — 20 | 20 |
5.2 — 6.6 | 10 — 15 | 15 |
6.7 — 8.0 | <10 | 10 |
In adults with renal failure undergoing hemodialysis, the amount of Gentamicin sulfate removed from the blood may vary depending upon several factors including the dialysis method used. An eight-hour hemodialysis may reduce serum concentrations of Gentamicin sulfate by approximately 50%. The recommended dose at the end of each dialysis period is 1 to 1.7 mg/kg depending upon the severity of infection.
The above dosage schedules are not intended as rigid recommendations but are provided as guides to dosage when the measurement of Gentamicin sulfate serum levels is not feasible.
A variety of methods are available to measure Gentamicin sulfate concentrations in body fluids; these include microbiologic, enzymatic and radioimmunoassay techniques.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Other drugs, especially those that affect the kidneys, can interact with Gentamicin sulfate resulting in dangerous side effects and/or decreased effectiveness. Do not take any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, without first talking to your doctor during treatment with Gentamicin sulfate.
The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.
To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.
Some products that may interact with this drug include: aminoglycoside antibiotics given by injection (such as amikacin, Gentamicin sulfate, tobramycin).
This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.
Generic name: miconazole nitrate
Dosage form: Cream
See also:
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
Sufficient Miconazole nitrate Cream should be applied to cover affected areas twice daily (morning and evening) in patients with tinea pedis, tinea cruris, tinea corporis, and cutaneous candidiasis, and once daily in patients with tinea versicolor. If Miconazole nitrate Cream is used in intertriginous areas, it should be applied sparingly and smoothed in well to avoid maceration effects.
Early relief of symptoms (2 to 3 days) is experienced by the majority of patients and clinical improvement may be seen fairly soon after treatment is begun; however, Candida infections and tinea cruris and corporis should be treated for two weeks and tinea pedis for one month in order to reduce the possibility of recurrence. If a patient shows no clinical improvement after a month of treatment, the diagnosis should be redetermined. Patients with tinea versicolor usually exhibit clinical and mycological clearing after two weeks of treatment.
Avoid using other topicals at the same time unless your doctor approves. Other skin medications may affect the absorption or effectiveness of miconazole topical.
Oral anticoagulants, sulfonylurea hypoglycemics, phenytoin, carbamazepine, astemizole, cisapride & terfenadine.
Users | % | ||
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1-5mg | 1 | 100.0% |
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Information checked by Dr. Sachin Kumar, MD Pharmacology
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