Betamethasone valerate/gentamicin/Miconazole Dosage
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 Injection, USP may be given intramuscularly or by intravenous infusion. 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 for patients with serious infections and normal renal function is 3 mg/kg/day, administered in three equal doses every eight hours ().
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 ().
It is desirable to measure both peak and trough serum concentrations of gentamicin 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. For example, the peak concentration (at 30 to 60 minutes after intramuscular injection) is expected to be in the range of 4 to 6 mcg/mL. When monitoring peak concentrations after intramuscular or 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, measurement of serum concentrations is recommended as a basis for dosage adjustment.
Children: 6 to 7.5 mg/kg/day (2 to 2.5 mg/kg administered every 8 hours).
Infants and Neonates: 7.5 mg/kg/day (2.5 mg/kg administered every 8 hours).
Premature or Full-Term Neonates One Week of Age or Less: 5 mg/kg/day (2.5 mg/kg administered every 12 hours).
NOTE: For further information concerning the use of gentamicin in infants and children, see pediatric Gentamicin 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.
The intravenous administration of gentamicin 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 may be diluted in 50 to 200 mL of sterile isotonic saline solution or in a sterile solution of 5% dextrose in water, in infants and children, the volume of diluent should be less. The solution may be infused over a period of one-half to two hours.
The recommended dosage for intravenous and intramuscular administration is identical.
Gentamicin 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 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, 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 (2 x 8).
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 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 (). 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.
In adults with renal failure undergoing hemodialysis, the amount of gentamicin 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 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. In children, a dose of 2 mg/kg may be administered.
The above dosage schedules are not intended as rigid recommendations but are provided as guides to dosage when the measurement of gentamicin serum levels is not feasible.
A variety of methods are available to measure gentamicin 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 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.
Penicillins: Gentamicin is inactivated by solutions containing β-lactam antibiotics (penicillins and cephalosporins) so the 2 drugs should not be administered simultaneously nor should they be combined in the IV fluid. The inactivation of gentamicin by penicillins may occur in vivo, especially in patients with renal failure who maintain a higher level of the penicillin for a longer period of time. Therefore, when gentamicin and penicillins are used together in patients with renal failure, the time of administration of each drug should be staggered so that several hours separate each infusion.
Diuretics: Potent diuretics eg, ethacrynic acid or frusemide may potentiate the ototoxic effects of gentamicin.
Other Neurotoxic and/or Nephrotoxic Agents: Since the ototoxic or nephrotoxic effects of gentamicin may be additive, avoid concurrent or sequential use of other neurotoxic and/or nephrotoxic antibiotics, including other aminoglycosides, polymyxin B, colistin, cisplatin, vancomycin, amphotericin, clindamycin and cephalosporins.
Neuromuscular-Blocking Agents: Respiratory paralysis and prolongation of neuromuscular blockade may occur if a neuromuscular-blocking agent eg, suxamethonium (succinylcholine), tubocurarine, decamethonium, halogenated hydrocarbon inhalation anaesthetics, opioid analgesics or massive transfusions with citrated anticoagulated blood are administered to a patient receiving gentamicin.
Vitamin K: Gentamicin may inhibit the action of IV vitamin K upon the synthesis of clotting factors.
Potential Interactions: In vitro synergism and antagonism have been found between various antineoplastic agents and aminoglycosides.
Incompatibilities. When gentamicin is used in combination with any other drug, mixing the drugs before administration should be avoided at all costs.
Applies to the following strength(s): 50 mg; 10 mg/mL
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
Oropharyngeal candidiasis: Apply 50 mg buccally to the upper gum region once a day for 14 consecutive days.
16 years or older: Apply 50 mg buccally to the upper gum region once a day for 14 consecutive days.
No adjustment recommended.
The manufacturer recommends caution when administering this drug to patients with liver dysfunction.
Miconazole buccal tablets are contraindicated in patients with known hypersensitivity (e.g., anaphylaxis) to milk protein concentrate.
Allergic reactions (including anaphylactic reactions and hypersensitivity) have been reported with the use of miconazole products. Miconazole should be discontinued at once at the first sign of hypersensitivity.
There are no data regarding cross-hypersensitivity between miconazole and other azole antifungal agents. Patients with a history of hypersensitivity to azoles should be monitored.
Safety and effectiveness have not been established in pediatric patients less than 16 years of age.
No adjustment recommended.
Miconazole buccal tablets should be applied with dry hands each morning after brushing teeth. The tablets should be placed against the upper gum, above the incisor tooth, and held in place with slight pressure over the upper lip for 30 seconds to ensure adhesion. Once in place, the buccal tablet stays in position and gradually dissolves. Subsequent applications should be made to alternate sides of the mouth. Any remaining tablet material should be cleared away before the next tablet is applied.
Miconazole buccal tablets should not be crushed, chewed, or swallowed. Food and drink can be taken normally when the buccal tablet is in place but chewing gum should be avoided.
If the miconazole buccal tablet does not adhere or falls off within the first 6 hours, the same tablet should be repositioned at once; however, if the tablet still does not adhere, a new tablet should be used. If the buccal tablet is swallowed within the first 6 hours, the patient should drink a glass of water and a new tablet should be applied only once. If the buccal tablet falls off or is swallowed after it was in place for at least 6 hours, a new tablet should not be applied until the next scheduled dose.
It is not likely that other drugs you take orally or inject will have an effect on topically applied miconazole. But many drugs can interact with each other. Tell each of your health care providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.
Interaction with other medicinal products and other forms of interaction: When using any concomitant medication, the corresponding label should be consulted for information on the route of metabolism. Miconazole can inhibit the metabolism of drugs metabolized by the CYP3A4 and CYP2C9 enzyme systems. This can result in an increase and/or prolongation of their effects, including adverse effects.
Drugs which should not be used during treatment with miconazole:
Oral miconazole is contraindicated with the co-administration of the following drugs that are subject to metabolism by CYP3A4 : Substrates known to prolong QT-interval eg, astemizole, bepridil, cisapride, dofetilide, halofantrine, mizolastine, pimozide, quinidine, sertindole and terfenadine; ergot alkaloids; HMG-CoA reductase inhibitors eg, simvastatin and lovastatin; triazolam and oral midazolam.
When co-administered with oral miconazole, the following drugs should be used with caution because of a possible increase or prolongation of the therapeutic outcome and/or adverse effects. If necessary, their dosage should be reduced and when appropriate, plasma levels monitored: Others:
Oral hypoglycemics (CYP2C9), phenytoin (CYP2C9), carbamazepine, buspirone, alfentanil, sildenafil, alprazolam, brotizolam, midazolam IV, rifabutin, methylprednisolone, trimetrexate, ebastine and reboxetine.
Drugs subject to metabolism by CYP2C9 :
Other drugs subject to metabolism by CYP3A4: HIV protease inhibitors eg, saquinavir; certain antineoplastic agents eg, vinca alkaloids, busulfan and docetaxel; certain calcium channel blockers eg, dihydropyridines and verapamil; certain immunosuppressive agents: cyclosporine, tacrolimus, sirolimus (rapamycin); others: alfentanil, alprazolam, brotizolam, buspirone, carbamazepine, cilostasol, disopyramide, ebastin, methylprednisolone, midazolam IV, reboxetine, rifabutin, sildenafil and trimetrexate.
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Information checked by Dr. Sachin Kumar, MD Pharmacology