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Desoximetasone

Pronunciation

(des oks i MET a sone)

Index Terms

  • Desoxymethasone

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External:

Topicort: 0.05% (15 g [DSC], 60 g, 100 g [DSC]) [contains cetostearyl alcohol, edetate disodium]

Topicort: 0.25% (15 g [DSC], 60 g, 100 g [DSC]) [contains cetostearyl alcohol]

Generic: 0.05% (15 g, 60 g, 100 g); 0.25% (15 g, 60 g, 100 g)

Gel, External:

Topicort: 0.05% (15 g [DSC], 60 g) [contains alcohol, usp, edetate disodium, trolamine (triethanolamine)]

Generic: 0.05% (15 g, 60 g)

Liquid, External:

Topicort Spray: 0.25% (100 mL) [contains isopropyl alcohol, levomenthol]

Ointment, External:

Topicort: 0.05% (15 g [DSC], 60 g, 100 g); 0.25% (15 g [DSC], 60 g, 100 g [DSC])

Generic: 0.05% (60 g, 100 g); 0.25% (15 g, 60 g, 100 g)

Brand Names: U.S.

  • Topicort
  • Topicort Spray

Pharmacologic Category

  • Corticosteroid, Topical

Pharmacology

Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties. May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins) through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid. Desoximetasone has intermediate to high range potency (dosage-form dependent).

Absorption

May be increased with occlusion, inflammation, or vary with site of application

Metabolism

Hepatic

Excretion

Urine, feces

Use: Labeled Indications

Cream, gel, ointment: Relief of inflammation and pruritic symptoms of corticosteroid-responsive dermatosis

Spray: Plaque psoriasis treatment

Contraindications

Cream, gel, ointment: Hypersensitivity to desoximetasone or any component of the formulation

Spray: There are no contraindications listed in the manufacturer’s labeling.

Dosage

Note: Therapy should be discontinued when control is achieved; if no improvement is seen within 4 weeks, reassessment of diagnosis may be necessary.

Corticosteroid-responsive dermatoses: Children, Adolescents, and Adults: Topical: Cream, gel, ointment: Apply a thin film to affected area twice daily

Plaque psoriasis treatment: Adults: Topical: Spray: Apply a thin film to affected area twice daily

Dosage adjustment in renal impairment: No dosage adjustment provided in manufacturer’s labeling.

Dosage adjustment in hepatic impairment: No dosage adjustment provided in manufacturer’s labeling; use caution.

Administration

Topical: For external use only. Apply to clean, dry skin and rub in gently. Wash hands thoroughly before and after use. Unless otherwise directed by healthcare professional, do not use with occlusive dressing.

Cream, gel, ointment: Avoid contact with eyes.

Spray: Avoid use on the face, axilla, or groin. Avoid heat, flame, or smoking when applying (flammable).

Storage

Store between at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Spray is flammable; keep away from heat or flame. Prior to dispensing, insert spray pump into bottle and fasten tightly. Spray must be discarded 30 days after dispensing.

Drug Interactions

Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Avoid combination

Ceritinib: Corticosteroids may enhance the hyperglycemic effect of Ceritinib. Monitor therapy

Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Monitor therapy

Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Monitor therapy

Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Consider therapy modification

Adverse Reactions

>10%: Endocrine & metabolic: HPA-axis suppression (psoriasis patients: spray: 8% to 22%)

<1% (Limited to important or life-threatening): Acneiform eruption, allergic contact dermatitis, atrophic striae, burning sensation, erythema, folliculitis (including folliculopustular lesions), hypertrichosis, hypopigmentation, local irritation, localized burning, localized vesiculation, maceration of the skin, miliaria, perioral dermatitis, pruritus, secondary infection, skin atrophy, xeroderma

Warnings/Precautions

Concerns related to adverse effects:

• Adrenal suppression: May cause hypercorticism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.

• Contact dermatitis: Allergic contact dermatitis can occur; it is usually diagnosed by failure to heal rather than clinical exacerbation.

• Immunosuppression: Prolonged use may result in fungal or bacterial superinfection; discontinue if dermatological infection persists despite appropriate antimicrobial therapy.

• Kaposi's sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered.

• Skin reactions: Local adverse effects (eg, atrophy, striae, telangiectasias, burning, itching, irritation, dryness, folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection, and miliaria) may occur. Reactions may not be reversible and may be more likely to occur with prolonged use, higher potency corticosteroids, and occlusive dressings.

• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing's syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.

Disease-related concerns:

• Skin infections: Use appropriate antibacterial or antifungal agents to treat concomitant skin infections; discontinue desoximetasone treatment if infection does not resolve promptly.

Special populations:

• Pediatric: Children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing's syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.

Dosage form specific issues:

• Spray: Flammable; avoid heat, flame, or smoking when applying.

Pregnancy Risk Factor

C

Pregnancy Considerations

Corticosteroids were found to be teratogenic following topical application in animal reproduction studies. In general, the use of topical corticosteroids during pregnancy is not considered to have significant risk; however, intrauterine growth retardation in the infant has been reported (rare). The use of large amounts or for prolonged periods of time should be avoided (Reed, 1997).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber signs of hyperglycemia, severe skin irritation, or skin changes (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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