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Here’s what to ask a doctor about hereditary angioedema

Halcinonide

Pronunciation

(hal SIN oh nide)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Halog: 0.1% (30 g, 60 g, 216 g) [contains cetyl alcohol, propylene glycol]

Ointment, External:

Halog: 0.1% (30 g, 60 g)

Brand Names: U.S.

  • Halog

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. Halcinonide has high range potency.

Absorption

Dependent on strength of preparation, amount applied, integrity of skin at application site, vehicle, and use of occlusive dressing; increased in areas of skin damage, inflammation, or occlusion.

Metabolism

Primarily hepatic

Excretion

Urine

Use: Labeled Indications

Relief of inflammatory and pruritic effects of corticosteroid-responsive dermatoses [high potency topical corticosteroid]

Contraindications

Hypersensitivity to halcinonide or any component of the formulation

Dosing: Adult

Steroid-responsive dermatoses: Topical: Apply sparingly 2-3 times daily, occlusive dressing may be used for severe or resistant dermatoses; a thin film is effective; avoid excessive application. Therapy should be discontinued when control is achieved; if no improvement is seen, reassessment of diagnosis may be necessary.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Refer to adult dosing.

Administration

For external use only; not for oral, ophthalmic, or intravaginal use. Wash hands before and after use. Apply a thin film to clean, dry skin and rub in gently. Avoid use of topical preparations on weeping or exudative lesions; occlusive dressings may be used on severe or resistant dermatoses.

Storage

Store at room temperature; avoid excessive heat ≥40°C (≥104°F)

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

Frequency not defined. Adverse reactions reported with topical corticosteroids; may occur more frequently with occlusive dressing.

Central nervous system: Intracranial hypertension (children), localized burning

Dermatologic: Acneiform eruption, allergic contact dermatitis, atrophic striae, folliculitis, hypertrichosis, hypopigmentation, maceration of the skin, miliaria, perioral dermatitis, pruritus, skin atrophy, xeroderma

Endocrine & metabolic: Cushing syndrome, glycosuria, growth suppression (children), HPA-axis suppression, hyperglycemia

Infection: Secondary infection

Local: Local irritation

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 antifungal or 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.

• Sensitization: Topical use has been associated with local sensitization (redness, irritation); discontinue if sensitization is noted.

• 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.

Special populations:

• Elderly: Because of the risk of adverse effects associated with systemic absorption, topical corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.

• 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.

Other warnings/precautions:

• Appropriate use: For external use only; not for oral, ophthalmic, or intravaginal use. Avoid use of topical preparations with occlusive dressings or on weeping or exudative lesions.

Monitoring Parameters

Evaluate for HPA axis suppression by using the following tests: ACTH stimulation test, urinary free cortisol test; growth (adolescents/children); presence of infection

Pregnancy Risk Factor

C

Pregnancy Considerations

Teratogenic effects have been observed in animals administered potent topical corticosteroids. Topical products are not recommended for extensive use, in large quantities, or for long periods of time in pregnant women (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?)

• Patient may experience dry skin, itching, burning, or stinging. Have patient report immediately to prescriber signs of high blood sugar (confusion, feeling sleepy, more thirst, hunger, passing urine more often, flushing, fast breathing, or breath that smells like fruit), signs of skin changes (pimples, stretch marks, slow healing, or hair growth), or severe skin irritation (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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