Active substance(s): CLOTRIMAZOLE / HYDROCORTISONE ACETATE
NAME OF THE MEDICINAL PRODUCT
QUALITATIVE AND QUANTITATIVE COMPOSITION
Each gram of cream contains 10mg clotrimazole and 11.2mg hydrocortisone acetate
(equivalent to 10mg hydrocortisone).
Excipient with known effect:
For the full list of excipients, see section 6.1.
Canesten Hydrocortisone is indicated for the treatment of the following skin
infections where co-existing symptoms of inflammation, e.g. itching, require
Posology and method of administration
Adults, elderly and children age 10 years and over:
Canesten Hydrocortisone should be thinly and evenly applied to the affected area
twice daily and rubbed in gently. The maximum period of treatment is seven
A total daily dose of 10 mg cream per kg body weight should not be exceeded.
For an adult weighing 50 kg the maximum daily dose is 500 mg cream which
equals approximately 2 cm of cream to be divided into 2 applications per day.
If the acute symptoms have subsided after about 7 days but treatment is still
required, this may be carried out with the corticoid-free preparation intended
for this purpose.
Canesten Hydrocortisone is contra-indicated in the following cases:
• Hypersensitivity to the active substances or to any of the excipients listed in
• Use on broken skin.
• Use on large areas of skin.
• Use for periods of longer than seven days.
• To treat cold sores or acne.
• Use on the face, eyes, mouth or mucous membranes.
• Children under 10 years of age, unless prescribed by a doctor.
• Pregnancy and lactation, unless prescribed by a doctor.
• Use on the ano-genital area, unless prescribed by a doctor.
• To treat ringworm, unless prescribed by a doctor.
• To treat secondarily infected skin conditions, unless prescribed by a doctor.
• Diseases affecting the skin (e.g. acne, rosacea, perioral dermatitis, lues,
• Any untreated bacterial skin diseases
• Viral skin diseases (e.g. herpes simplex, chicken pox, shingles etc.)
• Dermal vaccination reactions.
Special warnings and precautions for use
Because of its corticosteroid content, Canesten Hydrocortisone should not be
To large areas (more than 5 - 10% of the body surface).
In long term continuous therapy.
Under occlusive dressings (such as nappies and bandages).
These restrictions apply particularly in children, where increased systemic
absorption may occur resulting in adrenocortical suppression.
This product contains cetostearyl alcohol, which may cause local skin reactions
(e.g. contact dermatitis).
Interaction with other medicinal products and other forms of interaction
No interaction studies have been performed.
Fertility, pregnancy and lactation
No human studies of the effects of clotrimazole on fertility have been
performed; however, animal studies have not demonstrated any effects of the
drug on fertility. No data is available on the effects of topically applied
There is a limited amount of data from the use of clotrimazole or
hydrocortisone in pregnant women. Animal studies with clotrimazole and
corticosteroids have shown reproductive toxicity (see section 5.3). At the low
systemic exposures of clotrimazole and hydrocortisone following topical
treatment, harmful effects with respect to reproductive toxicity are not
Canesten Hydrocortisone cream can be used during pregnancy, but only under
the supervision of a physician or midwife. As a precautionary measure it is
preferable to refrain from applying the cream for long periods during pregnancy.
Available pharmacodynamic/toxicological data in animals have shown
excretion of clotrimazole/metabolites in milk after intravenous administration
(see section 5.3).
No data on hydrocortisone is available, but topically applied hydrocortisone is
unlikely to cause systematic effects due to the low percutaneous penetration.
However, cutaneous absorption may be increased under certain circumstances,
such as with use of occlusive dressing, the degree of skin damage, and the size
of the treated area.
A risk to the suckling child cannot be excluded. A decision must be made
whether to discontinue breast-feeding or to discontinue Canesten
Hydrocortisone therapy taking into account the benefit of breast-feeding for
the child and the benefit of therapy for the woman.
Effects on ability to drive and use machines
Canesten Hydrocortisone has no influence on the ability to drive and use machines.
As the listed undesirable effects are based on spontaneous reports, assigning
accurate frequency of occurrence for each is not possible
Immune system disorders: allergic reaction
(syncope, hypotension, dyspnea,
Skin and subcutaneous tissue disorders: blisters, discomfort/pain, oedema, erythema,
irritation, peeling/exfoliation, pruritus, rash, stinging/burning
After use on large areas (more than 10% of the body surface) and/or after
long-term use (longer than 2-4 weeks) or use under occlusive dressings, local
skin alterations such as skin atrophy, teleangiectasias, hypertrichosis,
striations, hypopigmentation, secondary infection and acneiform symptoms
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal
product is important. It allows continued monitoring of the benefit/risk balance
of the medicinal product. Healthcare professionals are asked to report any
suspected adverse reactions via the Yellow Card Scheme at:
No reports are available on cases of intoxication with Canesten
Hydrocortisone. No risk of acute intoxication is seen as it is unlikely to occur
following a single dermal application of an overdose (application over a large
area under conditions favourable to absorption) or inadvertent oral ingestion.
There is no specific antidote.
However, in the event of accidental oral ingestion, gastric lavage is rarely
required and should be considered only if a life-threatening amount of
clotrimazole has been ingested within the preceding hour or if clinical symptoms
of overdose become apparent (e.g. dizziness, nausea or vomiting). Gastric
lavage should be carried out only if the airway can be protected adequately.
Pharmacotherapeutic group: Antifungals for topical use – imidazole and
triazole derivatives, combinations.
ATC Code: D01A C20
Canesten Hydrocortisone is a combination of clotrimazole and hydrocortisone.
Mechanism of Action
Clotrimazole acts against fungi by inhibiting ergosterol synthesis. Inhibition of
ergosterol synthesis leads to structural and functional impairment of the fungal
Clotrimazole has a broad antimycotic spectrum of action in vitro and in vivo,
which includes dermatophytes, yeasts, moulds, etc.
Under appropriate test conditions, the MIC values for these types of fungi are
in the region of less than 0.062-8.0 µg/ml substrate. The mode of action of
clotrimazole is fungistatic or fungicidal depending on the concentration of
clotrimazole at the site of infection. In vitro activity is limited to proliferating
fungal elements; fungal spores are only slightly sensitive.
In addition to its antimycotic action, clotrimazole also acts on gram-positive
microorganisms (Streptococci / Staphylococci / Gardnerella vaginalis), and
gram-negative microorganisms (Bacteroides).
In vitro clotrimazole inhibits the multiplication of Corynebacteria and grampositive cocci - with the exception of Enterococci – in concentrations of 0.5-10
Primary resistant variants of sensitive fungal species are very rare; the
development of secondary resistance by sensitive fungi has so far only been
observed in very isolated cases under therapeutic conditions.
Hydrocortisone is a weak corticosteroid with both glucocorticoid and to a lesser
extent mineralocorticoid activity. As the active ingredient in a topical cream it
exerts antiphlogistic, antipruriginous, antiexudative and antiallergic effects.
Hydrocortisone, like other topically applied glucocorticoids, exerts an
(antiproliferative), antipruriginous and vasoconstrictive effect on skin. Thus, in
addition to the elimination of inflammation and pruritis, a normalisation of
keratinisation, inhibition of excess fibroblast activity and epidermopoiesis,
degradation of pathological metabolic products and inhibition of acantholysis are
achieved. However, this is not a curative therapy but rather a symptomatic
Pharmacokinetic investigations after dermal application have shown that
clotrimazole is minimally absorbed from intact or inflamed skin into the human
blood circulation. The resulting peak serum concentrations of clotrimazole were
below the detection limit of 0.001 µg/ml, suggesting that clotrimazole applied
topically in unlikely to lead to measurable systemic effects or side effects.
Dermal absorption of hydrocortisone depends on the thickness and condition
of the skin. In healthy skin no systemic effects of corticoids have been
observed after local application.
However, in the case of inflamed or damaged skin, cutaneous absorption may
be increased depending on the site of application, use of occlusive dressings,
the degree of skin damage, and size of the treated area. Systemic effects
cannot be ruled out under such conditions.
An increase in the skin temperature or moisture content, e.g. in skin folds or
under an occlusive dressing, also promotes absorption. In infants and small
children the epidermal "barrier" is still poorly developed, which facilitates
transcutaneous uptake of drugs. The occurrence of systemic effects depends
partly on the dose and, to a much greater extent, on the duration of treatment.
More than 90% of the hydrocortisone absorbed is bound to plasma proteins.
Hydrocortisone is metabolised in the liver and tissues, and the metabolites are
excreted with urine. The biological half-life is approximately 100 minutes.
No relevant absorption of hydrocortisone is expected after its use for a short
period on limited skin inflamed areas.
Preclinical safety data
Non-clinical data reveal no special hazard for humans based on studies of
repeated dose toxicity, genotoxicity and carcinogenicity. Clotrimazole was not
teratogenic in reproductive toxicity studies in mice, rats and rabbits. In rats high
oral doses were associated with maternal toxicity, embryotoxicity, reduced fetal
weights and decreased pup survival.
In rats clotrimazole and/or its metabolites were secreted into milk at levels higher
than in plasma by a factor of 10 to 20 at 4 hrs after administration, followed by a
decline to a factor of 0.4 by 24 hrs.
As an adrenocortical hormone, hydrocortisone is classified as relatively nontoxic for topical use. Teratogenic effects of high doses of corticosteroids
including cleft palate formation, growth retardation, and fetal mortality were
observed after systemic use in animal studies.
Clotrimazole plus hydrocortisone:
Non-clinical data based on acute and repeated dose toxicity studies reveal no
special hazard to humans. In a 90-day repeated dose dermal study, effects
were observed only at exposures considered sufficiently in excess of the
maximum human exposure indicating little relevance to clinical use.
List of excipients
Medium chain triglycerides
Sealed: 24 months
After opening: 6 months
Special precautions for storage
Do not store above 25°C.
Nature and contents of container
Aluminium tube with internal lacquer coating and HDPE screw-on cap containing
15g of cream.
Special precautions for disposal
No special requirements.
MARKETING AUTHORISATION HOLDER
Trading as: Bayer plc, Consumer Care Division
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION/RENEWAL OF THE
DATE OF REVISION OF THE TEXT
Source: Medicines and Healthcare Products Regulatory Agency
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