WARNINGS
No information provided.
PRECAUTIONS
General
Systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal
(HPA) axis suppression, manifestations of Cush- ing's syndrome, hyperglycemia,
and glucosuria in some patients. Conditions which augment systemic absorption
include the application of the more potent steroids, use over large surface
areas, prolonged use, and the addition of occlusive dressings.
Therefore, patients receiving a large dose of a potent topical steroid applied
to a large sur- face area and under an occlusive dressing should be evaluated
periodically for evidence of HPA axis suppression by using the urinary free
cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt
should be made to withdraw the drug, to reduce the frequency of application,
or to substitute a less potent steroid.
Recovery of HPA axis function is generally prompt and complete upon discontinuation
of the drug. Infrequently, signs and symptoms of steroid withdrawal may occur,
requiring supplemental systemic corticosteroids. Children may absorb proportionally
larger amounts of topical corticosteroids and thus be more susceptible to systemic
toxicity. (See PRECAUTIONS-Pediatric Use.)
If irritation develops, topical corticosteroids should be discontinued and
appropriate therapy instituted.
In the presence of dermatological infections, the use of an appropriate antifungal
or anti- bacterial agent should be instituted. If a favorable response does
not occur promptly the corticosteroid should be discontinued until the infection
has been adequately controlled.
Laboratory Tests
The following tests may be helpful in evaluating the HPA axis suppression:
Urinary free cortisol test ACTH stimulation test
Carcinogenesis, Mutagenesis, and Impairment of Fertility
Long-term animal studies have not been performed to evaluate the carcinogenic
potential or the effect on fertility of topical corticosteroids. Studies to
determine mutagenicity with prednisolone and hydro- cortisone have revealed
negative results.
Pregnancy
Teratogenic Effects - Pregnancy Category C
Corticosteroids are generally teratogenic in laboratory animals when administered
systemically at relatively low dosage levels. The more potent corticosteroids
have been shown to be teratogenic after dermal application in laboratory animals.
There are no adequate and well-controlled studies in pregnant women on teratogenic
effects from topically applied corticosteroids. Therefore, topical corticosteroids
should be used during pregnancy only if the potential benefit justifies the
potential risk to the fetus. Drugs of this class should not be used extensively
on pregnant patients, in large amounts, or for prolonged periods of time.
Nursing Mothers
It is not known whether topical administration of corticosteroids could result
in sufficient systemic absorption to produce detectable amounts in breast milk.
Systemically administered corticosteroids are secreted into breast milk in
quantities NOT likely to have a deleterious effect on the infant. Nevertheless,
caution should be exercised when topical corticosteroids are administered to
a nursing woman.
Pediatric Use
Pediatric patients may demonstrate greater susceptibility to topical corticosteroid
induced HPA axis suppression and Cushing's syndrome than mature patients because
of a larger skin surface area to body weight ratio.
Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome,
and intra-cranial hypertension have been reported in children receiving topical
corticosteroids. Manifestations of adrenal suppression in children include linear
growth retardation, delayed weight gain, low plasma cortisol levels, and absence
of response to ACTH stimulation. Manifestations of intracranial hypertension
include bulging fontanelles, headaches, and bilateral papilledema.
Administration of topical corticosteroids to children should be limited to
the least amount compatible with an effective therapeutic regimen. Chronic corticosteroid
therapy may interfere with the growth and development of children.