calcitriol (ointment) (kal-si-trye-ole)
Pharmacologic: vitamin D analogues
Mild-to-moderate plaque psoriasis.
Exact mechanism is unknown, but may affect keratinocyte proliferation and differentiation and decrease the action of proinflammatory cytokines. Therapeutic Effects: Decreased severity of plaque psoriasis.
Adverse Reactions/Side Effects
GU: hypercalcuria. Derm: pruritus, skin discomfort.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess the area being treated to help document whether drug therapy is successful in decreasing skin plaques and other psoriatic skin lesions.
Monitor any new or increased reactions at the site of application, including pain, irritation, burning, swelling, and rash. Report severe or prolonged skin reactions to the physician.
Check that the patient and family or caregivers understand topical application procedures and adhere to the recommended dosing schedule.
Instruct patient to report signs of excess calcium in the urine (hypercalcuria). Signs include increased urination, painful urination, increased nighttime urination, and increased thirst.
Absorption: Although intended action is skin, some systemic absorption follows topical use.
Metabolism and Excretion: Absorbed calcitriol undergoes enterohepatic recycling and is excreted in bile.
Contraindicated in: No contraindications noted.
Use Cautiously in: Concurrent use of medications known to ↑ serum calcium levels, including thiazide diuretics, calcium supplements, or high doses of vitamin D; Exposure of the treated areas to natural or artificial sunlight, including tanning booths, sun lamps, or phototherapy; use should be limited or avoided; OB: Use during pregnancy only if potential benefit to patient justifies risk to fetus; Lactation: Use cautiously; Pedi: Safety and effectiveness in patients <18 yr has not been established.
Drug-Drug: Concurrent use with medications known to ↑ serum calcium levels, including thiazide diuretics, calcium supplements, or high doses of vitamin D may additively ↑ serum calcium levels; use cautiously.
Topical (Adults 18 yr): Apply twice daily; use should not exceed 200 g/wk.
Ointment: 3 mcg/g in 5- and 100-g tubes.