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INTRODUCTION

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pimecrolimus (pim-eck-roe-lee-mus)

Elidel

Classification

Therapeutic: immunosuppressants (topical)

Pharmacologic: calcineurin inhibitors

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Indications
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Short-term and intermittent long-term management of mild-to-moderate atopic dermatitis unresponsive to or in patients intolerant of conventional treatment.

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Action
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Inhibits T-cell and mast cell activation by interfering with production of inflammatory cytokines. Therapeutic Effects: ↓ severity of atopic dermatitis.

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Adverse Reactions/Side Effects
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Local: burning. Misc: ↑ risk of lymphoma/skin cancer.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess the area being treated to help document whether drug therapy is successful in resolving skin conditions.

  • Monitor any new or increased skin reactions at the site of application, including burning, rash, or other suspicious skin lesions that might indicate skin cancer or lymphoma. Report severe or unusual skin reactions to the physician.

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Patient/Client-Related Instruction
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  • Check that the patient and family or caregivers understand topical application procedures and adhere to the recommended dosing schedule.

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Pharmacokinetics
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Absorption: Minimally absorbed through intact skin.

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Distribution: Local distribution after topical administration.

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Metabolism and Excretion: Systemic metabolism and excretion is negligible with local application.

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Half-life: Not applicable.

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TIME/ACTION PROFILE (improvement in symptoms)

ROUTE ONSET PEAK DURATION
topical within 6 days unknown unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Should not be applied to areas of active cutaneous viral infections (increased risk of dissemination); Concurrent use of occlusive dressings; Netherton's syndrome (increased absorption of pimecrolimus); Lactation: Discontinue breast-feeding.

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Use Cautiously in: Possible risk of cancer. Do not use as first-line therapy; Clinical infection at treatment site (infection should be treated/cleared prior to use); Skin papillomas (warts); allow treatment/resolution prior to use; Natural/artificial sunlight (minimize exposure); OB: Use only if clearly needed; Pedi: Use only if other treatments have failed; safety not established in children <2 yr.

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Interactions
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Drug-Drug: None significant as systemic absorption is negligible.

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Route/Dosage
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Topical (Adults and Children ≥2 yr): Apply thin film twice daily; rub in gently and completely.

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Availability
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Cream: 1% in 30-g, 60-g, and 100-g tubes.

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