Ciclopirox

INTRODUCTION

Indications

Treatment of cutaneous fungal infections, including cutaneous candidiasis (lotion and cream only), tinea pedis (athlete's foot) (gel, lotion, and cream only), tinea cruris (jock itch) (lotion and cream only), tinea corporis (ringworm) (gel, lotion, and cream only), tinea versicolor (lotion and cream only), seborrheic dermatitis (shampoo and gel only), and onychomycosis of fingernails and toenails (nail lacquer only).

Action

Inhibits the transport of essential elements in fungal cell, disrupting the synthesis of DNA, RNA, and protein. Therapeutic Effects: Decrease in symptoms of fungal infection.

Adverse Reactions/Side Effects

Local: burning, itching, local hypersensitivity reactions, redness, stinging.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess healing of skin lesions to help document drug effectiveness.

Interventions

• Avoid contact with cutaneous lesions when treating patient.

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection.

Patient/Client-Related Instruction

• Advise patient to report any increased local sensitivity to this drug (pain, burning, itching, redness, stinging).

• Instruct patient about proper hygiene; e.g., thoroughly wash and dry the affected area, wear clean socks and ventilated shoes for tinea pedis, and so forth.

• Advise patient to apply the drug as directed for the full course of treatment even if the patient feels better.

• Inform patient that early relief of cutaneous symptoms may be seen in 2–3 days. Full therapeutic response may take up to 4 wk.

• Advise patient to seek medical help if infections persist or recur after the full treatment. Recurrent fungal infections may be a sign of systemic illness.

Pharmacokinetics

Absorption: Absorption through intact skin is minimal (<5%).

Distribution: Distribution after topical administration is primarily local.

Metabolism and Excretion: Eliminated by kidneys (3–10% for gel).

Half-life: 5.5 hr (gel).

Contraindications/Precautions

Contraindicated in: Hypersensitivity to active ingredients, additives, preservatives, or bases; Some products contain alcohol (nail lacquer) and should be avoided in patients with known intolerance.

Use Cautiously in: OB/Lactation: Safety not established.

Interactions

Drug-Drug: Not known.

Route/Dosage

Topical (Adults and Children >10 yr): Shampoo: Apply 5 mL (10 mL may be used for long hair) to scalp and leave on for 3 min before rinsing off. Use twice weekly (wait at least 3 ...