Pharmacological properties

Pharmacodynamics. active agent of cream of fokort-darniyets is Triamcinolonum acetonide — gks, the containing fluorine, at topical administration has anti-inflammatory, antiallergic and antipruritic effect.

Pharmacological action of GKS is based on regulation of synthesis of specific proteins of an organism and ensuring adaptability of an organism to stressful situations due to decrease in utilization of glucose and strengthening of a gluconeogenesis. They promote adjournment of a glycogen, first of all in a liver, due to strengthening of secretion of insulin in the conditions of a hyperglycemia. Reduce synthesis and strengthen catabolism of proteins of a muscle, skin and bone tissue; promote a lipolysis. Narrow vessels, reduce their permeability and puffiness of fabrics.

Numerous receptors of GKS are also in tissues of a brain and heart. GKS strengthen β-adrenergic reactions in lungs, expand bronchial tubes and reduce vascular resistance in lungs.

Esterification of molecule GKS fatty acids in the 17th and 21st positions significantly strengthens its impact on skin. The arrangement of cyclic acetonide in the 16th and 17th positions strengthens local anti-inflammatory action, without affecting system effect of GKS. Fluorine promotes further increase in local activity of medicine.

Pharmacokinetics. Triamcinolonum well gets into deep skin layers, partially comes to blood. At application of an occlusive bandage on the struck skin sites it is soaked up in the quantity sufficient for rendering system effect. GKS are quickly distributed in body tissues. The main metabolite of Triamcinolonum — 6-β-гидрокситриамцинолон, is metabolized by a liver, kidneys, removed with a stake and urine in equal ratios. The t _½ makes of blood plasma about 5 h, a half-life period — 18–36 h

Indication

Disease of skin at which treatment is shown by corticosteroids (eczema, vulgar psoriasis, allergic dermatitis).

Use

For external use.

Adult: a thin film of cream is applied by 2–3 times a day on an affected area of skin (the maximum dose — no more than 15 g of cream a day) or use medicament under an occlusive bandage (the maximum dose — no more than 10 g of cream a day). Duration of treatment is defined by the doctor individually.

to Children: 1 years are aged more senior a thin film of cream is applied by at most 2 times a day on an affected area of skin. Duration of use of medicine for children should not exceed 5 days. Use of an occlusive bandage for children is contraindicated.

Prescribing of cream to children is only possible

in exceptional cases.

At patients of advanced age needs to use medicament with care and within a short period of time as it must be kept in mind that at this category of patients the skin is thinner.

Contraindication

Hypersensitivity to Triamcinolonum to acetonide or excipients of medicine. tuberculosis, virus damages of skin, especially at a herpes simplex and chicken pox, skin manifestations of syphilis, skin reactions after vaccination, a perianal and genital itch, widespread blyashechny psoriasis, a varicosity, shin ulcers; damages of face skin (pink eels, vulgar eels, perioral dermatitis); the skin intertrigo caused by wet diapers; application as monotherapy without performing specific treatment at fungal and bacterial skin infections, treatment of dry peeling of skin, a carcinoma cutaneum, children's age till 1 year.

Side effects

at topical administration are characteristic

glucocorticosteroid medicines side reactions of local character, however, depending on amount of substance which came to a system blood-groove, system effects are possible.

At prolonged use on big surfaces the oppression of function of bark of adrenal glands, especially at children is possible

and also at application of occlusive bandages; the negative nitrogenous balance owing to the strengthened disintegration of proteins is possible.

from the immune system: hypersensitivity reactions.

from water and electrolytic exchange: oppression of function of bark of adrenal glands (secondary insufficiency of bark of adrenal glands), a gipokaliyemichesky Alkalosis, a delay in an organism of water and sodium, a hypopotassemia, AG.

from central nervous system: mental violations, spasms, dizziness, headache, increase in intracranial pressure, insomnia.

from an organ of sight: cataract, back subkapsulyarny cataract, exophthalmos, glaucoma, papilledema, helcoma, exophthalmos. The likelihood of developing a cataract is higher at children.

from a cardiovascular system: heart failure, AG.

from digestive system: gastric bleeding, gastrointestinal bleeding, gastrointestinal perforation, esophagitis, pancreatitis, round ulcer.

from skin: dermatitis, burning sensation, a folliculitis, akneformny rashes, contact dermatitis, dryness and thinning of skin, an erythema, a hirsutism, the increased sweating, an intertrigo, an itch, a skin atrophy, hypopigmentation, irritation, extensions, teleangiectasias, delay of healing of wounds.

from the musculoskeletal system: a growth inhibition at children, a steroid myopathy, osteoporosis, an osteonecrosis, aseptic necrosis.

Laboratory deviations: increase in intraocular pressure, negative nitrogenous balance, delay of reactions at skin tests.

Infection and parasitic diseases: activization of latent infections, masking of a course of infections, opportunistic infections.

Special instructions

At emergence of irritation of skin should stop use of cream of fokort-darniyets and to continue treatment by other medicine.

perhaps systemic action of medicine — in such cases is required to

At application of occlusive bandages and treatment of big body surfaces extra care.

At use of cream the microorganisms which are on skin (first of all piogenic microorganisms, sometimes a blastomyces), can get through the loosened corneal layer and cause various pyodermas which are treated by the washing-away disinfectants. Fungus diseases are possible. Under an occlusive bandage bruises can sometimes develop. At prolonged use of cream on the same part of the body, especially at young patients, the atrophy can develop. Prolonged use of medicine on face skin is not recommended because of danger of an atrophy of skin.

Some parts of the body, such as axillary hollows, inguinal folds (where there are natural occlusion and skin more gentle and thin) are more inclined

to development of extensions and easily noticeable atrophy of this site of the skin having irreversible character. Therefore use of cream on these sites of skin has to be short.

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in case of development of a fungal or bacterial infection of skin needs additional application of local or system therapy.

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does not recommend use of cream on a hairy part of the head.

Prolonged use of medicine on face skin is not recommended to

because of danger of an atrophy of skin. Not to allow hit of medicine in eyes. In case of hit in eyes to wash out them a large amount of flowing water and to see a doctor.

At treatment of psoriasis the withdrawal, steroid dependence, development of generalized pustulous psoriasis and local or system toxicity because of violation of barrier function of skin are possible

. Treatment of patients with psoriasis local corticosteroids perhaps only under strict observation of the doctor.

Prescribing of cream to children is aged more senior than 1 year perhaps only in exceptional cases. Duration of use of medicine for children should not exceed 5 days. Use of an occlusive bandage for children is contraindicated.

in case of application for children needs to consider possibility of signs of oppression gipotalamo - a hypophysial and adrenal system and Cushing's syndrome which arise at children more often than at adults, because of a bigger ratio of the area of integuments to body weight and, respectively, children are more inclined to system toxicity. At the children receiving corticosteroids for topical administration the sharp insufficiency of bark of adrenal glands, Cushing's syndrome, increase in intracranial pressure were noted.

Use during pregnancy and feeding by a breast. Use of cream in the I trimester of pregnancy is contraindicated. The data confirming safety of medicine during pregnancy in II and III trimester, are not enough. A question of use of medicine during pregnancy, in II and III trimester of pregnancy and during feeding by a breast the doctor solves in each case individually, carefully weighing a ratio of the expected effect of treatment for mother and potential risk for the fruit/child. The data confirming safety of medicine during pregnancy are not enough.

Absorption of GKS in the blood circulatory system is followed by their penetration into breast milk of mother and influence on bark of adrenal glands and growth of the child.

putting cream on mammary glands just before feeding by a breast Is contraindicated to

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Children. At children aged till 1 year the use of cream is contraindicated.

Ability to influence speed of response at control of vehicles or other mechanisms. At the moment there are no messages. But at control of vehicles or work with other mechanisms it is recommended to adhere to extra care, considering a possibility of development of undesirable reactions from nervous system.

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Interaction

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At topical administration of steroids does not know interaction with other medicines.

Overdose

Depending on the quantity of corticosteroids which came to an organism the development of both local, and system side reactions is possible

. at overdose of medicine it is impossible to stop sharply treatment — it is done gradually, reducing a medicine dose. at development of symptoms of insufficiency of bark of adrenal glands can be required in/in introduction of a hydrocortisone.

Storage conditions

In original packing at a temperature not above 25 °C.