▶ In children Not licensed for use in infantile acne.
membranes, eczematous, broken or sunburned skin . avoid
exposure to UV light (including sunlight, solariums). avoid
in severe acne involving large areas . caution in sensitive
l INTERACTIONS → Appendix 1: retinoids
l CONCEPTION AND CONTRACEPTION Females of childbearing age must use effective contraception (oral
progestogen-only contraceptives not considered
l BREAST FEEDING Amount of drug in milk probably too
small to be harmful; ensure infant does not come in
l PATIENT AND CARER ADVICE If sun exposure is
unavoidable, an appropriate sunscreen or protective
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Disodium edetate, hydroxybenzoates
Adapalene 1 mg per 1 gram Adapalene 0.1% cream |
▶ Differin (Galderma (UK) Ltd)
Adapalene 1 mg per 1 gram Differin 0.1% cream | 45 gram P £16.43 DT = £16.43
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Disodium edetate, hydroxybenzoates
Adapalene 1 mg per 1 gram Adapalene 0.1% gel | 45 gram P s
▶ Differin (Galderma (UK) Ltd)
Adapalene 1 mg per 1 gram Differin 0.1% gel | 45 gram P £16.43 DT = £16.43
Adapalene with benzoyl peroxide
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, adapalene p. 1269, benzoyl peroxide
▶ Child 9–17 years: Apply once daily, to be applied thinly
▶ Adult: Apply once daily, to be applied thinly in the
l INTERACTIONS → Appendix 1: retinoids
l CONCEPTION AND CONTRACEPTION Females of childbearing age must use effective contraception (oral
progestogen-only contraceptives not considered
l PATIENT AND CARER ADVICE Gel may bleach clothing and
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (March
2014) that Epiduo ® should be restricted for use in mild to
moderate facial acne when monotherapy with benzoyl
peroxide or adapalene is inappropriate.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Disodium edetate, polysorbates, propylene
Adapalene 1 mg per 1 gram, Benzoyl peroxide 25 mg per
1 gram Epiduo 0.1%/2.5% gel | 45 gram P £19.53 DT = £19.53
Topical treatment of mild to moderate acne
▶ Adult: Apply 1–2 times a day, to be applied thinly
Severe acne (under expert supervision)| Acne which is
associated with psychological problems (under expert
supervision)| Acne which has not responded to an
adequate course of a systemic antibacterial (under
expert supervision)| Acne with scarring (under expert
supervision)| Systemic treatment of nodulo-cystic and
conglobate acne (under expert supervision)
▶ Adult: Initially 500 micrograms/kg daily in 1–2 divided
doses, increased if necessary to 1 mg/kg daily for
16–24 weeks, repeat treatment course after a period of
at least 8 weeks if relapse after first course; maximum
MHRA/CHM ADVICE: ISOTRETINOIN (ROACCUTANE ®): RARE
REPORTS OF ERECTILE DYSFUNCTION AND DECREASED LIBIDO
An EU-wide review has concluded that on rare occasions,
oral isotretinoin, indicated for severe acne, may cause
sexual side-effects, including erectile dysfunction and
▶ With oral use Hyperlipidaemia . hypervitaminosis A
▶ With topical use Perioral dermatitis .rosacea
▶ With oral use avoid blood donation during treatment and
for at least 1 month after treatment. diabetes . dry eye
syndrome (associated with risk of keratitis). history of
depression . monitor for depression
▶ With topical use allow peeling (resulting from other irritant
retinoid may give rise to contact dermatitis (reduce
frequency of retinoid application). avoid accumulation in
angles of the nose . avoid contact with eyes, nostrils,
mouth and mucous membranes, eczematous, broken or
sunburned skin . avoid exposure to UV light (including
sunlight, solariums). avoid in severe acne involving large
areas . avoid use of topical retinoids with abrasive cleaners,
comedogenic or astringent cosmetics . caution in sensitive
areas such as the neck . personal or familial history of skin
l INTERACTIONS → Appendix 1: retinoids
▶ Common or very common Skin reactions
▶ Rare or very rare Photosensitivity reaction
myalgia . nasal dryness . neutropenia . proteinuria . skin
fragility (trauma may cause blistering) .thrombocytopenia .thrombocytosis
▶ With oral use Anxiety . arthritis . behaviour abnormal . bone
granuloma . seizure . suicidal tendencies .tendinitis . vasculitis . vision disorders
▶ With oral use Rhabdomyolysis . severe cutaneous adverse
SIDE-EFFECTS, FURTHER INFORMATION Risk of pancreatitis
if triglycerides above 9 mmol/litre—discontinue if
uncontrolled hypertriglyceridaemia or pancreatitis.
Discontinue treatment if skin peeling severe or
haemorrhagic diarrhoea develops.
Visual disturbances require expert referral and possible
Psychiatric side-effects could require expert referral.
l CONCEPTION AND CONTRACEPTION
▶ With oral use Effective contraception must be used. In
women of child-bearing potential, exclude pregnancy up
to 3 days before treatment (start treatment on day 2 or 3 of
menstrual cycle), every month during treatment (unless
there are compelling reasons to indicate that there is no
risk of pregnancy), and 5 weeks after stopping treatment—
perform pregnancy test in the first 3 days of the menstrual
cycle. Women must practise effective contraception for at
least 1 month before starting treatment, during treatment,
and for at least 1 month after stopping treatment. Women
should be advised to use at least 1 method of
contraception, but ideally they should use 2 methods of
contraception. Oral progestogen-only contraceptives are
not considered effective. Barrier methods should not be
used alone, but can be used in conjunction with other
contraceptive methods. Each prescription for isotretinoin
should be limited to a supply of up to 30 days’ treatment
and dispensed within 7 days of the date stated on the
prescription; repeat prescriptions or faxed prescriptions
are not acceptable. Women should be advised to
discontinue treatment and to seek prompt medical
attention if they become pregnant during treatment or
within 1 month of stopping treatment.
▶ With topical use Females of child-bearing age must use
effective contraception (oral progestogen-only
contraceptives not considered effective).
l PREGNANCY Contra-indicated in pregnancy (teratogenic).
▶ With oral use Manufacturer advises avoid—limited
Dose adjustments ▶ With oral use In severe impairment,
reduce initial dose (e.g. 10 mg daily) and increase gradually
up to 1 mg/kg daily as tolerated.
▶ With oral use Measure hepatic function and serum lipids
before treatment, 1 month after starting and then every
3 months (reduce dose or discontinue if transaminase or
serum lipids persistently raised).
l PRESCRIBING AND DISPENSING INFORMATION Isotretinoin
▶ With oral use Warn patient to avoid wax epilation (risk of
epidermal stripping), dermabrasion, and laser skin
treatments (risk of scarring) during treatment and for at
least 6 months after stopping; patient should avoid
exposure to UV light (including sunlight) and use
sunscreen and emollient (including lip balm) preparations
from the start of treatment. Patients and carers should be
told how to recognise signs and symptoms of psychiatric
disorders such as depression, anxiety, and rarely suicidal
▶ With topical use Patients should be warned that some
redness and skin peeling can occur initially but settles with
time. If undue irritation occurs, the frequency of
application should be reduced or treatment suspended
until the reaction subsides; if irritation persists,
discontinue treatment. Several months of treatment may
be needed to achieve an optimal response and the
treatment should be continued until no new lesions
develop. If sun exposure is unavoidable, an appropriate
sunscreen or protective clothing should be used.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10, 11, 21
▶ Isotretinoin (non-proprietary) A
Isotretinoin 10 mg Isotretinoin 10mg capsules | 30 capsule P £14.54 DT = £14.54
Isotretinoin 40 mg Isotretinoin 40mg capsules | 30 capsule P £38.98 DT = £38.98
▶ Roaccutane (Roche Products Ltd)
Isotretinoin 10 mg Roaccutane 10mg capsules | 30 capsule P £14.54 DT = £14.54
Isotretinoin 20 mg Roaccutane 20mg capsules | 30 capsule P £20.02 DT = £16.65
Isotretinoin with erythromycin
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, isotretinoin p. 1270, erythromycin p. 539.
Topical treatment of mild to moderate acne
▶ Adult: (consult product literature)
l INTERACTIONS → Appendix 1: macrolides .retinoids
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Butylated hydroxytoluene
▶ Isotrexin (Stiefel Laboratories (UK) Ltd)
Isotretinoin 500 microgram per 1 gram, Erythromycin 20 mg per
1 gram Isotrexin gel | 30 gram P £7.47 DT = £7.47
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, tretinoin p. 939, clindamycin p. 1268.
▶ Child 12–17 years: Apply daily, (to be applied thinly at
▶ Adult: Apply daily, (to be applied thinly at bedtime)
l CONTRA-INDICATIONS Perioral dermatitis . personal or
familial history of skin cancer.rosacea
l CAUTIONS Allow peeling (resulting from other irritant
retinoid may give rise to contact dermatitis (reduce
frequency of retinoid application). avoid accumulation in
angles of the nose . avoid contact with eyes, nostrils,
mouth and mucous membranes, eczematous, broken or
sunburned skin . avoid exposure to UV light (including
sunlight, solariums). avoid in severe acne involving large
areas . avoid use of topical retinoids with abrasive cleaners,
comedogenic or astringent cosmetics . caution in sensitive
l INTERACTIONS → Appendix 1: clindamycin .retinoids
l SIDE-EFFECTS Dry skin (discontinue if severe). eye
irritation . oedema . photosensitivity reaction . skin
pigmentation change (transient). skin reactions
l CONCEPTION AND CONTRACEPTION Females of childbearing age must use effective contraception (oral
progestogen-only contraceptives not considered
l PREGNANCY Contra-indicated in pregnancy.
l BREAST FEEDING Amount of drug in milk after topical
application probably too small to be harmful; ensure
infant does not come in contact with treated areas.
l PATIENT AND CARER ADVICE If sun exposure is
unavoidable, an appropriate sunscreen or protective
Patients and carers should be warned that some redness
and skin peeling can occur initially but settles with time. If
undue irritation occurs, the frequency of application
should be reduced or treatment suspended until the
reaction subsides; if irritation persists, discontinue
treatment. Several months of treatment may be needed to
achieve an optimal response and the treatment should be
continued until no new lesions develop.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 11
EXCIPIENTS: May contain Butylated hydroxytoluene, hydroxybenzoates
▶ Treclin (Meda Pharmaceuticals Ltd)
Tretinoin 250 microgram per 1 gram, Clindamycin (as
Clindamycin phosphate) 10 mg per 1 gram Treclin 1%/0.025% gel
| 30 gram P £11.94 DT = £11.94
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, tretinoin p. 939, erythromycin p. 539.
▶ Child: Apply 1–2 times a day, apply thinly
▶ Adult: Apply 1–2 times a day, apply thinly
l CONTRA-INDICATIONS Perioral dermatitis . personal or
familial history of skin cancer.rosacea
l CAUTIONS Allow peeling (resulting from other irritant
retinoid may give rise to contact dermatitis (reduce
frequency of retinoid application). avoid accumulation in
angles of the nose . avoid contact with eyes, nostrils,
mouth and mucous membranes, eczematous, broken or
sunburned skin . avoid exposure to UV light (including
sunlight, solariums). avoid in severe acne involving large
areas . avoid use of topical retinoids with abrasive cleaners,
comedogenic or astringent cosmetics . caution in sensitive
l INTERACTIONS → Appendix 1: macrolides .retinoids
l SIDE-EFFECTS Dry skin (discontinue if severe). eye
irritation . oedema . photosensitivity reaction . skin
pigmentation change (transient). skin reactions
l CONCEPTION AND CONTRACEPTION Females of childbearing age must use effective contraception (oral
progestogen-only contraceptives not considered
l PREGNANCY Contra-indicated in pregnancy.
l BREAST FEEDING Amount of drug in milk after topical
application probably too small to be harmful; ensure
infant does not come in contact with treated areas.
l PATIENT AND CARER ADVICE Patients and carers should be
warned that some redness and skin peeling can occur
initially but settles with time. If undue irritation occurs,
the frequency of application should be reduced or
treatment suspended until the reaction subsides; if
irritation persists, discontinue treatment. Several months
of treatment may be needed to achieve an optimal
response and the treatment should be continued until no
new lesions develop. If sun exposure is unavoidable, an
appropriate sunscreen or protective clothing should be
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 11
▶ Aknemycin Plus (Almirall Ltd)
Tretinoin 250 microgram per 1 gram, Erythromycin 40 mg per
1 gram Aknemycin Plus solution | 25 ml P £7.05 DT = £7.05
VITAMINS AND TRACE ELEMENTS › VITAMIN B
▶ Adult: Apply twice daily, reduced to once daily or on
alternate days, dose reduced if irritation occurs
l CAUTIONS Avoid contact with eyes . avoid contact with
mucous membranes (including nose and mouth).reduce
frequency of application if excessive dryness, irritation or
l SIDE-EFFECTS Paraesthesia . skin reactions
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Nicotinamide 40 mg per 1 gram Freederm Treatment 4% gel | 25 gram p £5.56
▶ Nicam (Dermal Laboratories Ltd)
Nicotinamide 40 mg per 1 gram Nicam 4% gel | 60 gram p £7.10
Other drugs used for Rosacea Azelaic acid, p. 1269
▶ Adult: Apply daily for up to 4 months, the treatment
course may be repeated; discontinue if no
l INTERACTIONS → Appendix 1: ivermectin
▶ Common or very common Skin reactions
l PREGNANCY Manufacturer advises avoid—limited
information but toxicity following oral use in animal
l BREAST FEEDING Manufacturer advises avoid—limited
information but present in milk following oral use.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
severe impairment (no information available).
l DIRECTIONS FOR ADMINISTRATION Manufacturer advises
apply thinly to the face only, avoiding contact with eyes,
l PATIENT AND CARER ADVICE Wash hands immediately
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (December
2015) that ivermectin (Soolantra ®) is accepted for
restricted use within NHS Scotland for the treatment of
moderate-to-severe inflammatory lesions of rosacea
(papulopustular) where a topical treatment is considered
All Wales Medicines Strategy Group (AWMSG) decisions
The All Wales Medicines Strategy Group has advised (April
2016) that ivermectin (Soolantra ®) is recommended as an
option for use within NHS Wales for the topical treatment
of inflammatory lesions of rosacea (papulopustular) in
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), disodium edetate, isopropyl palmitate, propylene glycol
▶ Soolantra (Galderma (UK) Ltd)
Ivermectin 10 mg per 1 gram Soolantra 10mg/g cream | 30 gram P £18.29 DT = £18.29
SYMPATHOMIMETICS › ALPHA2-ADRENOCEPTOR
Brimonidine tartrate 12-Jul-2017
l DRUG ACTION Brimonidine, an alpha2-adrenoceptor
agonist, is used to reduce erythema in rosacea by
▶ Adult: Apply once daily until erythema subsides, apply
thinly, divide dose over forehead, chin, nose, and
cheeks, max. 1 g of gel per day
DOSE EQUIVALENCE AND CONVERSION
▶ 1 g of gel contains 5 mg of brimonidine tartrate
(equivalent to 3.3 mg of brimonidine).
MHRA/CHM ADVICE: BRIMONIDINE GEL (MIRVASO ®): RISK OF
SYSTEMIC CARDIOVASCULAR EFFECTS (JUNE 2017)
Systemic cardiovascular effects including bradycardia,
hypotension, and dizziness have been reported after
application of brimonidine gel. To minimise the
possibility of systemic absorption, it is important to
avoid application to irritated or damaged skin, including
MHRA/CHM ADVICE: BRIMONIDINE GEL (MIRVASO ®): RISK OF
EXACERBATION OF ROSACEA (NOVEMBER 2016)
Symptom exacerbation has been reported very
commonly in patients treated with brimonidine gel.
Treatment should be initiated with a small amount of gel
(less than the maximum dose) for at least 1 week, then
increased gradually, based on tolerability and response.
Patients should be counselled on the importance of not
exceeding the maximum daily dose, and advised to stop
treatment and seek medical advice if symptoms worsen
l INTERACTIONS → Appendix 1: brimonidine
▶ Common or very common Dizziness . dry mouth . flushing . headache . skin reactions
▶ Rare or very rare Bradycardia . hypotension
l PREGNANCY Manufacturer advises avoid—limited
l BREAST FEEDING Manufacturer advises avoid—no
l HEPATIC IMPAIRMENT Manufacturer advises caution (no
l RENAL IMPAIRMENT Manufacturer advises use with
l DIRECTIONS FOR ADMINISTRATION Avoid contact with
eyes, mouth, and mucous membranes; avoid use on
irritated or damaged skin or open wounds; apply other
topical preparations (including cosmetics) only after
brimonidine gel has dried on skin.
l PATIENT AND CARER ADVICE Patients should be advised on
Driving and skilled tasks Drowsiness may affect
performance of skilled tasks (e.g. driving).
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (December
2014) that brimonidine (Mirvaso ®) is accepted for
restricted use within NHS Scotland for the symptomatic
treatment of moderate to severe persistent facial erythema
associated with rosacea in adult patients.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 28
EXCIPIENTS: May contain Hydroxybenzoates (parabens), propylene
Brimonidine (as Brimonidine tartrate) 3 mg per 1 gram Mirvaso
3mg/g gel | 30 gram P £33.69 DT = £33.69
Dandruff is considered to be a mild form of seborrhoeic
dermatitis. Shampoos containing antimicrobial agents such
as pyrithione zinc (which are widely available) and
selenium below may have beneficial effects. Shampoos
containing tar extracts may be useful and they are also used
in psoriasis. Ketoconazole shampoo p. 1233 should be
considered for more persistent or severe dandruff or for
seborrhoeic dermatitis of the scalp.
Corticosteroid gels and lotions can also be used.
Shampoos containing coal tar with salicylic acid p. 1255
may also be useful. A cream or an ointment containing coal
tar with salicylic acid is very helpful in Psoriasis p. 1239 that
affects the scalp. Patients who do not respond to these
treatments may need to be referred to exclude the possibility
Cradle cap in infants may be treated with coconut oil or
olive oil applications followed by shampooing.
anabolic steroids, androgens, danazol p. 742, and
Weight loss can reduce hirsutism in obese women.
Women should be advised about local methods of hair
removal, and in the mildest cases this may be all that is
Eflornithine p. 1275 an antiprotozoal drug, inhibits the
enzyme ornithine decarboxylase in hair follicles. Topical
eflornithine can be used as an adjunct to laser therapy for
Co-cyprindiol p. 1267 may be effective for moderately
severe hirsutism. Metformin hydrochloride p. 692 is an
alternative in women with polycystic ovary syndrome
[unlicensed indication]. Systemic treatment is required for
6–12 months before benefit is seen.
Finasteride p. 787 is licensed for the treatment of
androgenetic alopecia in men. Continuous use for
3–6 months is required before benefit is seen, and effects are
reversed 6–12 months after treatment is discontinued.
Topical application of minoxidil may stimulate limited hair
growth in a small proportion of adults but only for as long as
Other drugs used for Scalp and hair conditions Coal tar,
p. 1253 . Coal tar with lecithin, p. 1254 . Coal tar with salicylic
acid and precipitated sulfur, p. 1255
ANTISEPTICS AND DISINFECTANTS ›
Cetrimide with undecenoic acid
Scalp psoriasis | Seborrhoeic dermatitis | Dandruff
▶ Child: Apply 3 times a week for 1 week, then apply
▶ Adult: Apply 3 times a week for 1 week, then apply
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Ceanel (Alliance Pharmaceuticals Ltd)
Undecenoic acid 10 mg per 1 ml, Phenylethyl alcohol 75 mg per
1 ml, Cetrimide 100 mg per 1 ml Ceanel Concentrate shampoo | 150 ml p £3.40 | 500 ml p £9.80
ANTISEPTICS AND DISINFECTANTS › OTHER
Seborrhoeic scalp conditions associated with dandruff
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Dermax (Dermal Laboratories Ltd)
Benzalkonium chloride 5 mg per 1 ml Dermax Therapeutic 0.5%
shampoo | 250 ml p £5.69 DT = £5.69
Seborrhoeic dermatitis | Dandruff
▶ Child 5–17 years: Apply twice weekly for 2 weeks, then
apply once weekly for 2 weeks, then apply as required
▶ Adult: Apply twice weekly for 2 weeks, then apply once
weekly for 2 weeks, then apply as required
▶ Adult: Apply once daily for 7 days, apply to the affected
area and leave on for 10 minutes before rinsing off. The
course may be repeated if necessary. Diluting with a
small amount of water prior to application can reduce
l UNLICENSED USE The use of selenium sulfide shampoo as
a lotion for the treatment of pityriasis (tinea) versicolor is
l INTERACTIONS → Appendix 1: selenium
l PATIENT AND CARER ADVICE Avoid using 48 hours before
or after applying hair colouring, straightening or waving
1274 Scalp and hair conditions BNF 78
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Fragrances
Selenium sulfide 25 mg per 1 ml Selsun 2.5% shampoo | 50 ml p
£1.61 DT = £1.61 | 100 ml p £2.15 DT = £2.15 | 150 ml p £3.06 DT
Other drugs used for Alopecia Finasteride, p. 787
REGAINE ® FOR MEN EXTRA STRENGTH FOAM
▶ Adult: Apply 0.5 capful twice daily, to be applied to the
affected areas of scalp; discontinue if no improvement
REGAINE ® FOR MEN EXTRA STRENGTH SOLUTION
▶ Adult: Apply 1 mL twice daily, to be applied to the
affected areas of scalp; discontinue if no improvement
REGAINE ® FOR WOMEN REGULAR STRENGTH
▶ Adult: Apply 1 mL twice daily, to be applied to the
affected areas of scalp; discontinue if no improvement
l CONTRA-INDICATIONS Phaeochromocytoma
l CAUTIONS Avoid contact with broken, infected, shaved, or
inflamed skin . avoid contact with eyes . avoid contact with
mouth . avoid contact with mucous membranes . avoid
inhalation of spray mist. avoid occlusive dressings
CAUTIONS, FURTHER INFORMATION When used topically
systemic effects unlikely; only about 1–2% absorbed
(greater absorption may occur with use on inflamed skin).
l INTERACTIONS → Appendix 1: minoxidil
▶ Common or very common Hair changes
SIDE-EFFECTS, FURTHER INFORMATION When used
topically systemic effects unlikely; only about 1–2%
absorbed (greater absorption may occur with use on
l PREGNANCY Avoid—possible toxicity including reduced
placental perfusion. Neonatal hirsutism reported.
l BREAST FEEDING Present in milk but not known to be
l PATIENT AND CARER ADVICE Ensure hair and scalp dry
before application. Patients and their carers should be
advised to wash hands after application of liquid or foam.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Propylene glycol
▶ Regaine (McNeil Products Ltd, Johnson & Johnson Ltd)
Minoxidil 20 mg per 1 ml Regaine for Women Regular Strength 2%
Minoxidil 50 mg per 1 ml Regaine for Men Extra Strength 5% scalp
solution | 60 ml G £21.63 | 180 ml G £43.28
CAUTIONARY AND ADVISORY LABELS 15
EXCIPIENTS: May contain Butylated hydroxytoluene, cetostearyl alcohol
(including cetyl and stearyl alcohol), polysorbates
▶ Regaine (McNeil Products Ltd)
Minoxidil 50 mg per 1 gram Regaine for Men Extra Strength 5%
scalp foam | 60 gram G £23.33 | 180 gram G £50.01
Other drugs used for Hirsutism Co-cyprindiol, p. 1267
l DRUG ACTION An antiprotozoal drug that inhibits the
enzyme ornithine decarboxylase in hair follicles.
Adjunct to laser therapy for facial hirsutism in women
▶ Adult: Apply twice daily, to be applied thinly,
discontinue use if no improvement after 4 months of
▶ Common or very common Alopecia . increased risk of
infection . paraesthesia . skin reactions
▶ Uncommon Face oedema . flushing . hair changes . oral
▶ Rare or very rare Skin neoplasm
l PREGNANCY Toxicity in animal studies—manufacturer
l BREAST FEEDING Manufacturer advises avoid—no
l PATIENT AND CARER ADVICE Medicines must be rubbed in
thoroughly. Cosmetics may be applied over treated area
5 minutes after eflornithine, do not wash treated area for
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (September
2005) that eflornithine 11.5% cream (Vaniqa ®) for facial
hirsutism be restricted for use in women in whom
alternative drug treatment cannot be used.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Cetostearyl alcohol (including cetyl and
stearyl alcohol), hydroxybenzoates (parabens)
Eflornithine (as Eflornithine monohydrate chloride) 115 mg per
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