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DRUGS & SUPPLEMENTS
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Ciprofloxacin Hydrochloride:
Ciprolar-FC is a broad-spectrum antimicrobial drug of fluoroquinolone group with bactericidal action. Inhibits DNA gyrase and inhibits the synthesis of bacterial DNA. Highly active against most gram-negative bacteria: Pseudomonas aeruginosa, Haemophilus influenzae, Escherichia coli, Shigella spp., Salmonella spp., Neisseria meningitidis, Neisseria gonorrhoeae.
Ciprolar-FC (Ciprofloxacin Hydrochloride) is active against Staphylococcus spp. (including strains producing and not producing penicillinase, methicillin-resistant strains), some strains of Enterococcus spp., Campylobacter spp., Legionella spp., Mycoplasma spp., Chlamydia spp., Mycobacterium spp.
Ciprolar-FC (Ciprofloxacin Hydrochloride) is active against bacteria producing beta-lactamases.
Ureaplasma urealyticum, Clostridium difficile, Nocardia asteroides resistant to Ciprolar-FC (Ciprofloxacin Hydrochloride). The effect on Treponema pallidum is studied not enough.
Ciprolar-FC (Ciprofloxacin Hydrochloride) rapidly absorbed from the gastrointestinal tract. Bioavailability after oral administration of 70%. Eating has a little effect on the absorption of Ciprolar-FC (Ciprofloxacin Hydrochloride). Plasma protein binding is 20-40%. Distributed in tissues and body fluids. It penetrates the cerebrospinal fluid: the concentration of Ciprolar-FC (Ciprofloxacin Hydrochloride) for not inflamed meninges reach 10% with inflammation - up to 37%. High concentrations are achieved in bile. Excreted in the urine and bile.
Infectious-inflammatory diseases caused by microorganisms susceptible to Ciprolar-FC (Ciprofloxacin Hydrochloride), including respiratory diseases, diseases of abdominal and pelvic organs, bones, joints, skin, septicemia; severe infections of ENT organs. Treatment of postoperative infections. Prevention and treatment of infections in patients with reduced immunity.
For Ciprolar-FC (Ciprofloxacin Hydrochloride) local use: acute and subacute conjunctivitis, blepharoconjunctivitis, blepharitis, bacterial corneal ulcers, keratitis, keratoconjunctivitis, chronic dacryocystitis, meybomity. Infectious lesions in the eyes from injury or contact with foreign bodies. Preoperative prophylaxis in ophthalmic surgery.
Individual. For oral administration dose of Ciprolar-FC is 250-750 mg 2 times / day. Treatment duration is from 7-10 days to 4 weeks.
For IV administration a single dose is 200-400 mg, the multiplicity of the introduction is 2 times / day, duration of treatment - 1-2 weeks and more if necessary. May be IV injected as jet but more preferably a drip for 30 minutes.
When Ciprolar-FC (Ciprofloxacin Hydrochloride) applied topically instilled 1-2 drops into the lower conjunctival sac of the affected eye every 1-4 hours. After improving the intervals between instillation can be increased. The maximum oral daily dose for adults is 1.5 g.
Digestive system: nausea, vomiting, diarrhea, abdominal pain, increase in liver transaminases, alkaline phosphatase, LDH, bilirubin, pseudomembranous colitis.
CNS: headache, dizziness, fatigue, insomnia, nightmares, hallucinations, fainting, disorders of vision.
Urinary system: crystalluria, glomerulonephritis, dysuria, polyuria, albuminuria, hematuria, transient increase of serum creatinine.
Hemopoietic system: eosinophilia, leukopenia, neutropenia, changes in the number of platelets.
Cardiovascular system: tachycardia, cardiac arrhythmias, hypotension.
Allergic reactions: itching, urticaria, Quincke's edema, Stevens-Johnson syndrome, arthralgia.
Adverse reactions associated with the chemotherapeutic effect: candidiasis.
Local reactions: pain, phlebitis (for IV injections). When applying eye drops in some cases may be mild pain and conjunctival hyperemia.
Other: vasculitis.
Pregnancy, lactation, childhood and adolescence to 15 years, increased sensitivity to Ciprolar-FC (Ciprofloxacin Hydrochloride) and other drugs hinolonovogo series; deficiency of glucose-6-phosphate dehydrogenase; in ophthalmology: viral keratitis.
Pronounced cerebral arteriosclerosis, cerebral circulatory disorder, mental illness, epilepsy, epileptic syndrome, marked renal and / or hepatic insufficiency.
Contraindicated in pregnancy ; Ciprolar-FC (Ciprofloxacin Hydrochloride) crosses the placenta, excreted in breast milk.
In experimental studies found that it causes arthropathy. In experiments on rats and mice treated with Ciprolar-FC (Ciprofloxacin Hydrochloride) in doses exceeding the usual daily dose for a person 6 times, adverse effects on the fetus is not revealed. In experiments on rabbits treated with oral dose of Ciprolar-FC (Ciprofloxacin Hydrochloride) 30 and 100 mg / kg, it is shown that the drug causes disruption of the gastrointestinal tract, leading to loss of body weight in females and increase the number of miscarriages but teratogenicity not found. When IV introduction to the doses of 20 mg / kg Ciprolar-FC (Ciprofloxacin Hydrochloride) did not exert toxic effects on the mother and embryo, showed no teratogenicity. The use of local forms of Ciprolar-FC (Ciprofloxacin Hydrochloride) in pregnancy is possible if the anticipated benefits exceed the potential risk to the fetus.
Category of the fetus by FDA - C.
Ciprolar-FC (Ciprofloxacin Hydrochloride) is excreted in breast milk, so the period of lactation should decide, stop taking Ciprolar-FC (Ciprofloxacin Hydrochloride) or breastfeeding based on the degree of importance of the use of drugs for the mother.
With careful use of local forms of Ciprolar-FC (Ciprofloxacin Hydrochloride) in breast-feeding (not known whether Ciprolar-FC (Ciprofloxacin Hydrochloride) is excreted in breast milk when applied topically).
Patients with impaired renal function requires correction dosing regimen. With caution used in elderly patients, with cerebral arteriosclerosis, cerebral circulatory disorders, epilepsy, convulsive syndrome of unknown etiology.
During treatment patients with Ciprolar-FC (Ciprofloxacin Hydrochloride) should receive enough amounts of liquids.
In the case of persistent diarrhea Ciprolar-FC (Ciprofloxacin Hydrochloride) should not be taken.
At the same time of Ciprolar-FC (Ciprofloxacin Hydrochloride) IV introduction and barbiturates is necessary to monitor heart rate, blood pressure, ECG. In the course of treatment is necessary to monitor blood concentrations of urea, creatinine, hepatic transaminases.
In the period of treatment may decrease the reactivity (especially when used with alcohol).
Not allowed the introduction of Ciprolar-FC (Ciprofloxacin Hydrochloride) subconjunctival or directly into the anterior chamber of the eye.
Due to the threat of adverse reactions from the CNS Ciprolar-FC should be used only according to the life in the pathology of the CNS in history: organic brain lesions, epilepsy, lowering the convulsive threshold, severe atherosclerosis of the brain (risk of circulatory disorders, stroke), the elderly, with severely impaired renal function and liver (requires monitoring concentrations in blood plasma).
Patients with allergic reactions to fluoroquinolone derivatives in history may develop reactions to Ciprolar-FC (Ciprofloxacin Hydrochloride). During the period of treatment should avoid sunlight and UV radiation, intense physical exercise, control of drinking mode, pH of urine.
Reported cases of crystalluria, particularly in patients with alkaline reaction of urine (pH 7 or more). In order to avoid the development of crystalluria unacceptable excess of the recommended daily dose, should also be adequate fluid intake and maintaining acidic urine.
If you have pain in the tendons or the first signs tendovaginitah treatment should be discontinued (described isolated cases of inflammation or tendon rupture during fluoroquinolone treatment).
It can reduce the speed of psychomotor reactions, especially against the backdrop of alcohol, that should be considered for patients who work with potentially dangerous machinery or drive vehicles.
If you have severe diarrhea, pseudomembranous colitis should be excluded (for which Ciprolar-FC (Ciprofloxacin Hydrochloride) is contraindicated). At the same time of barbiturates IV injections requires monitoring function of the cardiovascular system (heart rate, BP, ECG). Teenagers under 18 years shall be appointed only if the pathogen resistance to other chemotherapeutic drugs. The solution in the form of eye drops are not designed for intraocular injections. The use of other ophthalmic means the interval between injections should be at least 5 minutes.
Activity increases when combined with beta-lactam antibiotics, aminoglycosides, vancomycin, clindamycin, metronidazole. Sukralfat, bismuth preparations, antacids containing aluminum ions, magnesium or calcium, cimetidine, ranitidine, vitamin and mineral supplement, iron sulfate, zinc, didanosine (recommended for 2 hours before or 4 hours after these drugs) reduce the suction. Probenecid, azlocillin increase the concentration in the blood. Decreases clearance and increases in plasma caffeine, aminophylline and theophylline (increased likelihood of side effects). Ciprolar-FC (Ciprofloxacin Hydrochloride) enhances the effect of warfarin and other oral anticoagulants (prolongs bleeding time). Increases nephrotoxicity of cyclosporine, increase the risk of CNS excitability and convulsive reactions against the background of NSAIDs. Medicines alkalinizing the urine (citrates, sodium bicarbonate, carbonic anhydrase inhibitors) reduce the solubility (increases the probability of crystalluria). Infusion solutions of Ciprolar-FC (Ciprofloxacin Hydrochloride) ready to use can be combined with infusion solutions: 0.9% sodium chloride solution, Ringer's solution, Ringer lactate, 5 and 10% dextrose, 10% solution of fructose, and a solution containing 5% dextrose with 0,225 or 0.45% sodium chloride. Incompatible with solutions having a pH > 7.
May occur after receiving a single large dose or prolonged use. If a single dose of less than 150 mg / kg, acute poisoning feel light, 150-300 mg / kg - moderate, when using higher doses - heavy.
Symptoms: No specific symptoms.
Treatment: gastric lavage, the use of emetic drugs, the introduction of large quantities of liquid, the creation of acidic urine, in addition - hemodialysis and peritoneal dialysis (can be derived only 10% of the drug), all events are held on the background to maintain vital functions. The specific antidote is unknown.
Clotrimazole:
Ciprolar-FC is an antifungal agent of imidazole derivatives group for topical use. This medication has an effect at the expense of the synthesis of ergosterol, which is part of the cell membrane of fungi. Ciprolar-FC (Clotrimazole) has a broad spectrum of action.
Ciprolar-FC (Clotrimazole) is active against dermatophytes, molds, fungi of the genus Candida, Malassezia furfur.
This drug is also active against Corynebacterium minutissimum, Streptococcus spp., Staphylococcus spp., Trichomonas vaginalis.
For external use Ciprolar-FC (Clotrimazole) is well into the various layers of the skin reaching therapeutic concentrations. When this medication applied topically a small amount of it absorbed into the bloodstream.
Fungal skin and mucous membranes: ringworm, tinea, trichophytosis, athlete, mikrosporiya, candidiasis, a fungal interdigital erosion, fungal paronychia; fungal infections complicated by a secondary pyoderma; colorful lichen, erythrasma; thrush; Candida vulvitis, vulvovaginitis, balanitis, trichomoniasis; for the renovation of the birth canal before delivery.
When Ciprolar-FC used externally it applied to affected skin 2-3 times / day in 2-4 weeks.
For local orally this medicine used 1-2 times / day, no more than 7 days.
Intravaginal - on 100-500 mg for 1-6 days.
Local reactions: contact allergic dermatitis, redness, burning sensation.
When applied topically to the skin: erythema, blisters, swelling, burning and tingling, irritation and flaking skin.
When applied topically for the treatment of urogenital infections: itching, burning, redness and swelling of the mucous membrane, vaginal discharge, frequent urination, intercurrent cystitis, burning sensation in the penis with a partner, pain during sexual intercourse.
When applied topically in the oral cavity: redness of the oral mucosa, burning sensation and tingling at the site of application, irritation.
Hypersensitivity to Ciprolar-FC (Clotrimazole), I trimester of pregnancy.
In experimental studies there have been found that Ciprolar-FC used in high doses exerts embryotoxic effect.
It is not known whether Ciprolar-FC (Clotrimazole) released in breast milk. Although Ciprolar-FC (Clotrimazole) is not contraindicated during pregnancy and lactation, it should be considered a potential risk when selecting antifungal therapy.
Prescribed intravaginal Dosage forms of Ciprolar-FC (Clotrimazole) is not used during menstruation.
To prevent reinfection it should be simultaneous treatment of sexual partners.
Ciprolar-FC (Clotrimazole) is not recommended for use in ophthalmology.
Simultaneous administration of Ciprolar-FC (Clotrimazole) with amphotericin B, nystatin, natamycin activity of Ciprolar-FC (Clotrimazole) decreases.
Symptoms: anorexia, nausea, vomiting, stomachodynia, abnormal liver function, rarely - drowsiness, hallucinations, thamuria, allergic skin reactions.
Treatment: taking activated charcoal, symptomatic therapy.
Fluocinolone Acetonide:
Ciprolar-FC Cream is a combination of Ciprolar-FC (Fluocinolone Acetonide) acetonide (a corticosteroid), hydroquinone (a melanin synthesis inhibitor), and tretinoin (a retinoid) that is indicated for the short-term treatment of moderate to severe melasma of the face, in the presence of measures for sun avoidance, including the use of sunscreens.
Ciprolar-FC (Fluocinolone Acetonide) Cream is a combination of Ciprolar-FC (Fluocinolone Acetonide) acetonide (a corticosteroid), hydroquinone (a melanin synthesis inhibitor), and tretinoin (a retinoid) that is indicated for the short-term treatment of moderate to severe melasma of the face, in the presence of measures for sun avoidance, including the use of sunscreens.
Ciprolar-FC (Fluocinolone Acetonide) Cream is NOT indicated for the maintenance treatment of melasma. After achieving control with Ciprolar-FC (Fluocinolone Acetonide) Cream, some patients may be managed with other treatments instead of triple therapy with Ciprolar-FC (Fluocinolone Acetonide) Cream. Melasma usually recurs upon discontinuation of Ciprolar-FC (Fluocinolone Acetonide) Cream.
The safety and efficacy of Ciprolar-FC (Fluocinolone Acetonide) Cream in patients of Fitzpatrick Skin Types V and VI have not been studied. Excessive bleaching resulting in undesirable cosmetic effect in patients with darker skin cannot be excluded.
The safety and efficacy of Ciprolar-FC (Fluocinolone Acetonide) Cream in the treatment of hyperpigmentation conditions other than melasma of the face have not been studied.
Because pregnant and lactating women were excluded from, and women of childbearing potential had to use birth control measures in the clinical trials, the safety and efficacy of Ciprolar-FC (Fluocinolone Acetonide) Cream in pregnant women and nursing mothers have not been established [see Use in Specific Populations (8.1, 8.3)].
Apply a thin film of Ciprolar-FC (Fluocinolone Acetonide) Cream to the effected area once daily, at least 30 minutes before bedtime.
Gently wash the face and neck with a mild cleanser. Rinse and pat the skin dry. Apply Ciprolar-FC (Fluocinolone Acetonide) Cream to the hyperpigmented areas of melasma including about 1/2 inch of normal appearing skin surrounding each lesion. Rub lightly and uniformly into the skin.
Therapy should be discontinued when control is achieved.
During the day, use a sunscreen of SPF 30, and wear protective clothing. Avoid sunlight exposure. Patients may use moisturizers and/or cosmetics during the day.
Ciprolar-FC (Fluocinolone Acetonide) Cream is for topical use only. It is not for oral, ophthalmic, or intravaginal use.
Cream, 0.01%/4%/0.05%.
Each gram of Ciprolar-FC (Fluocinolone Acetonide) Cream contains 0.1 mg of Ciprolar-FC (Fluocinolone Acetonide) acetonide, 40 mg of hydroquinone, and 0.5 mg of tretinoin in a light yellow, hydrophilic cream base.
Ciprolar-FC (Fluocinolone Acetonide) Cream is contraindicated in individuals with a history of hypersensitivity to this product or any of its components.
Ciprolar-FC (Fluocinolone Acetonide) Cream contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening asthmatic episodes in susceptible individuals. If anaphylaxis, asthma or other clinically significant hypersensitivity reactions occur, institute appropriate therapy and discontinue Ciprolar-FC (Fluocinolone Acetonide). Allergic contact dermatitis may also occur [see Warnings and Precautions 5.4].
Ciprolar-FC Cream contains hydroquinone, which may produce exogenous ochronosis, a gradual blue-black darkening of the skin, the occurrence of which should prompt discontinuation of therapy. The majority of patients developing this condition are Black, but it may also occur in Caucasians and Hispanics.
Ciprolar-FC (Fluocinolone Acetonide) Cream contains the corticosteroid Ciprolar-FC (Fluocinolone Acetonide) acetonide. Systemic absorption of topical corticosteroids can produce reversible hypothalamic-pituitary-adrenal (HPA) axis suppression with the potential for glucocorticosteroid insufficiency after withdrawal of treatment. Manifestations of Cushing’s syndrome, hyperglycemia, and glucosuria can also be produced by systemic absorption of topical corticosteroid while on treatment. If HPA axis suppression is noted, the use of Ciprolar-FC (Fluocinolone Acetonide) Cream should be discontinued. Recovery of HPA axis function generally occurs upon discontinuation of topical corticosteroids.
The ACTH or cosyntropin stimulation test may be helpful in evaluating patients for HPA axis suppression.
Cutaneous hypersensitivity to the active ingredients of Ciprolar-FC (Fluocinolone Acetonide) Cream has been reported in the literature. In a patch test study to determine sensitization potential in 221 healthy volunteers, three volunteers developed sensitivity reactions to Ciprolar-FC (Fluocinolone Acetonide) Cream or its components.
Ciprolar-FC (Fluocinolone Acetonide) Cream contains hydroquinone and tretinoin that may cause mild to moderate irritation. Local irritation, such as skin reddening, peeling, mild burning sensation, dryness, and pruritus may be expected at the site of application. Transient skin reddening or mild burning sensation does not preclude treatment. If a reaction suggests hypersensitivity or chemical irritation, the use of the medication should be discontinued.
Patients should avoid medicated or abrasive soaps and cleansers, soaps and cosmetics with drying effects, products with high concentrations of alcohol and astringents, and other irritants or keratolytic drugs while on Ciprolar-FC (Fluocinolone Acetonide) Cream treatment. Patients are cautioned on concomitant use of medications that are known to be photosensitizing.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
In the controlled clinical trials, adverse events were monitored in the 161 subjects who used Ciprolar-FC (Fluocinolone Acetonide) Cream once daily during an 8-week treatment period. There were 102 (63%) subjects who experienced at least one treatment-related adverse event during these trials. The most frequently reported events were erythema, desquamation, burning, dryness, and pruritus at the site of application. The majority of these events were mild to moderate in severity. Adverse events reported by at least 1% of patients and judged by the investigators to be reasonably related to treatment with Ciprolar-FC (Fluocinolone Acetonide) Cream from the controlled clinical trials are summarized (in decreasing order of frequency) as follows:
In an open-label trial, subjects who had cumulative treatment of melasma with Ciprolar-FC (Fluocinolone Acetonide) Cream for 6 months showed a similar pattern of adverse events as in the 8-week studies.
The following local adverse reactions have been reported with topical corticosteroids. They may occur more frequently with the use of occlusive dressings, especially with higher potency corticosteroids. These reactions are listed in an approximate decreasing order of occurrence: burning, itching, irritation, dryness, folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection, skin atrophy, striae, and miliaria.
Most common adverse reactions (incidence > 5%) are erythema, desquamation, burning, dryness, pruritus, and acne. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Galderma Laboratories, L.P. at 1-866-735-4137 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Ciprolar-FC Cream contains the teratogen, tretinoin, which may cause embryofetal death, altered fetal growth, congenital malformations, and potential neurologic deficits. Ciprolar-FC (Fluocinolone Acetonide) Cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. (8.1)
Teratogenic Effects: Pregnancy Category C
There are no adequate and well-controlled studies in pregnant women. Ciprolar-FC (Fluocinolone Acetonide) Cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Ciprolar-FC (Fluocinolone Acetonide) Cream contains the teratogen, tretinoin, which may cause embryo-fetal death, altered fetal growth, congenital malformations, and potential neurologic deficits.
In clinical trials involving Ciprolar-FC (Fluocinolone Acetonide) Cream in the treatment of facial melasma, women of child-bearing potential initiated treatment only after having had a negative pregnancy test and used effective birth control measures during therapy. However, 13 women became pregnant during treatment with Ciprolar-FC (Fluocinolone Acetonide) Cream. Most of the pregnancy outcomes are unknown. Three women gave birth to apparently healthy babies. One pregnancy was terminated prematurely, and another ended in miscarriage.
In general, use of drugs should be reduced to a minimum in pregnancy. If a patient has been inadvertently exposed to Ciprolar-FC (Fluocinolone Acetonide) Cream in pregnancy, she should be counseled on the risk of teratogenesis due to this exposure. The risk of teratogenesis due to topical exposure to Ciprolar-FC (Fluocinolone Acetonide) Cream may be considered low. However, exposure during the period of organogenesis in the first trimester is theoretically more likely to produce adverse outcome than in later pregnancy.
Tretinoin is considered to be highly teratogenic upon systemic administration. Animal reproductive studies are not available with topical hydroquinone. Corticosteroids have been shown to be teratogenic in laboratory animals when administered systemically at relatively low dosage levels. Some corticosteroids have been shown to be teratogenic after dermal application in laboratory animals.
- In a dermal application study using Ciprolar-FC (Fluocinolone Acetonide) Cream in pregnant rabbits, there was an increase in the number of in utero deaths and a decrease in fetal weights in litters from dams treated topically with the drug product.
- In a dermal application study in pregnant rats treated with Ciprolar-FC (Fluocinolone Acetonide) Cream during organogenesis there was evidence of teratogenicity of the type expected with tretinoin. These morphological alterations included cleft palate, protruding tongue, open eyes, umbilical hernia, and retinal folding or dysplasia.
- In a dermal application study on the gestational and postnatal effects of a 10-fold dilution of Ciprolar-FC (Fluocinolone Acetonide) Cream in rats, an increase in the number of stillborn pups, lower pup body weights, and delay in preputial separation were observed. An increase in overall activity was seen in some treated litters at postnatal day 22 and in all treated litters at five weeks, a pattern consistent with effects previously noted in animals exposed in utero with retinoic acids. No adequate study of the late gestational and postnatal effects of the full-strength Ciprolar-FC (Fluocinolone Acetonide) Cream has been performed.
- It is difficult to interpret these animal studies on teratogenicity with Ciprolar-FC (Fluocinolone Acetonide) Cream, because the availability of the dermal applications in these studies could not be assured, and comparison with clinical dosing is not possible.
Corticosteroids, when systemically administered, appear in human milk. It is not known whether topical application of Ciprolar-FC Cream could result in sufficient systemic absorption to produce detectable quantities of Ciprolar-FC (Fluocinolone Acetonide) acetonide, hydroquinone, or tretinoin in human milk. Because many drugs are secreted in human milk, caution should be exercised when Ciprolar-FC (Fluocinolone Acetonide) Cream is administered to a nursing woman. Care should be taken to avoid contact between the infant being nursed and Ciprolar-FC (Fluocinolone Acetonide) Cream.
Safety and effectiveness of Ciprolar-FC (Fluocinolone Acetonide) Cream in pediatric patients have not been established.
Clinical studies of Ciprolar-FC (Fluocinolone Acetonide) Cream did not include sufficient number of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.
Ciprolar-FC (Fluocinolone Acetonide) (fluocinolone acetonide, hydroquinone, and tretinoin) Cream, 0.01%/4%/0.05% contains Ciprolar-FC (Fluocinolone Acetonide) acetonide, USP, hydroquinone, USP, and tretinoin, USP, in a light yellow, hydrophilic cream base for topical application.
Ciprolar-FC (Fluocinolone Acetonide) acetonide is a synthetic fluorinated corticosteroid. It is a white crystalline powder that is odorless and stable in light.
The chemical name for Ciprolar-FC (Fluocinolone Acetonide) acetonide is: (6α,11β,16α)-6,9-difluoro-11,21-dihydroxy-16,17-[(1-methylethylidene)bis(oxy)]-pregna-1,-4-diene-3,20-dione.
The molecular formula is C24H30F2O6 and molecular weight is 452.50.
Ciprolar-FC (Fluocinolone Acetonide) acetonide has the following structural formula:
Hydroquinone is a melanin synthesis inhibitor. It is prepared from the reduction of p-benzoquinone with sodium bisulfite. It occurs as fine white needles that darken on exposure to air.
The chemical name for hydroquinone is: 1,4-benzenediol.
The molecular formula is C6H6O2 and molecular weight is 110.11.
Hydroquinone has the following structural formula:
Tretinoin, a retinoid, is all-trans-retinoic acid formed from the oxidation of the aldehyde group of retinene to a carboxyl group. It occurs as yellow to light-orange crystals or crystalline powder with a characteristic odor of ensilage. It is highly reactive to light and moisture.
The chemical name for tretinoin is: (all-E)-3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexen-1-yl)-2,4,6,8-nonatetraenoic acid.
The molecular formula is C20H28O2 and molecular weight is 300.44.
Tretinoin has the following structural formula:
Each gram of Ciprolar-FC (Fluocinolone Acetonide) Cream contains Active: Ciprolar-FC (Fluocinolone Acetonide) acetonide 0.01% (0.1 mg), hydroquinone 4% (40 mg), and tretinoin 0.05% (0.5 mg). Inactive: butylated hydroxytoluene, cetyl alcohol, citric acid anhydrous, glycerin, glyceryl stearate, magnesium aluminum silicate, methyl gluceth-10, methylparaben, PEG-100 stearate, propylparaben, purified water, sodium metabisulfite, stearic acid, and stearyl alcohol.
fluocinolone-mol hydro-mol tretinoin
The mechanism of action of the active ingredients in Ciprolar-FC Cream in the treatment of melasma is unknown.
Percutaneous absorption of unchanged tretinoin, hydroquinone and Ciprolar-FC (Fluocinolone Acetonide) acetonide into the systemic circulation of two groups of healthy volunteers (Total N=59) was found to be minimal following 8 weeks of daily application of 1g (Group I, n=45) or 6g (Group II, n=14) of Ciprolar-FC (Fluocinolone Acetonide) Cream.
For tretinoin quantifiable plasma concentrations were obtained in 57.78% (26 out of 45) of Group I and 57.14% (8 out of 14) of Group II subjects. The exposure to tretinoin as reflected by the Cmax values ranged from 2.01 to 5.34 ng/mL (Group I) and 2.0 to 4.99 ng/mL (Group II). Thus, daily application of Ciprolar-FC (Fluocinolone Acetonide) Cream resulted in a minimal increase of normal endogenous levels of tretinoin. The circulating tretinoin levels represent only a portion of total tretinoin-associated retinoids, which would include metabolites of tretinoin and that sequestered into peripheral tissues.
For hydroquinone, quantifiable plasma concentrations were obtained in 18% (8 out of 44) Group I subjects. The exposure to hydroquinone, as reflected by the Cmax values, ranged from 25.55 to 86.52 ng/mL. All Group II subjects (6g dose) had post-dose plasma hydroquinone concentrations below the quantitation limit. For Ciprolar-FC (Fluocinolone Acetonide) acetonide, Groups I and II subjects had all post-dose plasma concentrations below quantitation limit.
When Ciprolar-FC (Fluocinolone Acetonide) acetonide, hydroquinone, and tretinoin in fixed combinations equivalent to 10%, 50%, 100%, and 150% of the concentrations in the clinical formulation of Ciprolar-FC (Fluocinolone Acetonide) Cream were applied topically to male and female CD-1 mice for up to 24 months at dosages approximating up to 50, 19,000, and 250 µg/kg/day, respectively (corresponding to dosages of 150, 57,000, and 750 μg/m2/day, respectively), no statistically significant changes in tumor incidence were observed.
When Ciprolar-FC (Fluocinolone Acetonide) acetonide, hydroquinone, and tretinoin in fixed combinations equivalent to 10%, 25%, 50%, and 100% of the concentrations in the clinical formulation of Ciprolar-FC (Fluocinolone Acetonide) Cream were applied topically to male and female SD rats for up to 24 months at dosages approximating up to 10, 4000, and 50 µg/kg/day, respectively (corresponding to dosages of 60, 24,000, and 300 μg/m2/day, respectively), statistically significant increases in the incidences of islet cell adenomas and combined islet cell adenomas and carcinomas of the pancreas in both males and females were observed. The clinical relevance of these findings is unknown.
Studies of hydroquinone in animals have demonstrated some evidence of carcinogenicity. The carcinogenic potential of hydroquinone in humans is unknown.
Studies in hairless albino mice suggest that concurrent exposure to tretinoin may enhance the tumorigenic potential of carcinogenic doses of UVB and UVA light from a solar simulator. This effect has been confirmed in a later study in pigmented mice, and dark pigmentation did not overcome the enhancement of photocarcinogenesis by 0.05% tretinoin. Although the significance of these studies to humans is not clear, patients should minimize exposure to sunlight or artificial ultraviolet irradiation sources.
Mutagenicity studies were not conducted with this combination of active ingredients. Published studies have demonstrated that hydroquinone is a mutagen and a clastogen. Treatment with hydroquinone has resulted in positive findings for genetic toxicity in the Ames assay in bacterial strains sensitive to oxidizing mutagens, in in vitro studies in mammalian cells, and in the in vivo mouse micronucleus assay. Tretinoin has been shown to be negative for mutagenesis in the Ames assay. Additional information regarding the genetic toxicity potential of tretinoin and of Ciprolar-FC (Fluocinolone Acetonide) acetonide is not available.
A dermal reproductive fertility study was conducted in SD rats using a 10-fold dilution of the clinical formulation. No effect was seen on the traditional parameters used to assess fertility, although prolongation of estrus was observed in some females, and there was a trend towards an increase in pre-and post-implantation loss that was not statistically significant. No adequate study of fertility and early embryonic toxicity of the full-strength drug product has been performed. In a six-month study in minipigs, small testes and severe hypospermia were found when males were treated topically with the full strength drug product.
Two adequate and well-controlled efficacy and safety trials were conducted in 641 subjects between the ages of 21 to 75 years, having Fitzpatrick Skin types I-IV and moderate to severe melasma of the face. Ciprolar-FC (Fluocinolone Acetonide) Cream was compared with 3 possible combinations of 2 of the 3 active ingredients [(1) hydroquinone 4% (HQ) + tretinoin 0.05% (RA); (2) Ciprolar-FC (Fluocinolone Acetonide) acetonide 0.01% (FA) + tretinoin 0.05% (RA); (3) Ciprolar-FC (Fluocinolone Acetonide) acetonide 0.01% (FA) + hydroquinone 4% (HQ)], contained in the same vehicle as Ciprolar-FC (Fluocinolone Acetonide) Cream. Subjects were instructed to apply their study medication each night, after washing their face with a mild soapless cleanser, for 8 weeks. Instructions were given to apply a thin layer of study medication to the hyperpigmented lesion, making sure to cover the entire lesion including the outside borders extending to the normal pigmented skin. Subjects were provided a mild moisturizer for use as needed. A sunscreen with SPF 30 was also provided with instructions for daily use. Protective clothing and avoidance of sunlight exposure to the face was recommended.
Subjects were evaluated for melasma severity at Baseline and at Weeks 1, 2, 4, and 8 of treatment. Primary efficacy was based on the proportion of subjects who had an investigators’ assessment of treatment success, defined as the clearing of melasma at the end of the eight-week treatment period. The majority of subjects enrolled in the two trials were white (approximately 66%) and female (approximately 98%). Ciprolar-FC (Fluocinolone Acetonide) Cream was demonstrated to be significantly more effective than any of the other combinations of the active ingredients.
PRIMARY EFFICACY ANALYSIS:
p-value is from Cochran-Mantel-Haenszel chi-square statistics controlling for pooled investigator and comparing Ciprolar-FC (Fluocinolone Acetonide) Cream to the other treatment groups.
In the Investigators’ assessment of melasma severity at Day 56 of treatment, the following table shows the clinical improvement profile for all subjects treated with Ciprolar-FC (Fluocinolone Acetonide) Cream based on severity of their melasma at the start of treatment.
Assessment Scale: Cleared (melasma lesions approximately equivalent to surrounding normal skin or with minimal residual hyperpigmentation); Mild (slightly darker than the surrounding normal skin); Moderate (moderately darker than the surrounding normal skin); Severe (markedly darker than the surrounding normal skin).
Subjects experienced improvement of their melasma with the use of Ciprolar-FC (Fluocinolone Acetonide) Cream as early as 4 weeks. However, among 7 subjects who had clearing at the end of 4 weeks of treatment with Ciprolar-FC (Fluocinolone Acetonide) Cream, 4 of them did not maintain the remission after an additional 4 weeks of treatment.
After 8 weeks of treatment with the trial drug, subjects entered into an open-label extension period in which Ciprolar-FC (Fluocinolone Acetonide) Cream was given on an as-needed basis for the treatment of melasma. The remission periods appeared to shorten between progressive courses of treatment. Additionally, few subjects maintained complete clearing of melasma (approximately 1 to 2%).
Ciprolar-FC (Fluocinolone Acetonide) Cream is light yellow in color, and supplied in 30 g aluminum tubes, NDC 0299-5950-30.
Storage: Keep tightly closed. Store in a refrigerator, 2° - 8°C (36° - 46°F). Protect from freezing.
See FDA-approved patient labeling (Patient Information)
Inform patients of the following:
Marketed by:
GALDERMA LABORATORIES, L.P.
Fort Worth, TX 76177 USA
Manufactured by:
Hill Dermaceuticals, Inc.
Sanford, FL 32773 USA
P51400-1
or
Manufactured by:
G Production Inc.
Baie d’Urfé, QC, H9X 3S4 Canada
Made in Canada
P52091-2
PATIENT INFORMATION
Ciprolar-FC (Fluocinolone Acetonide)® (try-LOOM-ah)
(fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%)
Cream
Important information: Ciprolar-FC (Fluocinolone Acetonide) Cream is for use on skin only. Do not use Ciprolar-FC (Fluocinolone Acetonide) Cream in your mouth, eyes, or vagina.
What is the most important information I should know about Ciprolar-FC (Fluocinolone Acetonide) Cream?
Ciprolar-FC (Fluocinolone Acetonide) Cream may cause birth defects or death of the baby if used during pregnancy. The risk of birth defects or death of the baby may be greater if Ciprolar-FC (Fluocinolone Acetonide) Cream is used during the first trimester of pregnancy. Tell your doctor if you are pregnant or plan to become pregnant.
If you become pregnant while using Ciprolar-FC (Fluocinolone Acetonide) Cream, tell your doctor right away.
What is Ciprolar-FC (Fluocinolone Acetonide) Cream?
Ciprolar-FC (Fluocinolone Acetonide) Cream is a prescription medicine used for the short-term treatment of moderate to severe melasma of the face, in combination with sun avoidance and the use of sunscreens.
Ciprolar-FC (Fluocinolone Acetonide) Cream is not for continuous treatment of melasma.
It is not known if Ciprolar-FC (Fluocinolone Acetonide) Cream is safe and effective in children.
It is not known if Ciprolar-FC (Fluocinolone Acetonide) Cream is safe and effective in people with dark brown to black skin color.
It is not known if Ciprolar-FC (Fluocinolone Acetonide) Cream is safe and effective in the treatment of dark spots (hyperpigmentation) of the skin caused by conditions other than melasma of the face.
It is not known if Ciprolar-FC (Fluocinolone Acetonide) Cream is safe and effective in females who are pregnant or who are breastfeeding. See "What is the most important information I should know about Ciprolar-FC (Fluocinolone Acetonide) Cream? and What should I tell my doctor before using Ciprolar-FC (Fluocinolone Acetonide) Cream?"
Who should not use Ciprolar-FC (Fluocinolone Acetonide) Cream?
Do not use Ciprolar-FC (Fluocinolone Acetonide) Cream if you are allergic to it or any of the ingredients in Ciprolar-FC (Fluocinolone Acetonide) Cream. See the end of this leaflet for a complete list of ingredients in Ciprolar-FC (Fluocinolone Acetonide) Cream.
What should I tell my doctor before using Ciprolar-FC (Fluocinolone Acetonide) Cream?
Before you use Ciprolar-FC (Fluocinolone Acetonide) Cream, tell your doctor if you:
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, herbal supplements and skin products that you use.
How should I use Ciprolar-FC (Fluocinolone Acetonide) Cream?
What should I avoid while using Ciprolar-FC (Fluocinolone Acetonide) Cream?
What are the possible side effects of Ciprolar-FC (Fluocinolone Acetonide) Cream?
Ciprolar-FC (Fluocinolone Acetonide) Cream may cause serious side effects, including:
- allergic reactions. Ciprolar-FC (Fluocinolone Acetonide) Cream may cause allergic reactions that can be life threatening. Stop using Ciprolar-FC (Fluocinolone Acetonide) Cream and call your doctor or get medical help right away if you get any of the following symptoms:
- change in skin color. One of the medicines in Ciprolar-FC (Fluocinolone Acetonide) Cream can cause a blue-black darkening of your skin. Stop using Ciprolar-FC (Fluocinolone Acetonide) Cream and tell you doctor if you develop a blue-black darkening of your skin.
- Ciprolar-FC (Fluocinolone Acetonide) Cream can pass through your skin. Too much Ciprolar-FC (Fluocinolone Acetonide) Cream passing through your skin can cause your adrenal glands to stop working. Your doctor may do blood tests to check for adrenal gland problems.
- skin irritation. Stop using Ciprolar-FC (Fluocinolone Acetonide) Cream and call your doctor if you have:
The most common side effects of Ciprolar-FC (Fluocinolone Acetonide) Cream include:
Tell your doctor if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of Ciprolar-FC (Fluocinolone Acetonide) Cream. For more information, ask your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
You may also report side effects to Galderma Laboratories, L.P. at 1-866-735-4137.
How should I store Ciprolar-FC (Fluocinolone Acetonide) Cream?
General information about the safe and effective use of Ciprolar-FC (Fluocinolone Acetonide) Cream
Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Ciprolar-FC (Fluocinolone Acetonide) Cream for a condition for which it was not prescribed. Do not give Ciprolar-FC (Fluocinolone Acetonide) Cream to other people, even if they have the same symptoms you have. It may harm them.
If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about Ciprolar-FC (Fluocinolone Acetonide) Cream that is written for health professionals.
What are the ingredients in Ciprolar-FC (Fluocinolone Acetonide) Cream?
Active ingredients: Ciprolar-FC (Fluocinolone Acetonide) acetonide, hydroquinone, and tretinoin
Inactive ingredients: butylated hydroxytoluene, cetyl alcohol, citric acid anhydrous, glycerin, glyceryl stearate, magnesium aluminum silicate, methyl gluceth-10, methylparaben, PEG-100 stearate, propylparaben, purified water, sodium metabisulfite, stearic acid, and stearyl alcohol
This Patient Information has been approved by the U.S. Food and Drug Administration.
Marketed by:
GALDERMA LABORATORIES, L.P.
Fort Worth, TX 76177 USA
Manufactured by:
Hill Dermaceuticals, Inc.
Sanford, FL 32773 USA
or
Manufactured by:
G Production Inc.
Baie dUrfé, QC, H9X 3S4 Canada
Made in Canada
Revised: March 2014
Ciprolar-FC (Fluocinolone Acetonide)® (fluocinolone acetonide, hydroquinone, tretinoin) cream, 0.01%/4%/0.05%
MUST BE REFRIGERATED
NDC 0299-5950-30
Rx Only
NET WT. 30 g
GALDERMA
Lot No.: Exp. Date:
For Topical Use Only. Not for Ophthalmic Use.
Usual
Dosage: Apply a thin film to affected areas once daily at night. See package insert for complete prescribing information.
Each gram contains: Active: Ciprolar-FC (Fluocinolone Acetonide) acetonide 0.01% (0.1 mg), hydroquinone 4% (40 mg), and tretinoin 0.05% (0.5 mg). Inactive: butylated hydroxytoluene, cetyl alcohol, citric acid anhydrous, glycerin, glyceryl stearate, magnesium aluminum silicate, methyl gluceth-10, methylparaben, PEG-100 stearate, propylparaben, purified water, sodium metabisulfite, stearic acid, and stearyl alcohol.
Storage: Store in a refrigerator, 2° to 8°C (36° to 46°F). Protect from freezing.
www.triluma.com
Marketed by:
GALDERMA LABORATORIES, L.P.
Fort Worth, Texas 76177 USA
Galderma is a registered trademark.
P51399-2
MUST BE REFRIGERATED
p51399-2-tri-luma-30g-crm-crtn
Depending on the reaction of the Ciprolar-FC after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Ciprolar-FC not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.
Is Ciprolar-FC addictive or habit forming?Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
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Once in a day | 1 | 100.0% |
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16-29 | 1 | 100.0% |
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The information was verified by Dr. Rachana Salvi, MD Pharmacology