Dermatoses: Topical: Apply 3 to 4 times daily to affected area(s).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Dermatoses: Children ≥12 years and Adolescents: Topical: Refer to adult dosing.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
See individual agents.
Hypersensitivity to iodoquinol, hydrocortisone, or any component of the formulation
Alcortin A: Additional contraindications: Hypersensitivity to aloe vera, glycine, histidine, lysine, or palmitic acid.
Concerns related to adverse effects:
• Adrenal suppression: Systemic absorption of topical corticosteroids may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.
• Anaphylactoid reactions: Rare cases of anaphylactoid reactions have been observed in patients receiving corticosteroids.
• Contact dermatitis: Allergic contact dermatitis can occur and is usually diagnosed by failure to heal rather than clinical exacerbation; discontinue use if irritation occurs and treat appropriately.
• Immunosuppression: Prolonged use of corticosteroids may increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines. Exposure to chickenpox or measles should be avoided; corticosteroids should not be used to treat ocular herpes simplex. Corticosteroids should not be used for cerebral malaria, fungal infections, or viral hepatitis. Close observation is required in patients with tuberculosis (TB) infection (latent TB) and/or TB reactivity; restrict use in TB disease (active TB) (only fulminating or disseminated TB in conjunction with antituberculosis treatment). Amebiasis should be ruled out in any patient with recent travel to tropical climates or unexplained diarrhea prior to initiation of corticosteroids.
• Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi sarcoma (case reports); if noted, discontinuation of therapy should be considered. (Goedert 2002)
• Myopathy: Acute myopathy has been reported with high-dose corticosteroids, usually in patients with neuromuscular transmission disorders; may involve ocular and/or respiratory muscles; monitor creatinine kinase; recovery may be delayed.
• Optic atrophy/neuritis: Prolonged use of high doses of iodoquinol may result in optic neuritis and optic atrophy; avoid long-term therapy.
• Peripheral neuropathy: Prolonged use of high doses of iodoquinol may result in peripheral neuropathy; avoid long-term therapy.
• Psychiatric disturbances: Corticosteroid use may cause psychiatric disturbances, including depression, euphoria, insomnia, mood swings, and personality changes. Preexisting psychiatric conditions may be exacerbated by corticosteroid use.
• Sensitization: Topical use has been associated with local sensitization (redness, irritation); discontinue if sensitization is noted.
• Superinfection: Prolonged use may result in the overgrowth of nonsusceptible organisms.
• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with heart failure and/or hypertension.
• Diabetes: Use with caution in patients with diabetes mellitus.
• Gastrointestinal disease: Use with caution in patients with GI diseases (diverticulitis, intestinal anastomoses, peptic ulcer, nonspecific ulcerative colitis).
• Hepatic impairment: Use with caution in patients with hepatic impairment, including cirrhosis.
• Myasthenia gravis: Use with caution in patients with myasthenia gravis.
• Myocardial infarction: Use with caution following acute myocardial infarction (MI); corticosteroids have been associated with myocardial rupture.
• Ocular disease: Use with caution in patients with cataracts and/or glaucoma; increased intraocular pressure, glaucoma, and cataracts have occurred with prolonged use.
• Osteoporosis: Use with caution in patients with osteoporosis.
• Renal impairment: Use with caution in patients with renal impairment; fluid retention may occur.
• Thyroid disease: Use with caution in patients with thyroid abnormalities; wait one month after discontinuing therapy before performing thyroid tests.
• Ulcerative colitis: With severe ulcerative colitis, it may be hazardous to delay surgery while waiting for response to treatment.
Special populations:
• Older adult: Because of the risk of adverse effects associated with systemic absorption, topical corticosteroids should be used cautiously in elderly patients in the smallest possible effective dose for the shortest duration.
• Pediatric: Children may absorb proportionally larger amounts of corticosteroids after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing's syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP 1997; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
Other warnings/precautions:
• Appropriate use: For external use only; avoid contact with eyes, lips, and mucous membranes. Staining of the skin, hair and fabrics may occur. Not recommended for use under occlusive dressings, tight fitting garments, or diapered areas. If occlusive dressings are used, general caution should be observed; adverse effects may be increased.
• Discontinuation of therapy: After long-term use, withdraw therapy with gradual tapering of dose.
• Stress: May require higher doses when subject to stress (ie, trauma, surgery, severe infection).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Cream, topical:
Dermazene: Iodoquinol 1% and hydrocortisone acetate 1% (2 g, 30 g) [contains cetyl alcohol]
Vytone: Iodoquinol 1% and hydrocortisone 1.9% per 2 g packet (30s) [contains benzyl alcohol]
Generic: Iodoquinol 1% and hydrocortisone acetate 1% (28.4 g, 30 g); Iodoquinol 1% and hydrocortisone 1.9% per 2 g packet (30s)
Gel, topical:
Alcortin A: Iodoquinol 1% and hydrocortisone 2% (2 g [DSC], 48 g [DSC]) [contains aloe, benzyl alcohol]
Generic: Iodoquinol 1% and hydrocortisone 2% (48 g)
Yes
Cream (Hydrocortisone-Iodoquinol External)
1-1% (per gram): $3.77 - $6.07
Cream (Iodoquinol-Hydrocortisone-Aloe External)
1-1.9% (per gram): $10.08
Cream (Vytone External)
1-1.9% (per gram): $17.08
Gel (Iodoquinol-HC-Aloe Polysacch External)
1-2-1% (per gram): $179.25 - $198.75
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
For external use only; avoid contact with eyes, lips, and mucous membranes. Not recommended for use under occlusive dressings, tight fitting garments, or diaper areas. Staining of the skin, hair, and fabrics may occur.
Topical: For external use only; avoid contact with eyes, lips, and mucous membranes. Not recommended for use under occlusive dressings, tight fitting garments, or diaper areas. Staining of the skin, hair, and fabrics may occur.
Dermatoses: Treatment of eczema (including impetiginized, nuchal, and nummular); acne urticata; anogenital pruritus (vulvae, scroti, ani); atopic or contact dermatitis; endogenous chronic infectious dermatitis; chronic eczematoid otitis externa; folliculitis; intertrigo; lichen simplex chronicus; moniliasis; dermatoses (mycotic or bacterial); neurodermatitis (localized or systemic); pyoderma, stasis dermatitis.
Vytone may be confused with Hytone, Zydone
KIDs List: Medium, high, and very high potency topical corticosteroids, when used in neonates and infants <1 year of age for diaper dermatitis, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided due to risk of adrenal suppression; systemic absorption is higher in pediatric patients than adults (strong recommendation; low quality of evidence) (PPA [Meyers 2020]).
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Calcipotriene: Hydrocortisone (Topical) may diminish the therapeutic effect of Calcipotriene. Management: Monitor for reduced calcipotriene efficacy if combined with hydrocortisone valerate. Consider separating the administration of these agents by 10 to 12 hours to minimize the risk of this potential interaction. Risk C: Monitor therapy
Animal reproduction studies have not been conducted with this combination. Refer to individual monographs.
It is not known if iodoquinol or hydrocortisone are present in breast milk following use of this preparation. The manufacturer recommends that caution be exercised when administering iodoquinol/hydrocortisone to breastfeeding women. Also refer to individual monographs.
Iodoquinol: Amebicide that has antifungal and antibacterial properties.
Hydrocortisone: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability.
See individual agents.
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