Anti-Fungal

Indications

Skin and nail infections due to dermatophytes, yeasts and other fungi such as: Tinea capitis, corporis, manuum, pedis, barbae, cruris, unguium or onychomycosis. Pityriasis versicolor, candidiasis of skin and nails, stomatitis angularis, otitis externa. Since Miconazole Topical Cream has an antibacterial effect on Gram-positive bacteria, it may be used in mycoses secondarily infected with such bacteria.

Pharmacology

Miconazole topical cream is a broad-spectrum antimycotic which offers a high antifungal activity against dermatophytes, yeasts and other phyco-Asco and Adelomycetes, with a potent antibacterial activity against Gram-positive bacilli and cocci. Miconazole topical cream proved to be markedly effective in secondary infected mycoses, which under other treatments were resistant or reappeared. Miconazole topical cream does not stain skin or clothes.

Dosage & Administration

The dosage is same for all the ages.

For skin infections: Apply some cream to the lesions twice daily and rub it well with finger until it has fully penetrated the skin. All lesions usually disappear after 2 to 5 weeks. Prolong treatment for some 10 days to prevent relapse.

For nail infections: Clip infected nail as shortly as possible. Apply some cream once daily to the infected nail and rub with your finger, cover nail with a non-perforated occlusive plastic bandage.

Also after loosening of the infected nail (from 2-3 weeks onwards) uniterrupted treatment should be continued until the growth of a new nail has set in and definite cure can be observed (usually after seven months or more).

Contraindications

No contraindication is known.

Side Effects

Topical application of Miconazole Nitrate has almost no side effect.

Pregnancy & Lactation

Only small amounts of Miconazole nitrate are absorbed following local administration. However as with other imidazoles, Miconazole nitrate should be used with caution during pregnancy.

Precautions & Warnings

Miconazole Nitrate is intended for topical use. If accidental ingestion of large quantities of the product occurs, an appropriate method of gastric emptying may be used if considered desirable.

Therapeutic Class

Topical Antifungal preparations

Price:

15 mg tube-55tk

Indications

Ciclopirox Cream is indicated for the topical treatment of the following dermal infections: Tinea pedis, Tinea cruris and Tinea corporis due to Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum and Microsporum canis, candidiasis (moniliasis) due to Candida albicans, and Tinea (pityriasis) versicolor due to Malassezia furfur. Ciclopirox Cream is also highly effective against some gram negative & some gram-positive bacteria. Owing to its anti-inflammatory effects, Ciclopirox Olamine alone is sufficient to treat mild to moderate inflammatory fungal infections

Pharmacology

Ciclopirox Olamine is a synthetic broad spectrum antifungal agent that inhibits the growth of pathogenic dermatophytes, yeasts, and Malassezia furfur. Ciclopirox Olamine exhibits fungicidal activity in vitro against isolates of Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, and Candida albicans. The mode of action of Ciclopirox Olamine was studied mainly in Candida albicans. It is presumed that Ciclopirox Olamine mediated growth inhibition or death of fungal cells is primarily caused by in vitro cellular depletion of some essential substrates and/or ions and that such effects are brought about through blockage of their uptake from the medium.In addition to its broad spectrum of antifungal action, Ciclopirox also exerts antibacterial activity against many Gram-positive and Gram-negative bacteria. Theanti-inflammatory effects of Ciclopirox have been demonstratedin human polymorphonuclear cells, where Ciclopirox has inhibited the synthesis of prostaglandin and leukotriene. Ciclopirox can also exhibit its anti-inflammatory effects by inhibiting the formation of 5-lipoxygenase and cyclooxygenase.

Dosage & Administration

Ciclopirox Cream should be gently massaged onto the affected and surrounding skin areas twice daily for four weeks. Clinical improvement with relief of pruritus and other symptoms usually occurs within the first week of treatment. If a patient shows no clinical improvement after four weeks of treatment with Ciclopirox cream, the diagnosis should be redetermined. Patients with Tinea versicolor usually exhibit clinical and mycological clearing after two weeks of treatment.

Use in children: Safety and effectiveness in children below the age of 10 years have not been established.

Contraindications

Ciclopirox Olamine cream is contraindicated in individuals who have shown hypersensitivity to any of its components.

Side Effects

Ciclopirox Olamine cream is well tolerated with a low incidence of adverse reactions reported in clinical trials.

Pregnancy & Lactation

Pregnancy category B. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Ciclopirox Olamine cream or is administered to nursing women.

Precautions & Warnings

Ciclopirox Olamine cream is not for ophthalmic use.

Therapeutic Class

Topical Antifungal preparations

Price: 15 mg tube-110tk

Indications

Voriconazole is an azole antifungal medicine. It is indicated for use in patients 12 years of age and older in the treatment of following fungal infections-

• Invasive aspergillosis

• Candidemia (nonneutropenic) and disseminated candidiasis in skin, abdomen, kidney, bladder wall and wounds

• Esophageal candidiasis

• Serious infections caused by Scedosporium apiospermum and Fusarium Species including Fusarium solani

• Patients intolerant of, or refractory to other therapy.

Pharmacology

Voriconazole is a triazole antifungal medication used to treat serious fungal infections. Voriconazole binds and inhibits ergosterol synthesis by inhibiting CYP450-dependent 14-alpha sterol demethylase. The inhibition of 14-alpha sterol demethylase results in a depletion of ergosterol in fungal cell membrane.

Dosage & Administration

Oral-
Voriconazole tablet and powder for suspension are to be taken at least one hour before or one hour following a meal

• At or over 40 kg body weight: Loading dose regimen is 400 mg or 10 ml every 12 hours (for the first 24 hours) and maintenance dose (after first 24 hours) is 200 mg or 5 ml twice daily.

• Below 40 Kg body weight: Loading dose regimen is 200 mg or 5 ml every 12 hours (for the first 24 hours) and maintenance dose (after first 24 hours) is 100 mg or 2.5 ml twice daily. Or, as directed by the registered physician.

Injection-
Invasive Aspergillosisd :

• Loading dose: 6 mg/kg 12 hourly for the first 24 hours.

• Maintenance Dose: 4 mg/kg 12 hourly.

Candidemia in nonneutropenic patients and other deep tissue Candida infections:

• Loading dose: 6 mg/kg 12 hourly for the first 24 hours.

• Maintenance Dose: 3-4 mg/kg 12 hourly.

Scedosporiosis and Fusariosis:

• Loading dose: 6 mg/kg 12 hourly for the first 24 hours.

• Maintenance Dose: 4 mg/

Interaction

• CYP3A4, CYP2C9 and CYP2C19 inhibitors and inducers: Adjust Voriconazole dosage and monitor for adverse reactions or lack of efficacy

• Voriconazole may increase the concentrations and activity of drugs that are CYP3A4, CYP2C9 and CYP2C19 substrates. Reduce doses of these other drugs and monitor for adverse reactions

• Increase maintenance oral and intravenous dosage of Voriconazole with co-administration of Phenytoin or Efavirenz

Contraindications

Known hypersensitivity to Voriconazole or any other components of this drug-

• Co-administration with terfenadine, astemizole, cisapride, pimozide or quinidine, sirolimus due to risk of serious adverse reactions

• Co-administration with rifampin, carbamazepine, long-acting barbiturates, efavirenz, ritonavir, rifabutin, ergot alkaloids and St. John's Wort due to risk of loss of efficacy

Side Effects

The most common side effects are abdominal pain, anemia, blurred vision, headache, chest pain, nausea and diarrhea.

Pregnancy & Lactation

There are no adequate and well-controlled studies in pregnant woman. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Precautions & Warnings

Long term exposure (treatment or prophylaxis) greater than 180 days requires careful assessment of the benefit-risk balance. Squamous cell carcinoma of the skin (SCC) has been reported in relation with long-term voriconazole treatment.

Use in Special Populations

The efficacy to the children under 12 years of age is not established.

Overdose Effects

There is no data found about overdose of Voriconazole.

Therapeutic Class

Other Antifungal preparations

Reconstitution

Reconstitution Instructions of suspension: Shake the bottle well before adding water to loosen the powder. Add 25 ml of boiled and cooled water to the bottle (5 spoons of a provided spoon). Shake the closed bottle vigorously until powder mixed completely with the water. Store reconstituted suspension between 15°-30° C. Discard suspension 14 days after reconstitution.

Price: 200mg-100tk