Comparison of Topical Corticosteroids - snapaprn.org

1 PL Detail-Document #280908. This PL Detail-Document gives subscribers additional insight related to the Recommendations published in . PHARMACIST'S LETTER / PRESCRIBER'S LETTER. September 2012. Comparison of Topical Corticosteroids Potency of Topical steroids is based on their skin vasoconstricting ability and ranked on a scale of ,2 Typically, drugs that rank I are classified as very high potency; II is considered high potency; III, IV, and V are medium potency; and VI and VII are low ,5 Classification can vary depending on the source, however, especially in the medium and high range. Furthermore, similar vasoconstricting ability does not indicate therapeutic ,3 The following chart compares Topical Corticosteroids available in the for treatment of dermatologic conditions based on potency, dose, dosage forms and sizes, and cost.

2 Additional information pertinent to prescribing is provided. *Propylene glycol is added to optimize drug absorption in the augmented formulations. Drug Adult Dosage Form and Sizesb AWP ($) for Selected Commentsc,e Dosea Products (Brand is listed if generic is unavailable). Very High Potencyd It is recommended that patients Augmented* QD to BID Lotion (30, 60 mL) 30 mL lotion on very high potency steroids betamethasone Oint (15, 45, 50 gm) 60 mL lotion not be discontinued abruptly;. dipropionate Gel (15, 50 gm) 15 gm oint 30 but instead switch to a lower (Diprolene) 45 gm oint potency ,7. Generics available 50 gm oint 73. Clobetasol propionate QD Cream 15 gm cream (emollient) Treatment duration for very (Shampoo) (15, 30, 45, 60 gm) high potency steroids should (Clobex, Olux, Olux-E, generally not exceed 2 to 4.)

3 Temovate, Temovate E) Cream (emollient base) 30 gm cream (emollient) weeks of continuous use Generics available BID (15, 30, 60 gm) because of the potential for Foam (50, 100 gm) 60 gm cream (emollient) 69 systemic side ,e Gel (15, 30, 60 gm) 15 gm cream Lotion (60 mL, 120 mL) 30 gm cream Total dose should generally Oint (15, 30, 45, 60 gm) 45 gm cream not exceed 50 grams per week Scalp application 60 gm cream because of the potential for (25, 50 mL) 15 gm gel adrenal ,e Shampoo (118 mL) 30 gm gel Continued Spray (60, 125 mL) 60 gm gel Continued . More.. Copyright 2012 by Therapeutic Research Center Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249.

4 ~ ~ (PL Detail-Document #280908: Page 2 of 12). Drug Adult Dosage Form and Sizesb AWP ($) for Selected Commentsc,e Dosea Products (Brand is listed if generic is unavailable). Very High Potency, continued Occlusive dressings can be Clobetasol propionate, 15 gm oint used with caution with continued 30 gm oint diflorasone diacetate and 45 gm oint fluocinonide, but should be 60 gm oint avoided with other very high 25 mL scalp application potency agents, per FDA- approved labeling. 50 mL scalp application Clobestasol may cause HPA. axis suppression at doses as 118 mL shampoo low as 2 gm daily. 60 mL spray (Clobex). Lower potency agents are 125 mL spray (Clobex) preferred for the face, groin, armpits, or skinfolds due to 60 mL lotion susceptibility to local side 120 mL lotion effects and systemic 50 gm foam 100 gm foam Diflorasone diacetate QD to TID Oint (15, 30, 60 gm) 15 gm oint Symptoms of adrenal 30 gm oint suppression include weakness, Generic available weight loss, hypotension, and 60 gm oint gastrointestinal distress.

5 Fluocinonide QD to BID Cream (30, 60, 120 gm) 30 gm cream (Vanos) 60 gm cream 120 gm cream Halobetasol propionate QD to BID Cream (15, 50 gm) 15 gm cream (Ultravate) Oint (15, 50 gm) 50 gm cream Generics available 15 gm oint 50 gm oint More.. Copyright 2012 by Therapeutic Research Center Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249. ~ ~ (PL Detail-Document #280908: Page 3 of 12). Drug Adult Dosage Form and Sizesb AWP ($) for Selected Commentsc,e Dosea Products (Brand is listed if generic is unavailable). High Potencyd Amcinonide BID to TID Cream (15, 30, 60 gm) 15 gm cream 26 Occlusive dressings should Generics available Lotion (60 mL) 30 gm cream be avoided with Oint (60 gm) 60 gm cream betamethasone dipropionate, 60 mL lotion but can be used with caution 60 gm oint with other high potency Augmented* BID Cream (15, 50 gm) 15 gm cream agents, per FDA-approved betamethasone 50 gm cream labeling.

6 Dipropionate (Diprolene Lower potency agents are AF) Generics available preferred for the face, groin, Betamethasone QD to BID Oint (15, 45 gm) 15 gm oint armpits, or skinfolds due to dipropionate 45 gm oint susceptibility to local side effects and systemic Desoximetasone BID Cream (15, 60, 100 gm) 15 gm cream (Topicort) Gel (15, 60 gm) 60 gm cream Generics available Oint (15, 60, 100 gm) 100 gm cream 15 gm gel 60 gm gel 15 gm oint 60 gm oint 100 gm oint Diflorasone diacetate BID Cream (15, 30, 60 gm) 15 gm cream Generics available 30 gm cream 60 gm cream Fluocinonide BID to Cream 15 gm cream Generics available QID (15, 30, 60, 120 gm) 30 gm cream Gel (15, 30, 60 gm) 60 gm cream Continued Oint (15, 30, 60 gm) 120 gm cream Solution (20, 60 mL) 15 gm gel More.

7 Copyright 2012 by Therapeutic Research Center Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249. ~ ~ (PL Detail-Document #280908: Page 4 of 12). Drug Adult Dosage Form and Sizesb AWP ($) for Selected Commentsc,e Dosea Products (Brand is listed if generic is unavailable). High Potency, continued Fluocinonide, continued 30 gm gel 60 gm gel 15 gm oint 30 gm oint 60 gm oint 20 mL sol 60 mL sol Halcinonide BID to TID Cream (30, 60, 216 gm) 30 gm cream (Halog) Oint (30, 60 gm) 60 gm cream 216 gm cream 30 gm oint 60 gm oint Triamcinolone acetonide BID to Oint (15 gm) 15 gm oint Generics available QID. Medium Potencyd Betamethasone QD to BID Cream (15, 45, 50 gm) 15 gm cream dipropionate (cream) Lotion (60 mL) 45 gm cream Medium or low potency Generics available 50 gm cream agents are preferable when a BID 60 mL lotion 45 large body surface area needs (lotion) to be Betamethasone valerate QD to TID Cream (15, 45 gm) 15 gm cream Medium potency agents are (Luxiq) Oint (15, 45 gm) 45 gm cream generally well tolerated when Generics available BID Foam (50, 100 gm) 15 gm oint used for three months or less (Luxiq) Lotion (60 mL) 45 gm oint on nonfacial, 50 gm foam (Luxiq) nonintertriginous 100 gm foam (Luxiq).

8 60 mL lotion 72 Continued . More.. Copyright 2012 by Therapeutic Research Center Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249. ~ ~ (PL Detail-Document #280908: Page 5 of 12). Drug Adult Dosage Form and Sizesb AWP ($) for Selected Commentsc,e Dosea Products (Brand is listed if generic is unavailable). Medium Potency, continued Occlusive dressings should be Clocortolone pivalate TID Cream 30 gm cream avoided with betamethasone (Cloderm) (30, 45, 75, 90 gm) 45 gm cream dipropionate and fluticasone 75 gm cream propionate cream per 90 gm cream FDA-approved labeling. Desoximetasone BID Cream (15, 60, 100 gm) 15 gm cream (Topicort LP) 60 gm cream Generics available 100 gm cream Fluocinolone acetonide TID to QID Cream (15, 60 gm) 15 gm cream Generics available Oint (15, 60 gm) 60 gm cream 15 gm oint 60 gm oint Fluocinonide (emulsified BID to Cream (15, 30, 60 gm) 15 gm cream base) QID 30 gm cream Generics available 60 gm cream Flurandrenolide BID to TID Cream (15, 30, 60 gm) 15 gm cream 108.

9 (Cordran, Cordran SP) Lotion (15, 60 , 120 mL) 30 gm cream 186. 60 gm cream 15 mL lotion 108. 60 mL lotion 120 mL lotion 690. QD to BID 4 mcg/cm2 tape cm x 60 cm ( cm x 60 cm tape, cm x 200 cm cm x 200 cm tape). More.. Copyright 2012 by Therapeutic Research Center Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249. ~ ~ (PL Detail-Document #280908: Page 6 of 12). Drug Adult Dosage Form and Sizesb AWP ($) for Selected Commentsc,e Dosea Products (Brand is listed if generic is unavailable). Medium Potency, continued Fluticasone propionate QD to BID Cream (15, 30, 60 gm) 15 gm cream (Cutivate) 30 gm cream Generics available 60 gm cream BID Oint (15, 30, 60 gm) 15 gm oint 30 gm oint 60 gm oint QD Lotion (60, 120 mL) 60 mL (Cutivate) 120 mL (Cutivate) Hydrocortisone butyrate BID to TID Cream (15, 45 gm) 15 gm cream (Locoid, Lipocream (15, 45, 60 gm) 45 gm cream Locoid Lipocream) BID Oint (15, 45 gm) 15 gm cream Generics available (lotion) Sol (20, 60 mL) (Locoid Lipocream) Lotion (60, 120 mL) 45 gm cream (Locoid Lipocream) 60 gm cream (Locoid Lipocream) 59 mL lotion (Locoid).

10 ; 118 mL lotion (Locoid) 15 gm oint 45 gm oint 20 mL sol 60 mL sol Hydrocortisone valerate BID to TID Cream (15, 45, 60 gm) 15 gm cream (Westcort) Oint (15, 45, 60 gm) 45 gm cream Generics available 60 gm cream 15 gm oint 45 gm oint 60 gm oint More.. Copyright 2012 by Therapeutic Research Center Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249. ~ ~ (PL Detail-Document #280908: Page 7 of 12). Drug Adult Dosage Form and Sizesb AWP ($) for Selected Commentsc,e Dosea Products (Brand is listed if generic is unavailable). Medium Potency, continued Mometasone furoate QD Cream (15, 45 gm) 15 gm cream (Elocon) Oint (15, 45 gm) 45 gm cream 49.