Lorinden

Pharmacological properties

the properties of the ointment lorinden a are due to the combined action of flumethasone pivalate and salicylic acid.

Flumethasone pivalate is a synthetic corticosteroids with a moderate anti-inflammatory property. If applied in the form of an ointment, it has a local effect of medium intensity. It has a lipophilic effect, easily penetrates the stratum corneum of the skin and exhibits a long anti-inflammatory, antipruritic and anti-allergic effect. With external use of flumetasone, pivalate inhibits the formation of prostaglandins and leukotrienes in the skin due to inhibition of phospholipase A activity₂ and decreasing the release of arachidonic acid from cell membrane phospholipids. It inhibits phagocytosis, the release of interleukins and other cytokines that cause inflammatory processes. Suppresses the release of histamine and the manifestation of local allergic reactions, reduces proliferative processes. Due to local vasoconstrictor action, it reduces the severity of exudative reaction. Reduces protein synthesis and collagen deposition.

Salicylic acid in the concentration available in the drug has a weak keratolytic effect.

Pharmacokinetics Flumethasone pivalate penetrates well into the stratum corneum, where it accumulates. It is not metabolized in the skin. When applied externally, in small amounts it can penetrate the body and in this case have a systemic effect. After penetration through the skin, the drug is metabolized mainly in the liver, excreted in the urine and in small quantities with bile in the form of glucuronide conjugates, as well as unchanged. The absorption of flumethasone pivalate is increased when applied to areas with delicate skin - in the area of ​​folds or face, on skin with damaged epidermis or inflammatory skin. The use of an occlusive dressing, which helps to increase the temperature and humidity of the skin, also increases the absorption of flumetasone pivalate. In addition, absorption increases with frequent use of the drug or in large areas of the skin. Absorption through the skin in young people is more intense than in older people.

External use of salicylic acid facilitates the penetration of flumethasone pivalate through the keratinized epidermis.

Indications

Inflammation of the skin (without exudation), uncomplicated by a secondary bacterial infection, including an allergic one, accompanied by persistent itching and hyperkeratosis: seborrheic dermatitis, atopic dermatitis, nodular urticaria (papular urticaria), allergic contact dermatitis, erythema multiforme, psoriasis, red tuberculosis, tuberculosis lichen planus.

Application

Designed for topical use. the ointment is applied in a thin layer on the affected area of ​​the skin at first 2-3 times a day, and after the relief of acute phenomena - 1-2 times a day. Application of the drug under an occlusive dressing is allowed. upon the onset of clinical recovery, treatment is continued for another 3-4 days. continuous therapy for more than 2 weeks should not be given. can not be applied to the skin for more than 1 week. during the week it is recommended to use no more than 1 tube of cream.

With significant lichenization or excessive hyperkeratosis in the area of ​​skin changes, the use of an occlusive dressing is allowed, which should be changed every 24–48 hours.

Contraindications

Hypersensitivity to corticosteroids, salicylic acid or other components of the drug. viral (e.g. herpetic skin lesions) and fungal skin diseases, skin tuberculosis, skin neoplasms, acne rosacea and diaper dermatitis, anal pruritus, inflammation or ulcers of varicose nodes.

Do not use on large areas of the skin, especially if skin integrity is impaired, such as burns.

Side effects

On the part of the skin and subcutaneous tissue: rash, peeling of the skin, acne, poststeroidal purpura, inhibition of epidermal growth, atrophy of the subcutaneous tissue, dry skin, burning sensation, irritation, itching, excessive hair growth on the body or alopecia, discoloration or hyperpigmentation of the skin, atrophy and violation of the integrity of the skin, telangiectasia, contact and perioral dermatitis, inflammation of the hair follicles, secondary infections. in some cases, there may appear: urticaria, maculopapular rash or exacerbation of existing changes.

From the side of the organ of vision: with external use on the skin of the eyelids, cataracts or glaucoma can sometimes develop.

From the cardiovascular system: AH.

From the endocrine system: glucosuria, hyperglycemia, dysfunction of the hypothalamic-pituitary-adrenal system, Cushings syndrome, inhibition of growth and development in children.

Others: the use of an ointment under an occlusive dressing, given increased absorption, can lead to a systemic effect, which manifests itself in the form of edema, hypertension, and increased sensitivity to infections.

In individuals with individual intolerance to the components of the drug, hypersensitivity reactions are possible.

special instructions

Do not continuously use the drug for more than 2 weeks. with prolonged therapy in large areas of the skin, the incidence of side effects increases.

The use of the drug should be stopped immediately if its use leads to pain or allergic reactions (itching, burning or redness of the skin). During external use of flumethasone pivalate, pituitary gland secretion by ACTH may decrease due to inhibition of the pituitary-adrenal gland, blood cortisol levels may increase and iatrogenic Cushings syndrome may appear after treatment is discontinued. During therapy, adrenal function is periodically monitored by determining the levels of cortisol in the blood and urine after stimulation of the adrenal glands by ACTH. In the event of an infectious process at the site of application of the ointment, antibacterial or antifungal therapy should be prescribed. If the infectious process does not regress, it is necessary to stop using the ointment until the infection is eliminated.

Avoid applying the drug to the eyelids or the skin around the eyes in patients with closed-angle and open-angle glaucoma, as well as with cataracts, given the possibility of increasing the symptoms of the disease. Contact of the drug with eyes and mucous membranes should be avoided.

On the skin of the face, inguinal and axillary areas, use only if absolutely necessary, since it is possible to increase absorption and a high risk of side effects (telangiectasia, perioral dermatitis), even after a short application.

The use of ointment under an occlusive dressing should be limited to exceptional cases due to the possibility of atrophy and defects of the epidermis, superinfection. Use the drug with caution in the presence of atrophy of the subcutaneous tissue, mainly in the elderly.

During the treatment of chronic conditions, such as psoriasis or chronic eczema, the drug should not be abruptly discontinued.

Caution should be given to patients with psoriasis, since topical application of GCS in this case can lead to relapse of the disease due to the development of tolerance, the risk of spreading pustular psoriasis and systemic toxicity due to skin dysfunction.

The product contains propylene glycol and lanolin, which can cause skin irritation and local skin reactions (e.g. contact dermatitis).

Use during pregnancy and lactation.In studies conducted on animals, it was confirmed that GCS have a teratogenic effect even when administered orally in low doses. The teratogenic effect is also confirmed with the external use of powerful GCS. No controlled studies have been conducted on the reliability of teratogenic effects with the external use of flumethasone pivalate during pregnancy.

Lorinden A ointment can be used in women during pregnancy only for a short time, in small areas of the skin, and only if, according to the doctor, the benefit exceeds the possible risk. The drug is not used in the first trimester of pregnancy.

The degree of excretion of flumetasone pivalate in breast milk with external use is unknown. When using corticosteroids inside, a significant amount of the hormone, which could have an effect on the body of a newborn, was not detected in breast milk. However, it is recommended with caution, under the supervision of a doctor, apply Lorinden A ointment in women during lactation. In some cases, you can use the drug for a short time on small areas of the skin. Do not apply Lorinden A ointment to the skin of the mammary glands.

Children. The drug is not prescribed for children under the age of 12 years. In children over the age of 12, the ointment is used in individual cases and in small areas of the skin. Do not apply the drug to the skin of the face.

The ability to influence the reaction rate when driving vehicles or working with other mechanisms. The drug does not limit mental and motor ability, as well as the ability to drive vehicles or other mechanisms.

Interactions

With external use of corticosteroids, interactions with other drugs have not been identified.

During therapy, it is not recommended to vaccinate against smallpox, as well as other types of immunization, especially with prolonged use on large areas of the skin, given the possibility of an insufficient immune response.

Only with prolonged use of the ointment in large areas of the skin in response to the absorption of a significant amount of salicylic acid, an increase in the effect of methotrexate and oral hypoglycemic drugs (sulfonylurea derivatives) is observed. Lorinden A can enhance the effect of immunosuppressive and suppress the effect of immunostimulating drugs.

Overdose

With prolonged use of the drug on large areas of the skin, overdose symptoms may develop, which are manifested by increased side effects (edema, burning sensation, irritation, itching, ag, hyperglycemia, decreased resistance to infections, dysfunction of the hypothalamic-pituitary-adrenal system, suppression of growth and development in children), and in severe cases - the development of Cushings syndrome. it is necessary to gradually stop the use of the drug in a timely manner or switch to the use of weak-acting corticosteroids. rarely, salicylate poisoning symptoms may appear: headache, dizziness, tinnitus, extremely rarely - a violation of core indicators, decreased visual acuity. symptomatic therapy.

Storage conditions

At a temperature not exceeding 25 ° C.