PIMECROLIMUS

PIMECROLIMUS
(pim-e-cro-lim'us)
Elidel
Classifications: biologic response modifier; immunosuppressant;
Therapeutic: immunosuppressant; antiinflammatory

Prototype: Cyclosporine
Pregnancy Category: C

Availability

1% cream

Action

Pimecrolimus selectively inhibits the inflammatory action of skin cells by blocking T-cell activation and cytokine release. It appears to inhibit the production of IL-2, IL-4, IL-10, and interferon gamma in T-cells. It also prevents release of inflammatory cytokines and mediators from mast cells after activation by antigen and IgE.

Therapeutic Effect

Topically applied to the skin, pimecrolimus produces significant antiinflammatory activity without evidence of skin atrophy.

Uses

Short-term intermittent treatment of mild to moderate atopic dermatitis.

Contraindications

Hypersensitivity to pimecrolimus or components in the cream; Netherton's syndrome; application to active cutaneous viral infection; occlusive dressing; pregnancy (category C); lactation; children <2 y.

Cautious Use

Infection at topical treatment sites; history of untoward effects with topical cyclosporine or tacrolimus; skin papillomas; immunocompromised patients.

Route & Dosage

Atopic Dermatitis
Adult: Topical Apply thin layer to affected skin b.i.d.

Administration

Topical
  • Do not apply to any skin surface that appears to be infected.

Adverse Effects (≥1%)

Body as a Whole: Flu-like symptoms, infections, fever, increased risk of cancer. CNS: Headache. GI: Gastroenteritis, abdominal pain, nausea, vomiting, diarrhea, constipation. Respiratory: Sore throat, upper respiratory infection, cough, nasal congestion, asthma exacerbation, rhinitis, epistaxis. Skin: Burning, irritation, pruritus, skin infection, impetigo, folliculitis, skin papilloma, herpes simplex dermatitis, urticaria, acne. Special Senses: Ear infection, earache, conjunctivitis.

Interactions

Drug: No clinically significant interactions established.

Pharmacokinetics

Absorption: Minimal through intact skin. Metabolism: No evidence of skin-mediated metabolism, metabolized in liver by CYP3A4. Elimination: Primarily in feces.

Nursing Implications

Assessment & Drug Effects

  • Assess for and report persistent skin irritation that develops following application of the cream and lasts for more than 1 wk.

Patient & Family Education

  • Minimize exposure of treated area to natural or artificial sunlight.
  • Immediately report a new or changed skin lesion to the physician.
  • Stop topical application once signs of dermatitis have disappeared. Resume application at the first sign of recurrence.
  • Wash hand thoroughly after application if hands are not the treatment sites.
  • Report any significant skin irritation that results from application of the cream.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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