Psoriasis Drug Summary

Apply thinly to affected skin 12 hourly

Adverse Reactions

• Local effects: Burning, sensation of warmth which usually decreases with continued use, application site reactions (eg irritation, erythema, itching)
• Less common: Bacterial and viral infections
• If lymphadenopathy occurs, the cause should be investigated and if no clear cause, Pimecrolimus should be discontinued

• Contraindicated in patients with malignant or premalignant skin lesions and areas affected by acute cutaneous viral infections or in immunocompromised patients
  • Clinical cutaneous infections should be cleared before application of Pimecrolimus
• Use is not recommended in patients with Netherton’s syndrome or skin conditions which may increase the potential for systemic absorption
• Avoid excessive or unnecessary exposure to UV light and sunlight during treatment
  • Higher dose than used in humans shortened time to skin tumor formation in an animal photocarcinogenicity study
• Should not be used with occlusive dressing
• Patients should minimize or avoid natural or artificial sunlight

Apply thinly to affected skin 12 hourly

• Hematologic effect (bone marrow suppression); GI effects (nausea/vomiting); Hepatic effect (mild hepatitis which is not permanent); CNS effects (dizziness, drowsiness, disorientation, hallucinations, convulsions, headache); Dermatologic effects (hyperpigmentation, transient alopecia, cutaneous vasculitic toxicities); Other effects (renal function impairment, dyspnea, hyperuricemia)

• Contraindicated in patients with severe bone marrow depression, severe anemia, pregnancy and lactation
• Use with caution in patients with renal impairment
• Vaccination with live-virus vaccines not recommended
• Monitor CBC with platelets, uric acid, hepatic and renal function regularly prior to and during treatment
  • Toxic range: Hb <4.5 g/dL, neutrophils <2,000 cells/mm³, platelet count <80,000 mm³
• Discontinue therapy if there is infection and if no response after 8 weeks of treatment

• Hematologic effects (bone marrow depression which can occur abruptly, leukopenia, thrombocytopenia, anemia); GI effects (nausea/vomiting, loss of appetite, abdominal pain, diarrhea); Hepatic effect (acute and chronic liver damage); CNS effects (dizziness, fever, seizure); Other effects (renal failure, renal tubular necrosis, interstitial lung disease, potentially fatal dermatologic reactions eg toxic epidermal necrolysis and Stevens-Johnson syndrome, ocular irritation, alopecia, osteoporosis, neurotoxicity, impaired fertility, arthralgia, soft tissue and bone necrosis)
• Low-dose Methotrexate has been associated with development of malignant lymphomas
• Use may predispose patients to opportunistic infection
• Early signs of toxicity: Mouth ulcers, stomatitis, diarrhea. If these occur, therapy may need to be interrupted

• Avoid in patients with alcoholic liver disease or abnormal LFT or in those with significant renal impairment, blood disorders or immunodeficiency
• Contraindicated in pregnancy and lactation
• Use with caution in patients with peptic ulcer disease, ulcerative colitis, hepatic or renal impairment
• Monitor CBC with platelets, LFT and renal function prior to and regularly during therapy
• Baseline liver biopsy should be performed before Methotrexate institution in patients with risk factors for hepatotoxicity
• Medication should be interrupted if diarrhea, myelosuppression, stomatitis or signs of liver dysfunction occur
• Signs of infection (eg fever, sore throat) should be reported to physician immediately
• May cause folic acid deficiency, consider giving folate supplement

Apply 6-24 hourly

Adverse Reactions

• Prolonged use over large BSA may result in salicylate toxicity
• Local irritation when in contact with normal skin, sensitivity, excessive drying

• Avoid use on broken skin, mouth, eyes, mucous membranes and anogenital regions

Apply 12-24 hourly

Adverse Reactions

• Skin irritation and dermatitis

• Avoid contact with eyes, mouth and other mucous membranes

Apply 8-12 hourly

Adverse Reactions

• May be irritating to sensitive skin

• Avoid contact with eyes
• Contraindicated in patients with viral skin infection