Plaque psoriasis: Topical:
Cream: Apply a thin film to the affected skin twice daily.
Foam: Apply a thin film to the affected skin or scalp twice daily.
Ointment: Apply a thin film to the affected skin once or twice daily.
Solution: Apply to the affected scalp twice daily.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing; use with caution.
(For additional information see "Calcipotriol (calcipotriene): Pediatric drug information")
Plaque psoriasis, mild to moderate: Note: Vitamin D analogs (eg, calcipotriene) are recommended treatment options in pediatric patients (particularly to minimize corticosteroid exposure) with or without topical corticosteroids (AAD [Menter 2020]; de Jager 2010; Zeichner 2010).
Foam: Sorilux: Children ≥4 years and Adolescents: Topical: Apply a thin layer to affected areas of scalp and body twice daily (manufacturer's labeling).
Cream, ointment: Limited data available: Children ≥2 years and Adolescents: Topical: Apply a thin layer to affected areas of scalp and body twice daily; ointment dosing based on multicenter trials including over 100 children ≥2 years of age and adolescents with mild to moderate psoriasis covering <30% BSA; significant improvement (based on psoriasis scores) was reported in over 60% of patients in an open-labeled trial; similar efficacy (>50% improvement) was reported in a placebo-controlled study; however, this was not statistically significant (Darley 1996; Oranje 1997); cream dosing based on a small trial, experience with ointment formulation, and expert recommendations (AAD [Menter 2009]; Duweb 2003; Schachner 2011; Zeichner 2010).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Dermatologic: Burning sensation of skin (≤23%), pruritus (1% to 15%; including application-site pruritus), skin irritation (1% to 15%), skin rash (1% to 11%), stinging of the skin (≤23%)
Nervous system: Tingling of skin (≤23%)
1% to 10%:
Dermatologic: Dermatitis, desquamation, erythema of skin, exacerbation of psoriasis (including facial/scalp psoriasis), xeroderma
Local: Application-site erythema (2%), application-site pain (3%)
<1%:
Dermatologic: Folliculitis, hyperpigmentation, skin atrophy
Endocrine & metabolic: Hypercalcemia
Frequency not defined: Local: Application-site pruritus
Postmarketing:
Dermatologic: Allergic contact dermatitis, contact dermatitis, dyschromia (at application site), exfoliation of skin, skin photosensitivity, urticaria
Hypersensitivity: Hypersensitivity reaction
Local: Application-site vesicles
Hypersensitivity to calcipotriene or any component of the formulation; patients with demonstrated hypercalcemia or evidence of vitamin D toxicity; use on the face (cream, ointment); patients with acute psoriatic eruptions (scalp solution).
Canadian labeling: Additional contraindications (not in the US labeling): Ophthalmic use; known disorders of calcium metabolism; pregnancy.
Concerns related to adverse effects:
• Contact dermatitis: Contact dermatitis, including allergic contact dermatitis, may occur.
• Hypercalcemia: May cause transient increases in serum calcium (reversible); if hypercalcemia occurs, discontinue treatment until calcium levels return to normal.
• Irritation: Transient irritation of both lesions and surrounding uninvolved skin may occur; discontinue use if irritation occurs.
Special populations:
• Older adult: Use with caution in elderly patients; severity of skin-related adverse reactions may be increased compared to younger adults.
• Pediatric: Children may be at higher risk of systemic side effects due to a greater skin surface area:body weight ratio. In an off-label trial of pediatric patients (2 to 14 years of age) with psoriasis affecting <30% BSA, no serious adverse effects (including calcium or bone metabolism changed) were observed with calcipotriene ointment application for 8 weeks of therapy (Oranje 1997). With foam application in older pediatric patients (5 to <17 years of age), pharmacokinetic studies have not shown significant evidence of systemic calcipotriene absorption or any effects on indices of calcium metabolism.
Dosage form specific issues:
• Foam, solution: Flammable; keep the foam and the solution away from fire, flame, or smoking during and immediately following application.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated with hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP ["Inactive" 1997]; Zar 2007).
Other warnings/precautions:
• Appropriate use: For external use only; not for ophthalmic, oral, or intravaginal use. Avoid or limit excessive exposure to natural or artificial sunlight, or phototherapy. Thoroughly wash hands after use. The safety and effectiveness in dermatoses other than psoriasis have not been established.
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities, which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults, including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External:
Dovonex: 0.005% (60 g [DSC], 120 g [DSC]) [contains cetearyl alcohol, disodium edta]
Generic: 0.005% (60 g, 120 g)
Foam, External:
Sorilux: 0.005% (60 g [DSC], 120 g) [contains cetyl alcohol, edetate (edta) disodium, propylene glycol]
Generic: 0.005% (60 g [DSC])
Ointment, External:
Calcitrene: 0.005% (60 g) [contains disodium edta, propylene glycol]
Generic: 0.005% (60 g, 120 g)
Solution, External:
Generic: 0.005% (60 mL)
Yes
Cream (Calcipotriene External)
0.005% (per gram): $7.06 - $10.15
Foam (Sorilux External)
0.005% (per gram): $16.95
Ointment (Calcipotriene External)
0.005% (per gram): $6.03 - $6.88
Ointment (Calcitrene External)
0.005% (per gram): $6.38
Solution (Calcipotriene External)
0.005% (per mL): $5.39 - $5.66
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment, External:
Dovonex: 0.005% (30 g, 120 g) [contains disodium edta, propylene glycol]
Topical: For external use only. Avoid contact with face and eyes (rinse thoroughly with water if contact occurs).
Cream, foam, ointment: Apply to affected skin; rub in gently and completely. Wash hands thoroughly after use.
Foam, solution (scalp psoriasis): Prior to using, comb hair to remove debris; apply only to scalp lesions. Rub in gently and completely. Wash hands thoroughly after use. Foam should be applied when hair is dry.
If the use of multiple topical agents is necessary, apply the various agents at separate times throughout the day (AAD/NPF [Elmets 2021]).
Topical: For external use only. Avoid contact with face and eyes (rinse thoroughly with water if contact occurs). If the use of multiple topical agents is necessary, consider application of the various agents at separate times throughout the day; calcipotriene may be inactivated by acidic topical agents (eg, salicylic acid, lactic acid, hydrocortisone valerate preparations) (AAD [Menter 2009]; Zeichner 2010).
Cream, foam, ointment: Apply to affected skin; rub in gently and completely. Wash hands thoroughly after use, unless hands are the site being treated. For scalp psoriasis, foam should be applied when hair is dry; prior to using, comb hair to remove debris.
Plaque psoriasis: Treatment of plaque psoriasis of the body (cream, ointment) or of the scalp (solution) in adults; treatment of plaque psoriasis of the body or of the scalp in patients ≥4 years of age (foam).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Calcium Salts: May enhance the adverse/toxic effect of Vitamin D Analogs. Risk C: Monitor therapy
Cardiac Glycosides: Vitamin D Analogs may enhance the arrhythmogenic effect of Cardiac Glycosides. Risk C: Monitor therapy
Hydrocortisone (Topical): May diminish the therapeutic effect of Calcipotriene. Management: Monitor for reduced calcipotriene efficacy if combined with hydrocortisone valerate. Consider separating the administration of these agents by 10 to 12 hours to minimize the risk of this potential interaction. Risk C: Monitor therapy
Lactic Acid: May diminish the therapeutic effect of Calcipotriene. Management: Monitor for reduced calcipotriene efficacy if combined with lactic acid. Consider separating the administration of these agents by 10 to 12 hours to minimize the risk of this potential interaction. Risk C: Monitor therapy
Multivitamins/Fluoride (with ADE): May enhance the adverse/toxic effect of Vitamin D Analogs. Risk X: Avoid combination
Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Vitamin D Analogs. Risk X: Avoid combination
Salicylic Acid: May diminish the therapeutic effect of Calcipotriene. Management: Monitor for reduced calcipotriene efficacy if combined with salicylic acid. Consider separating the administration of these agents by 10 to 12 hours to minimize the risk of this potential interaction. Risk C: Monitor therapy
Thiazide and Thiazide-Like Diuretics: May enhance the hypercalcemic effect of Vitamin D Analogs. Risk C: Monitor therapy
Vitamin D Analogs: May enhance the adverse/toxic effect of other Vitamin D Analogs. Risk X: Avoid combination
Topical agents are recommended for the treatment of psoriasis in pregnancy; however, agents other than calcipotriene are preferred. When alternatives are not appropriate, limit use to smallest possible area (AAD-NPF [Elmets 2021]; Maul 2021; Simionescu 2021).
It is not known if calcipotriene is present in breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Because the risk of significant systemic absorption is limited, breastfeeding is considered compatible with maternal therapy (Butler 2014).
Serum calcium
Synthetic vitamin D3 analog which regulates skin cell production and proliferation. Binds to vitamin D receptors and inhibits keratinocyte proliferation and enhances keratinocyte differentiation (AAD/NPF [Elmets 2021]).
Onset of action: Improvement begins after 2 weeks; marked improvement seen after 8 weeks
Absorption: When applied to psoriasis plaques: Cream, foam: Undetermined; Ointment: ~6%; Solution: <1%
Metabolism: Absorbed calcipotriene is converted to inactive metabolites
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