Clobetasone 17-Butyrate BP 0.05% w/w
Eumovate Cream is white in appearance and contains 0.05% w/w clobetasone butyrate. The emollient cream is water-miscible.
Short-term (up to 7 days) treatment of milder forms of eczema and dermatitis.
Adults and children 12 years and over
Apply a thin film and gently rub in, using only enough to cover the affected area twice daily for up to 7 days. If the condition resolves within 7 days, treatment with Eumovate Cream should be stopped. If the condition does not improve within the first 7 days or becomes worse, the patient should see a doctor. If after 7 days of treatment, improvement is seen but further treatment is required, the patient should see a doctor. After application, the hands should be washed unless they are the site being treated. Patients advised by their doctors to use this cream for prolonged periods should be advised to tell subsequent doctors about this use. All patients should be warned against prolonged used on one area of skin, or use of excessive quantities. All patients should also be informed that the preparation is prescribed only for a specific condition occurring in a specific individual.
Children
Use in children under 12 years only on the advice of a doctor. Children are more likely to develop local and systemic adverse reactions of topical corticosteroids and, in general, require shorter courses and less potent agents than adults. Care should be taken when using clobetasone to ensure the amount applied is the minimum that provided therapeutic benefit.
Elderly
Clinical studies have not identified differences in responses between the elderly and younger patients. The greater frequency of decreased hepatic or renal function in the elderly may delay elimination if systemic absorption occurs. Therefore the minimum quantity should be used for the shortest duration to achieve the desired clinical benefit.
Renal/Hepatic Impairment
In case of systemic absorption (when application is over a large surface area for a prolonged period) metabolism and elimination may be delayed therefore increasing the risk of systemic toxicity. Therefore the minimum quantity should be used for the shortest duration to achieve the desired clinical benefit. .
Eumovate Cream should not be used in patients with a history of hypersensitivity to clobetasone butyrate or to any of the excipients in the product. The following conditions should not be treated with Eumovate Cream:
Rosacea, acne, pruritus without rash, perioral dermatitis.
Untreated bacterial infections such as cellulitis, folliculitis, furunculosis or impetigo.
Fungal infections such as those associated with tinea (eg athletes foot, jock itch).
Viral infections including cold sores (herpes simplex), chicken pox or shingles (Varicella zoster) or vaccinia.
Parasitic infestations such as scabies.
Psoriasis
Do not use on broken or infected skin or on inflamed skin near chronic ulcers. Topical corticosteroids inhibit wound healing processes and are contraindicated in skin ulcers, cuts and abrasions. Topical corticosteroids inhibit wound healing processes and are contraindicated in skin ulcers, cuts and abrasions.
Manifestations of hypercortolism (Cushing's syndrome) can occur in some individuals, due to prolonged duration of use, extensive application to the skin, or because of increased systemic absorption due to use of occlusive dressings or application to broken or thin skin. The management of eczema and dermatitis in adults and children usually requires the supervision of a doctor. Eumovate Cream should not be used for the treatment of psoriasis as this condition needs to be managed by a doctor. Eumovate Cream should not be used concomitantly with other corticosteroids (by systemic or topical routes), as this may increase the risk of unwanted effects. For external use only. This and all medication should be kept out of the reach of children. In the case of accidental ingestion, professional assistance should be sought or the Poisons Information Centre contacted immediately (see OVERDOSAGE).
EUMOVATE Cream treatment for more than a few days may lead to significant systemic absorption. Do not use Eumovate Cream for more than 7 days without medical supervision. The systemic absorption of clobetasone would be expected to increase if:
large amounts of Eumovate Cream are used;
large areas of skin are treated;
treated skin is damaged or diseased;
thin skin (such as on the face ) or skin in intertrigenous regions is treated;
the treated area is occluded.
In comparison with adults, children and infants may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic adverse effects. This is because children have an immature skin barrier and a greater surface area to body weight ratio compared with adults.
Do not use for children under 12 years old except under close medical supervision. In infants and children, long term continuous topical therapy should be avoided, since skin damage and adrenal suppression can occur even without occlusion. The least potent corticosteroid that will control the disease should be selected. In infants, the napkin may act as an occlusive dressing, and increase absorption. Corticosteroids may inhibit linear bone growth and inhibit epiphyseal maturation. Treatment should be minimised and supervised closely.
Topical corticosteroid therapy may predispose to local infection. Appropriate antimicrobial therapy should be used whenever treating inflammatory lesions which have become infected. Any spread of infection requires withdrawal of topical corticosteroid therapy and administration of appropriate antimicrobial therapy.
Topical corticosteroids cause atrophy of the epidermis and damage to the dermis. This may produce atrophic striae and discolouration, which are usually permanent. These are more likely to occur with prolonged therapy, occlusive dressings, application to intertrigenous areas, application to the face, and in children. Eumovate Cream should not be used on the face, groin, genitals or between the toes. As with other topical corticosteroids, it should not be used on skin with impaired circulation, such as stasis ulcers, since it may cause prolonged vasoconstriction.
Do not use Eumovate Cream with occlusive dressings. Use of occlusion increases the possibility of local and systemic side effects.
Care should be taken to ensure that the cream does not enter the eye, as cataracts and glaucoma might result from repeated exposure.
There are limited data from the use of Eumovate Cream in pregnant women. Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intra-uterine growth retardation. Studies in mice, rats and rabbits revealed similar findings following administration of clobetasone butyrate. The relevance of this finding to humans has not been established. Administration of clobetasone during pregnancy should only be considered if the expected benefit to the mother outweighs the risk to the foetus. The minimum quantity should be used for the minimum duration. Women who are pregnant should consult a doctor before use.
The safe use of topical corticosteroids during lactation has not been established. It is not known whether the topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable amounts in breast milk. Administration of clobetasone during lactation should only be considered if the expected benefit to the mother outweighs the risk to the infant. If used during lactation, clobetasone should not be applied to the breasts to avoid accidental ingestion by the infant. Women who are breast-feeding should seek medical advice before using this product.
In infants and children, long term continuous topical therapy should be avoided, since skin damage and adrenal suppression can occur even without occlusion. The least potent corticosteroid that will control the disease should be selected. In infants, the napkin may act as an occlusive dressing, and increase absorption. Corticosteroids may inhibit linear bone growth and inhibit epiphyseal maturation. Treatment should be minimised and supervised closely.
In case of systemic absorption (when application is over a large surface area for a prolonged period) metabolism and elimination may be delayed therefore increasing the risk of systemic toxicity).
Eumovate Cream is presumed to be unlikely to produce an effect.
Systemic side effects are more likely in children, if large areas of the skin are treated or if large amounts are used, if treatment is prolonged or if treated areas are occluded. The use of corticosteroids by multiple routes of administration (eg topical and oral or inhaled) may increase the likelihood of adverse reactions occurring. Adverse events drug reactions (ADRs) are listed below by MedDRA system organ class and by frequency. Frequencies are defined as: very common (>=1/10), common (>=1/100 and <1/10), uncommon (>=1/1000 and <1/100), rare (>=1/10,000 and <1/1000) and very rare (<1/10,000) including isolated reports.
Infections and Infestations
Very rare:Opportunistic infection
Immune System Disorders
Very rare:Hypersensitivity. Local hypersensitivity reactions such as erythema, rash, pruritus, urticaria, local skin burning and allergic contact dermatitis may occur at the site of application and may resemble symptoms of the condition under treatment. Patients should be advised to stop treatment if signs of hypersensitivity appear.
Endocrine Disorders
Very rare Hypothalamic-pituitary adrenal (HPA) axis suppression: Cushingoid features (e.g. moon face, central obesity), delayed weight gain/growth retardation in children, osteoporosis, glaucoma, hyperglycaemia/glucosuria, cataract, hypertension, increased weight/obesity, decreased endogenous cortisol levels
Skin and Subcutaneous Tissue Disorders
Rare Hypersensitivity, allergic contact dermatitis, urticaria, skin atrophy, pigmentation changes, exacerbation of underlying symptoms, local skin burning, hypertrichosis, rash, pruritus, erythema, hair disorders, bruising, rosacea. Exacerbation of eczema and dermatitis has also been reported. With prolonged treatment, permanent damage (including development of stria and telangiectases) to the dermis may occur. Patients should be advised to stop treatment if signs of hypersensitivity appear.
Eumovate Cream should not be used concomitantly with other topical or systemic corticosteroids, either prescribed or obtained over-the-counter (such as hydrocortisone) as this may increase the likelihood of drug interactions. Co-administered drugs that can inhibit CYP3A4 (e.g. ritonavir, itraconazole) have been shown to inhibit the metabolism of corticosteroids leading to increased systemic exposure. The extent to which this interaction is clinically relevant depends on the dose and route of administration of the corticosteroids and the potency of the CYP3A4
Symptoms and Signs
Topically applied clobetasone may be absorbed in sufficient amounts to produce systemic effects. Acute overdose is very unlikely to occur. Chronic overdosage requires continuous use of large quantities for long periods of time. However, in the case of chronic overdosage or misuse, the features of hypercortisolism may occur (see Adverse Effects). There is also a risk of skin atrophy with the chronic use of topical steroids.
Treatment
In the event of overdose, clobetasone should be withdrawn gradually under medical supervision because of the risk of glucocorticosteroid insufficiency. Further management should be as clinically indicated or as recommended by the National Poisons Centre (telephone 0800 764 766).
The least potent corticosteroid which will control the disease should be selected. EUMOVATE Cream preparations do not contain lanolin or parabens.
Topical corticosteroids act as anti-inflammatory agents via multiple mechanisms to inhibit late phase allergic reactions including decreasing the density of mast cells, decreasing chemotaxis and activation of eosinophils, decreasing cytokine production by lymphocytes, monocytes, mast cells and eosinophils, and inhibiting the metabolism of arachidonic acid.
Topical corticosteroids have anti-inflammatory, antipruritic and vasoconstrictive properties.
Absorption:
Topical corticosteroids can be systemically absorbed from intact healthy skin. The extent of percutaneous absorption of topical corticosteroids is determined by many factors, including the vehicle and the integrity of the epidermal barrier. Occlusion, inflammation and/or other disease processes in the skin may also increase percutaneous absorption.
Distribution:
The use of pharmacodynamic endpoints for assessing the systemic exposure of topical corticosteroids is necessary due to the fact that circulating levels are well below the level of detection.
Metabolism:
Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. They are metabolised, primarily in the liver.
Elimination:
Topical corticosteroids are excreted by the kidneys. In addition, some corticosteroids and their metabolites are also excreted in the bile.
Chemical structure:
List of excipients:
glycerol, glycerol monstearate, cetostearyl alcohol, beeswax substitute 6621, arlacel 165, dimethicone 20, chlorocresol, sodium citrate, citric acid monohydrate, water-purified.
Patients should be advised to wash their hands after applying Eumovate Cream, unless it is the hands that are being treated.
Store below 25degC, out of direct sunlight.
Aluminium tubes containing 15 g and 30 g Not all strengths, dose forms, pack sizes, container types may be distributed in New Zealand.
Restricted Medicine
GlaxoSmithKline NZ Limited Private Bag 106600 Downtown Auckland New Zealand Phone: (09) 367 2900 Facsimile (09) 367 2910
Prepared: 10 July 2012 Version 3.0 Eumovate(r) is a registered trade mark of the GlaxoSmithKline group of companies.