Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Ointment, External:
Cortisporin: Bacitracin 400 units, neomycin 3.5 mg, polymyxin B 5000 units, and hydrocortisone 10 mg per g (15 g)
Pharmacology
Mechanism of Action
See individual agents.
Use: Labeled Indications
Superficial dermal infection: Treatment of corticosteroid-responsive dermatoses with secondary infection
Contraindications
Hypersensitivity to bacitracin, neomycin, polymyxin B, hydrocortisone, or any component of the formulation.
Dosage and Administration
Dosing: Adult
Superficial dermal infection: Topical: Apply sparingly to affected area 2 to 4 times daily for up to 7 days
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Superficial dermal infection: Limited data available: Children and Adolescents: Topical: Apply 2 to 4 times daily for up to 7 days (Bradley 2015)
Administration
Topical: For external use only. Apply sparingly to the affected area. Limit therapy to 7 days of treatment.
Storage
Store at 15°C to 25°C (59°F to 77°F).
Drug Interactions
Aldesleukin: Corticosteroids may diminish the antineoplastic effect of Aldesleukin. Avoid combination
Calcipotriene: 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. Monitor therapy
Corticorelin: Corticosteroids may diminish the therapeutic effect of Corticorelin. Specifically, the plasma ACTH response to corticorelin may be blunted by recent or current corticosteroid therapy. Monitor therapy
Deferasirox: Corticosteroids may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Monitor therapy
Hyaluronidase: Corticosteroids may diminish the therapeutic effect of Hyaluronidase. Management: Patients receiving corticosteroids (particularly at larger doses) may not experience the desired clinical response to standard doses of hyaluronidase. Larger doses of hyaluronidase may be required. Consider therapy modification
Ritodrine: Corticosteroids may enhance the adverse/toxic effect of Ritodrine. Monitor therapy
Adverse Reactions
See individual agents.
Warnings/Precautions
Concerns related to adverse effects:
- Adrenal suppression: Systemic absorption of topical corticosteroids may cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.
- Immunosuppression: Prolonged use of corticosteroids may also increase the incidence of secondary infection, mask acute infection (including fungal infections), prolong or exacerbate viral infections, or limit response to vaccines.
- Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi sarcoma (case reports); if noted, discontinuation of therapy should be considered (Goedert 2002).
- Neomycin sensitization: Neomycin may cause cutaneous sensitization. Symptoms of neomycin sensitization include itching, reddening, edema, and failure to heal. Discontinuation of product and avoidance of similar products should be considered.
- Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas. Neomycin can induce permanent sensorineural hearing loss due to cochlear damage; risk is greater with prolonged use.
Special populations:
- Pediatric: Topical corticosteroids: Infants and small children may absorb proportionally larger amounts of corticosteroids after topical application and may be more prone to systemic effects due to larger skin surface area to body mass ratio, particularly if applying to >20% of BSA. HPA axis suppression, intracranial hypertension, and Cushing syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.
Dosage form specific issues:
- Topical ointment: Limit therapy to 7 days of treatment.
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Adverse events have been observed with topical corticosteroids in animal reproduction studies. Refer to individual agents.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience dry skin or burning. Have patient report immediately to prescriber signs of adrenal gland problems (severe nausea, vomiting, severe dizziness, passing out, muscle weakness, severe fatigue, mood changes, lack of appetite, or weight loss), hearing loss, unable to pass urine, change in amount of urine passed, signs of skin changes (acne, stretch marks, slow healing, or hair growth), or application site irritation, redness, edema, or pain (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
