Calcitriol (Ointment)

INTRODUCTION

Indications

Mild-to-moderate plaque psoriasis.

Action

Exact mechanism is unknown, but may affect keratinocyte proliferation and differentiation and decrease the action of proinflammatory cytokines. Therapeutic Effects: Decreased severity of plaque psoriasis.

Adverse Reactions/Side Effects

GU: hypercalcuria. Derm: pruritus, skin discomfort.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess the area being treated to help document whether drug therapy is successful in decreasing skin plaques and other psoriatic skin lesions.

• Monitor any new or increased reactions at the site of application, including pain, irritation, burning, swelling, and rash. Report severe or prolonged skin reactions to the physician.

Interventions

• Implement ultraviolet light therapy when indicated to help treat psoriasis and augment the effects of drug therapy.

Patient/Client-Related Instruction

• Check that the patient and family or caregivers understand topical application procedures and adhere to the recommended dosing schedule.

• Instruct patient to report signs of excess calcium in the urine (hypercalcuria). Signs include increased urination, painful urination, increased nighttime urination, and increased thirst.

Pharmacokinetics

Absorption: Although intended action is skin, some systemic absorption follows topical use.

Distribution: Unknown.

Metabolism and Excretion: Absorbed calcitriol undergoes enterohepatic recycling and is excreted in bile.

Half-life: 5–8 hr.

Contraindications/Precautions

Contraindicated in: No contraindications noted.

Use Cautiously in: Concurrent use of medications known to ↑ serum calcium levels, including thiazide diuretics, calcium supplements, or high doses of vitamin D; Exposure of the treated areas to natural or artificial sunlight, including tanning booths, sun lamps, or phototherapy; use should be limited or avoided; OB: Use during pregnancy only if potential benefit to patient justifies risk to fetus; Lactation: Use cautiously; Pedi: Safety and effectiveness in patients <18 yr has not been established.

Interactions

Drug-Drug: Concurrent use with medications known to ↑ serum calcium levels, including thiazide diuretics, calcium supplements, or high doses of vitamin D may additively ↑ serum calcium levels; use cautiously.

Route/Dosage

Topical (Adults 18 yr): Apply twice daily; use should not exceed 200 g/wk.

Availability

Ointment: 3 mcg/g in 5- and 100-g tubes.