halobetasol/tazarotene

General

Pronunciation:
hal-oh-bay-ta-sol/taz-ar-oh-teen


Trade Name(s)

  • Duobrii

Ther. Class.

antipsoriatics

Pharm. Class.

corticosteroids

retinoids

Indications

Plaque psoriasis.

Action

Halobetasol: Suppresses normal immune response and inflammation.  Tazarotene: Exerts anti-hyperproliferative and anti-inflammatory effects; also normalizes differentiation.

Therapeutic Effect(s):

Clearing of plaques.

Pharmacokinetics

Halobetasol

Absorption: Minimal absorption. Prolonged use on large surface areas or large amounts applied or use of occlusive dressings may ↑ systemic absorption.

Distribution: Remains primarily at site of action.

Metabolism and Excretion: Usually metabolized in skin.

Half-life: Unknown.

Tazarotene

Absorption: A prodrug that is rapidly converted to its active form, tazarotenic acid. Minimal systemic absorption.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

TIME/ACTION PROFILE (plasma concentrations)

ROUTEONSETPEAKDURATION
Halobetasol (topical)unknownunknownunknown
Tazarotene (topical)unknownunknownunknown

Contraindication/Precautions

Contraindicated in:

  • History of eczema;
  • OB:  Pregnancy (tazarotene may cause fetal harm).

Use Cautiously in:

  • Hepatic impairment
  • Concurrent use of photosensitizers
  • Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant; do not apply to nipple or areola;
  • Rep:  Women of reproductive potential;
  • Pedi:  Safety and effectiveness not established in children; may be more susceptible to adrenal and growth suppression.

Adverse Reactions/Side Effects

Derm: atrophy, contact dermatitis, folliculitis, photosensitivity, striae, telangiectasias

EENT: cataracts, glaucoma

Endo: adrenal suppression (↑ risk with use over larger surface areas, use of occlusive dressings, use on altered skin barriers, hepatic impairment, or long-term therapy)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

↑ risk of photosensitivity reactions with other  photosensitizing drugs  including  fluoroquinolones,  phenothiazines,  sulfonamides,  tetracyclines, and  thiazides.

Route/Dosage

Topical (Adults): Apply to affected area(s) once daily.

Availability

Lotion: halobetasol 0.01%/tazarotene 0.045%

Assessment

  • Assess skin lesions before and periodically during therapy.
  • Assess for signs and symptoms of skin irritation (redness, peeling, discomfort) during therapy. If irritation occurs, reduce frequency of application or temporarily stop therapy; resume once irritation subsides.

Lab Test Considerations:

Obtain a negative pregnancy test within 2 wks of starting therapy.

Implementation

  • Total dose should not exceed 50 g per wk due to potential for suppression the hypothalamic-pituitary-adrenal (HPA) axis. Avoid occlusive dressings unless directed by health care professional. Do not apply to face, groin, or axilla.
  • Topical Apply thin layer  Duobrii  lotion once daily to dry skin to cover only affected areas and rub in gently.

Patient/Family Teaching

  • Instruct patient to apply  Duobrii  lotion as directed and to limit dose to no more than 50 g/wk. Avoid bandaging, wrapping or occluding treatment areas, unless directed by health care professional. Advise patients to avoid use on face, groin, or axilla. Lotion is only for external use; not for oral, ophthalmic, or intravaginal use. Advise patient to read  Patient Information  before starting therapy and with each Rx refill in case of changes.
  • Caution patient to use only as directed. Avoid using cosmetics, bandages, dressings, or other skin products over the treated area unless directed by health care professional.
  • Advise patient to notify health care professional if skin irritation, blurred vision or visual changes occur.
  • Caution patient to wear protective clothing, use sunscreen, and avoid exposure of treated areas natural or artificial sunlight, tanning beds, and sunlamps to prevent photosensitivity reactions.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Rep:  May be teratogenic. Advise females of reproductive potential to use effective contraception during therapy. Advise patient to notify health care professional immediately if pregnancy is suspected and or if breastfeeding. Advise females who are breastfeeding to avoid application directly to nipple and areola and to avoid direct infant exposure.

Evaluation/Desired Outcomes

Clearing of plaques. Discontinue treatment when control is achieved.