tolnaftate, gentamicin, chinoform and betamethasone valerate

Action and Spectrum

Actions and spectrum: 

• tolnaftate: tolnaftate is an antifungal medication used topically to treat fungal infections, including athlete’s foot, ringworm, and jock itch. Its action is primarily antifungal, inhibiting the growth and multiplication of fungi responsible for these infections. 
• gentamicin: It is an antibiotic that belongs to aminoglycoside. It is used topically to treat or prevent bacterial infections of the skin. gentamicin works by inhibiting the growth of susceptible bacteria and disrupting their protein synthesis. 
• chinoform: It is also an antifungal and antibacterial agent used topically. It is effective against various fungal and bacterial skin infections, including certain types of dermatitis. 
• betamethasone valerate: betamethasone valerate is a corticosteroid that has anti-inflammatory, immunosuppressive, and vasoconstrictive properties. It is used topically to reduce inflammation and itching associated with various skin conditions, including eczema, psoriasis, and allergic reactions. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Loss of elasticity 

Acne at application site 

Rosacea 

Thinning of the skin 

Increased hair growth 

Mild depigmentation 

Dizziness 

Vomiting 

Ototoxicity 

Nephrotoxicity 

Nausea 

Seizures 

Irritation 

Stinging 

Contact dermatitis 

Redness 

Sensitization 

Pruritis 

Black Box Warning

Black Box Warning: 

There is no specific black box warning for the combination of tolnaftate, gentamicin, chinoform, and betamethasone valerate. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: Contraindications typically include a known hypersensitivity or allergy to any of the active ingredients (tolnaftate, gentamicin, iodochlorohydroxyquinoline, or betamethasone valerate) or other components of the product. 
• Viral Infections: These medications are primarily used for bacterial and fungal skin infections. They are not effective against viral infections. Therefore, they should not be used to treat conditions like herpes, chickenpox, or shingles. 
• Tuberculosis of the Skin: Topical corticosteroids like betamethasone valerate may suppress the immune response and could potentially worsen skin tuberculosis. These medications should not be used in the presence of skin tuberculosis. 
• Pregnancy and Lactation: Depending on the specific ingredients, there may be contraindications or precautions related to the use of these medications during pregnancy or while breastfeeding.

Caution: 

• Duration of Use: Topical corticosteroids like betamethasone valerate should be used for the shortest duration necessary to treat the condition effectively. Prolonged use leads to skin thinning and other potential side effects. Follow your healthcare provider’s recommendations regarding the duration of treatment. 
• Fungal Resistance: With antifungal agents like Tolnaftate, there is a risk of fungal resistance if the medication is used for extended periods. Use the medication as prescribed and follow the recommended treatment duration. 
• Children: Use caution when applying these medications to children and follow your healthcare provider’s recommendations. Prolonged use on children should be avoided, as they may be more susceptible to side effects.

Comorbidities: 

• Diabetes: Diabetes are at a higher risk of developing fungal and bacterial skin infections. When using medications like these, it is essential for individuals with diabetes to carefully monitor their skin and blood sugar levels. Poorly controlled diabetes can impact the effectiveness of treatment and the body’s ability to heal. 
• Immunosuppression: Conditions or treatments that suppress the immune system, such as HIV/AIDS, organ transplantation, or chemotherapy, can make individuals more susceptible to skin infections. These individuals may need more vigilant monitoring and treatment, and they should consult their healthcare provider for guidance. 
• Skin Disorders: If the primary condition being treated is a pre-existing skin disorder like psoriasis, eczema, or dermatitis, it is important to monitor the skin closely. Topical corticosteroids like betamethasone valerate can affect these conditions, and long-term use should be avoided without medical supervision. 
• Eye Disorders: Individuals with a history of eye disorders or eye surgery should be cautious when using any medication near the eyes. Avoid contact with the eyes and seek medical attention if accidental contact occurs. 

Pregnancy / Lactation

Pregnancy consideration: pregnancy category: not assigned 

Lactation: excreted into human milk: unknown  

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

The combination medication tolnaftate, gentamicin, chinoform, and betamethasone valerate is designed for topical use and combines several active ingredients with distinct pharmacological actions. tolnaftate is an antifungal agent that inhibits fungal growth and is effective against various dermatophyte fungi. gentamicin is an antibiotic with broad-spectrum activity against bacteria, including gram-negative and some gram-positive species.

chinoform also has antibacterial properties and is effective against a range of bacteria. betamethasone valerate is a corticosteroid that possesses anti-inflammatory and immunosuppressive properties, reducing skin inflammation and itching. This combination medication aims to provide a comprehensive approach to treating skin conditions that involve both fungal and bacterial components, along with inflammation, offering relief and promoting skin healing.  

Pharmacodynamics: 

• tolnaftate: tolnaftate is an antifungal agent that primarily works by inhibiting the growth of dermatophyte fungi. It interferes with fungal cell membrane function and disrupts their ability to reproduce. By targeting the fungal component of skin infections, it helps eliminate the underlying cause of conditions like athlete’s foot and ringworm. 
• gentamicin: gentamicin is a broad-spectrum antibiotic that disrupts bacterial protein synthesis in both gram-negative and some gram-positive bacteria. In this combination, it is used to combat bacterial infections of the skin. Its mechanism of action involves binding to bacterial ribosomes, leading to impaired protein production and bacterial cell death. 
• chinoform: chinoform is another antibacterial agent with a broad spectrum of activity. It disrupts the integrity of bacterial cell walls and membranes, leading to bacterial cell death. It can be particularly effective against gram-negative bacteria. 
• betamethasone valerate: betamethasone valerate is a corticosteroid with potent anti-inflammatory and immunosuppressive properties. It acts by reducing inflammation and suppressing immune response. In dermatological use, it helps alleviate the itching, redness, and swelling associated with skin conditions.

Pharmacokinetics: 

Absorption: 

• tolnaftate: When applied topically, tolnaftate is minimally absorbed through the skin. It primarily acts locally at the site of application. 
• gentamicin: Topical application of gentamicin results in minimal systemic absorption. It stays localized at the site of application. 
• chinoform: Like gentamicin, chinoform is primarily localized at the site of application and is not significantly absorbed systemically. 
• betamethasone valerate: Topical corticosteroids like betamethasone valerate can be absorbed through skin and into bloodstream to varying degrees, depending on potency of the steroid, the thickness of the skin, and the duration of application. Systemic absorption is minimized by applying a thin layer to the affected area. 

Distribution: 

• After absorption, if any, these medications may enter the bloodstream in small amounts. However, they do not distribute widely throughout the body like systemic medications. 

Metabolism: 

• tolnaftate, gentamicin, chinoform: These medications are not significantly metabolized within the body when applied topically. They are excreted primarily unchanged. 
• betamethasone valerate: betamethasone valerate may undergo some metabolic transformation in the liver, but the majority is excreted unchanged or as inactive metabolites. 

Excretion: 

• tolnaftate, gentamicin, chinoform: These drugs are primarily excreted through the kidneys, but because of limited systemic absorption with topical use, excretion is minimal. 
• betamethasone valerate: Metabolized corticosteroids like betamethasone valerate and their metabolites are excreted in the urine and feces. 

Adminstartion

Administration: 

• Wash Hands: Before applying the medication, wash your hands thoroughly with soap and water. 
• Clean the Affected Area: Gently clean and dry the affected skin area. Ensure it is free from any dirt, debris, or excess moisture. 
• Apply a Thin Layer: Apply to the affected area(s). Use enough to cover the affected skin without excessive application. Avoid applying it to unaffected areas. 
• Gently Rub In: After applying the medication, gently rub into the skin till it is absorbed. Wash hands after application unless you are treating your hands. 
• Frequency of Application: The frequency and duration of application is usually applied once or twice daily, or as directed. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: tolnaftate, gentamicin, chinoform and betamethasone valerate 

Pronounced: (Tol-naf-tate, Jen-ta-my-sin, Kye-noh-form, and Bay-tah-meth-a-sone Val-er-ate)  

Why do we use tolnaftate, gentamicin, chinoform and betamethasone valerate? 

The combination medication consisting of tolnaftate, gentamicin, chinoform, and betamethasone valerate is typically used to treat a variety of skin conditions. tolnaftate is an antifungal agent used in the treatment of fungal infections, including ringworm, tinea pedis, and jock itch. It works by inhibiting growth and multiplication of fungi. gentamicin is effective against a wide range of bacteria.

It is used to treat skin infections, such as impetigo, cellulitis, and infected wounds. chinoform is an antiseptic and antimicrobial agent that helps prevent and treat superficial skin infections and skin conditions caused by bacteria and fungi. betamethasone Valerate is a corticosteroid that reduces inflammation, redness, and itching associated with various skin conditions. It can help provide relief from discomfort and irritation.