tolnaftate, gentamicin, iodochlorohydroxyquinoline, chlorocresol, betamethasone valerate

Action and Spectrum

Actions and spectrum: 

tolnaftate: 

• Action: tolnaftate is an antifungal medication used to treat fungal skin infections like athlete’s foot, ringworm, and jock itch. It acts by inhibiting growth and multiplication of fungi. 
• Spectrum: tolnaftate primarily targets dermatophyte fungi responsible for skin infections. It may not be effective against all types of fungi. 

gentamicin: 

• Action: gentamicin is an antibiotic that belongs to the aminoglycoside class. It works by inhibiting bacterial protein synthesis, making it effective against wide range of bacteria. 
• Spectrum: gentamicin has a broad-spectrum of activity against many gram-negative and some gram-positive bacteria. It is often used to treat bacterial skin infections and may also be effective against certain skin-associated bacteria. 

iodochlorohydroxyquinoline (ICHQ): 

• Action: iodochlorohydroxyquinoline is an antimicrobial agent with both antibacterial and antifungal properties. It works by disrupting cell membranes of microorganisms. 
• Spectrum: ICHQ has a spectrum of activity against various bacteria and fungi. It is used in combination products to provide antimicrobial effects. 

chlorocresol: 

• Action: chlorocresol is an antimicrobial agent and preservative used to prevent contamination in pharmaceutical products. 
• Spectrum: chlorocresol is primarily used as a preservative to maintain the sterility of the medication and prevent the growth of microorganisms. 

betamethasone valerate: 

• Action: betamethasone valerate is a corticosteroid with anti-inflammatory and immunosuppressive properties. It acts by suppressing the immune response and reducing inflammation and itching in the skin. 
• Spectrum: betamethasone valerate is used to treat various skin conditions by inflammation, like eczema, psoriasis, and dermatitis. It is effective against inflammation but does not target bacteria or fungi. 

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, iodochlorohydroxyquinoline, chlorocresol, betamethasone valerate. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: The medication should not be used in individuals who have a known hypersensitivity or allergy to any of its active ingredients or components. Allergic reactions may include skin rash, itching, swelling, or severe allergic reactions. 
• Tuberculosis of the Skin: The medication should not be used in cases of tuberculosis of the skin, as it may exacerbate the condition or interfere with the treatment of tuberculosis. 
• Viral Infections: Topical corticosteroids like betamethasone valerate should be avoided in viral skin infections, such as herpes simplex, chickenpox, or shingles, unless directed by a healthcare provider. 
• Fungal Eye Infections: gentamicin, one of the components, should not be applied to the eye or used for treating fungal eye infections. It is not intended for ophthalmic use.

Caution: 

• Topical Use Only: This medication is typically intended for topical use on the skin. Avoid applying it to mucous membranes, eyes, or open wounds unless directed by a healthcare provider. 
• Duration of Use: Prolonged use of topical corticosteroids like betamethasone valerate can lead to skin thinning and other side effects. Healthcare providers should monitor the duration of treatment and consider alternatives for long-term use. 
• Infection Risk: Topical corticosteroids can mask or exacerbate certain skin infections. Use caution when applying this medication to skin with bacterial or fungal infections. It is advisable to consult a healthcare provider for appropriate treatment. 
• Avoiding Contact with Eyes: Care should be taken to avoid accidental contact with the eyes when applying this medication. 

Comorbidities: 

• Immunosuppression: Individuals with weakened immune systems, such as those with HIV/AIDS or undergoing immunosuppressive therapy, may increase the risk of skin infections. Healthcare providers should monitor and manage these infections carefully and consider the use of antimicrobial agents cautiously. 
• Diabetes: Diabetic individuals may be more susceptible to skin infections, including fungal infections. Proper diabetes management, including maintaining good blood sugar control and regular foot care, is essential to prevent and manage such infections. 
• Liver and Kidney Disease: The systemic absorption of some components of this medication, like gentamicin, can be influenced by kidney and liver function. In individuals with impaired kidney or liver function, systemic effects may be more pronounced, and dosage adjustments or alternative treatments may be necessary. 

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. 
• <b>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 of tolnaftate, gentamicin, iodochlorohydroxyquinoline, chlorocresol, and betamethasone valerate offers a multifaceted approach to treating various skin conditions. tolnaftate is an antifungal agent that inhibits the growth of fungi responsible for skin infections.

gentamicin is an antibiotic that combats bacterial infections, while iodochlorohydroxyquinoline provides additional antifungal properties. chlorocresol is a preservative with some antibacterial activity. betamethasone valerate is a corticosteroid that reduces inflammation and alleviates symptoms like redness and itching. This combination targets infections caused by fungi and bacteria and provides anti-inflammatory effects, offering a comprehensive solution for skin conditions.  

Pharmacodynamics: 

• tolnaftate (Antifungal): tolnaftate works by inhibiting the growth of fungi responsible for skin infections. It interferes with the fungal cell membrane, disrupting its structure and function, leading to fungal cell death. This helps treat and prevent fungal skin infections, such as athlete’s foot and ringworm. 
• gentamicin (Antibacterial): gentamicin is an antibiotic that targets and inhibits growth of wide range of bacteria. It achieves its antibacterial effect by disrupting protein synthesis in bacterial cells. gentamicin is particularly effective against Gram-negative bacteria. In this combination, it helps address bacterial skin infections. 
• iodochlorohydroxyquinoline (Antifungal): iodochlorohydroxyquinoline contributes additional antifungal properties to the medication, helping combat fungal skin infections. It disrupts fungal cell membranes and interferes with their growth and reproduction. 
• chlorocresol (Preservative): chlorocresol is used as a preservative in pharmaceutical formulations to prevent contamination and maintain product stability. It may also exhibit some antibacterial properties, contributing to the overall antimicrobial action of the combination. 
• betamethasone valerate (Corticosteroid): betamethasone valerate is a potent corticosteroid that exerts anti-inflammatory, immunosuppressive, and antipruritic (anti-itch) effects.

Pharmacokinetics: 

Absorption: 

• tolnaftate: When applied topically, tolnaftate is minimally absorbed through the skin, primarily acting locally at the site of application to treat fungal infections. 
• gentamicin: When used topically, gentamicin has limited systemic absorption and primarily exerts its effects at the site of application. Systemic absorption is minimal, reducing the risk of systemic side effects. 

Distribution: 

• tolnaftate: tolnaftate remains localized at the site of application, targeting fungal infections on the skin. 
• gentamicin: Topical gentamicin typically remains at the site of application in the skin or mucous membranes. It may have limited distribution beyond the application site. 

Metabolism: 

• tolnaftate: tolnaftate does not undergo significant metabolic transformation when applied topically. 
• gentamicin: Topically applied gentamicin is not significantly metabolized; it retains its antibacterial properties. 

Elimination: 

• tolnaftate: tolnaftate is primarily eliminated locally from the skin through exfoliation and normal skin shedding. 
• gentamicin: Any systemically absorbed gentamicin is eliminated primarily through the kidneys. 

Adminstartion

Administration: 

• Clean the Affected Area: Before applying medication, ensure that the affected skin area is clean and dry. Gently wash and pat dry the area with a clean towel. 
• Application: Apply a thin layer of the medication to the affected area. Use a clean finger or applicator, as recommended by healthcare provider. 
• Avoid Eyes and Mucous Membranes: Be cautious not to get the medication in your eyes, nose, mouth, or other sensitive areas.  
• Frequency: The frequency of application can vary depending on the condition being treated and the product’s instructions. Follow the recommended application schedule provided by your healthcare provider or on the product label. 
• Duration of Treatment: Continue using the medication for the prescribed duration, even if symptoms improve before completion. Stopping too early may allow the infection to return. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: tolnaftate, gentamicin, iodochlorohydroxyquinoline, chlorocresol, betamethasone valerate 

Pronounced: (Tol-naf-tate, Jen-ta-my-sin, Eye-oh-klor-oh-hye-drox-ee-kwin-oh-leen, Klo-ro-kree-sol, Bay-ta-meth-a-sone Val-er-ate)  

Why do we use tolnaftate, gentamicin, iodochlorohydroxyquinoline, chlorocresol, betamethasone valerate? 

tolnaftate and iodochlorohydroxyquinoline are antifungal agents that are effective against a range of fungal skin infections, including Tinea infections (ringworm), Athlete’s foot (tinea pedis), Jock itch (tinea cruris), Candidiasis (yeast infection) of the skin.

gentamicin is an antibiotic that can treat bacterial skin infections, including Impetigo, Infected dermatitis, Secondary bacterial infections in damaged or compromised skin. betamethasone valerate is a corticosteroid that helps reduce inflammation, redness, swelling, and itching associated with skin conditions, providing relief from discomfort and irritation.