Fluocinolone Acetonide is available as Cream, Drops, Solution, oil, and shampoo. It is a low to moderate potency corticosteroid available for the treatment of inflammatory conditions.

Fluocinolone acetonide Uses:

• Scalp oil:

  • Adults with psoriasis of the scalp may benefit from the use of scalp oil.

• Body oil:

  • In adults and children older than three months, it is used to treat moderate to severe atopic dermatitis.

• Shampoo:

  • The shampoo can be used to treat seborrheic dermatitis of the scalp

• Cream, ointment, topical solution:

  • Topical fluocinolone is used to relieve inflammation and itching associated with corticosteroid-responsive dermatoses

Fluocinolone acetonide Dose in Adults

Note: The drug's dosage is determined by the condition's severity and the affected area. The smallest amount should be used for a shorter period of time. Treatment must be discontinued as the condition improves.

Dose in the treatment of Atopic dermatitis:

• Topical: Body oil:
  • Three times per day, apply a thin coating to the affected area.

 Dose in the therapy of Corticosteroid-responsive dermatoses:

• Cream, ointment, or other topical product:
  To the affected area, apply a little layer twice daily, or four times each day.
  • Occlusive dressings can be used to treat stubborn disorders like psoriasis.

Dose in the treatment of Scalp psoriasis:

• Topical:
  • After thoroughly rubbing the scalp oil into damp or wet hair, put on a shower hat.
  • Leave the oil on for at least four hours or overnight.
  • Rinse the oil out completely and shampoo your hair to remove it.

Dose in the therapy of Seborrheic dermatitis of the scalp:

• Shampoo should only be applied topically once daily, and no more than one ounce should be used.
  • Create a lather, then leave it on the scalp for five minutes or so.
  • Rinse the hair with water completely to wash it.

 Dose in Children

Note:

• The dose and duration of the topical application depend on the severity of the disease and the response to the treatment.
• Treatment must be discontinued when the lesions heal.
• To prevent HPA axis suppression, the least dosage of the medication should be taken for the shortest duration possible.

Dose in the treatment of moderate to severe atopic dermatitis:

• Body oil Derma-Smoothe/FS (0.01%):

  • Children under the age of 13, as well as adolescents: 
    • To moisturise the skin, apply a light layer to the problematic region twice daily. 
    • It is not recommended to use for more than four weeks.

  Derma-Smoothe/FS scalp oil (0.01%):

  • Children over 2 years and Adolescents:
    • Apply a light application to the afflicted region twice daily.
    • It is not recommended to use for more than four weeks.

 Dose in the therapy of Corticosteroid-responsive dermatoses:

• Synalar cream (0.025%), ointment (0.025%), topical solution (0.01%):

  • Children and Adolescents:
    • Apply a thin layer topically twice daily or four times daily to the affected area.
    • Occlusive dressings are sometimes used in the treatment of psoriasis and other difficult-to-treat conditions.

Pregnancy Risk Factor C

• Negative fetal outcomes have been documented in animal reproduction studies.
• The effects of topical glucocorticoids are not significant on the foetus. However, intrauterine growth retardation is rarely reported.
• It is best to avoid using a lot of topical medication.

Fluocinolone use during breastfeeding:

• It is recommended that you use it with caution if you are breastfeeding.
• Breast milk contains corticosteroids. Hypertension has been observed in breastfeeding infants after topical application of corticosteroids over the nipple.

Fluocinolone acetonide Dose in Kidney Disease:

In the manufacturer's labeling, dose adjustment has not been recommended for kidney disease.

Fluocinolone acetonide dose in Liver disease:

In the manufacturer's labeling, dose adjustment has not been recommended in patients with liver disease.

Side effects of Fluocinolone acetonide:

• Cardiovascular:

  • Intracranial Hypertension (Rare)

• Miscellaneous:

  • Herpes Simplex
  • Secondary Infection

• Endocrine & Metabolic:

  • Cushing's Syndrome
  • HPA Axis Suppression
•  

• Dermatologic:

  • Dryness
  • Erythema
  • Irritation
  • Itching
  • Hypertrichosis
  • Hypopigmentation
  • Perioral Dermatitis
  • Pustules
  • Folliculitis
  • Acneiform Eruptions
  • Allergic Contact Dermatitis
  • Atopic Dermatitis (Secondary)
  • Burning
  • Shiny Skin
  • Skin Atrophy
  • Keratosis Pilaris
  • Miliaria
  • Papules
  • Striae

• Central Nervous System:

  • Telangiectasia

• Otic:

  • Ear Infection

Contraindications to Fluocinolone acetonide:

Allergy to any ingredient in this formulation, including fluocinolone 

Additional contraindications not included on Canadian labels

• Viral lesions on the skin, such as varicella and herpes
• Fungal or bacterial skin infections
• Parasitic infections
• Tuberculosis or Syphilis:
• Post-vaccinations eruptions
• Apply directly to the eyes

Warnings and precautions

• Suppression of the adrenals:

  • Topical steroid use over a long period of time may inhibit the adrenal glands.
  • The HPA (hypothalamic-pituitary-adrenal) axis can be suppressed by topical steroid use, particularly in young children and individuals who receive large doses of topical corticosteroids for an extended period of time.

• Contact dermatitis:

  • If the underlying problem is not resolved, allergic contact dermatitis can occur.

• Kaposi Sarcoma:

  • Kaposi sarcoma may develop from prolonged topical use, which may need to be discontinued.

• Local effects

  • The drug can cause skin atrophy, striae and itching. Some changes are not reversible.
  • Long-term use and the use of occlusive dressings are more likely to have local effects.
  • If irritation occurs, treatment may be stopped.

• Skin infections

  • Skin may become more susceptible to infections from topical corticosteroids.
  • If the infection continues to persist despite treatment, treatment may be stopped.

• Systemic effects

  • After the long-term application of corticosteroids, systemic absorption can occur.
  • Hyperglycemia and glucosuria are two clinical indications of Cushing's syndrome that you might experience.
  • Cushing's syndrome can be caused by occlusive dressings. The drug is applied to denuded skin, or an area larger than the body for a longer time.

Monitoring parameters:

• Keep an eye on children's growth
• Observe how the HPA axis is being suppressed (ACTH stimulation test, early morning plasma cortisol test, and urinary free cortisol test may be required for the diagnosis)
• Keep an eye out for overlapping bacterial or fungal infections.

How to Use Topical Fluocinolone acetonide?

• It is intended for topical application over the affected skin.
• Application on the oral mucosa, into the eyes, or intravaginal use should be avoided.
• If not advised otherwise by a healthcare professional, application on the face, axillae, or groyne should be avoided.

Cream, ointment, topical solution:

• Apply a tiny layer over the affected region, then gently rub it in.
• To allow the medicine to reach the lesions directly, part the hair in regions where there is hair.
• Psoriasis and other resistant disorders can be treated with occlusive dressings.
• If an infection starts, occlusive dressings should be avoided.

Body oil:

• Avoid applying over intertriginous areas. Apply the minimum required amount necessary to cover the affected area.

Shampoo:

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• Before using, shake the scalp solution.
• Don't apply a bandage. Except as recommended by a healthcare professional, avoid wrapping or covering the treated scalp region.

Mechanism of action of Fluocinolone acetonide:

• Fluocinolone can be used topically as a corticosteroid with anti-inflammatory, vasoconstrictive and antipruritic properties.
• It prevents endogenous inflammatory chemical mediators from being formed, released, and active, such as prostaglandins, histamines, liposomal enzymes and kinins. 
• By producing lipocortins, phospholipase inhibitory proteins, and successive suppression of arachidonic acid release, it blocks the synthesis of these mediators.
• Fluocinolone is a low- to medium-potency glucocorticoid (potency changes with dose).

Excretion:

• Primarily urine
• Bile

Absorption:

• The formulation, the amount of the product, and the skin type at the site of application will all affect the absorption.
• If the drug is used on inflamed skin or with occlusive dressings, it may increase absorption.

Metabolism:

• Hepatic

International Brands of Fluocinolone Acetonide:

• Synalar (Cream)
• Synalar (Ointment)
• Gelargin
• Inoderm
• Jellin
• Localyn
• Luci
• Paracort
• Synalar TS
• Bratofil
• Bravoderm
• Cinolon
• Cortoderm
• Derma-Smoothe/FS Scalp
• Synalar
• Dermasolon Gel
• Dermolar
• Emderm
• Esacinone
• Esinol
• Flucar
• Fluciderm
• Flucinar
• Xilapak
• Fluoderm
• Synalar Mild
• Adermina
• Capex
• Derma-Smoothe/FS Body
• Aplosyn
• Flucort
• Flucortone
• Flulone
• Flunolone
• Flunolone-V
• Fluo-A
• Fluociclerc
• Fluocid Forte
• Fluocinolona
• Fluoderm
• Fluonid
• Flutcinar
• Fungakil
• Petralar
• Radiocin
• Skinalar
• Supricort
• Synalar
• Synalar Simple
• Synflan
• Tretoflamin

Fluocinolone Acetonide Brand Names in Pakistan: