calcitriol (topical)

General

Pronunciation:
kal-si-trye-ole


Trade Name(s)

  • Silkis Canadian Trade name
  • Vectical

Ther. Class.

antipsoriatics

Pharm. Class.

vitamin d analogues

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 Effect(s):

Decreased severity of plaque psoriasis.

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.

TIME/ACTION PROFILE

improvement in psoriatic lesions

ROUTEONSETPEAKDURATION
Topicalunknownwithin 8 wkunknown

Contraindication/Precautions

Contraindicated in:

  • None.

Use Cautiously in:

  • Exposure of the treated areas to natural or artificial sunlight, including tanning booths, sunlamps, or phototherapy; use should be limited or avoided;
  • OB:  Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
  • Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
  • Pedi:  Children <2 yr (safety and effectiveness not established).

Adverse Reactions/Side Effects

Derm: pruritus, skin discomfort

GU: hypercalciuria

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

Interactions

Drug-Drug

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

Route/Dosage

Topical (Adults and Children ≥7 yr): Apply twice daily (not to exceed 200 g/wk).

Topical (Children 2–6 yr): Apply twice daily (not to exceed 100 g/wk).

Availability

Ointment: 3 mcg/g

Assessment

  • Assess psoriatic lesions periodically during therapy.

Lab Test Considerations:

May cause hypercalcemia and hypercalciuria.

Implementation

  • Topical Apply ointment to affected areas twice daily, morning and evening. Rub gently into skin so no medication remains visible. Do not apply to eyes, lips, or facial skin.

Patient/Family Teaching

  • Instruct patient to apply calcitriol ointment as directed. Do not use more than 200 g/wk in patients ≥7 yr or 100 g/wk in patient 2–6 yr of age.
  • Caution patient to avoid excessive exposure of treated areas to natural or artificial sunlight, including tanning booths and sunlamps; may increase risk of skin tumors.
  • Advise patient to report any signs of adverse reactions to health care professional.
  • Rep:  Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise breastfeeding patient to avoid applying ointment directly to nipple and areola.

Evaluation/Desired Outcomes

Decrease in color and elevation of psoriatic lesions.

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