ciclopirox

[si″klo-pir´oks] a broad-spectrum antifungal agent with activity similar to that of the imidazoles, used topically as the olamine salt against skin infections.

ciclopirox

(sye-kloe-peer-ox) ciclopirox,

Loprox

(trade name),

Penlac

(trade name),

Stieprox

(trade name)

Classification

Therapeutic: antifungals
Pregnancy Category: B

Indications

Treatment of cutaneous fungal infections including cutaneous candidiasis (lotion and cream only), tinea pedis (athlete’s foot) (gel, lotion, and cream only), tinea cruris (jock itch) (lotion and cream only), tinea corporis (ringworm) (gel, lotion, and cream only), tinea versicolor (lotion and cream only), seborrheic dermatitis (shampoo and gel only), and onychomycosis of fingernails and toenails (nail lacquer only).

Action

Inhibits the transport of essential elements in fungal cell, disrupting the synthesis of DNA, RNA, and protein.

Therapeutic effects

Decrease in symptoms of fungal infection.

Pharmacokinetics

Absorption: Absorption through intact skin is minimal (<5%).Distribution: Distribution after topical administration is primarily local.Metabolism and Excretion: Eliminated by kidneys (3–10% for gel).Half-life: 5.5 hr (gel).

Time/action profile

ROUTE	ONSET	PEAK	DURATION
Top	unknown	unknown	unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to active ingredients, additives, preservatives, or bases; Some products contain alcohol (nail lacquer) and should be avoided in patients with known intolerance;.Use Cautiously in: Obstetric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Local

burning
itching
local hypersensitivity reactions
redness
stinging

Interactions

Drug-Drug interaction

Not known.

Route/Dosage

Topical (Adults and Children >10 yr) Shampoo:Apply 5 mL (10 mL may be used for long hair) to scalp and leave on for 3 min before rinsing off. Use twice weekly (wait at least 3 days between treatments) for 4 wk. Cream/lotion: Apply twice daily for 2–4 wk. Gel: Apply twice daily for 4 wk. Topical solution (nail lacquer): Apply to nails once daily (at bedtime or 8 hr before bathing) for up to 48 wk. Each daily application should be made over the previous coat and then removed with alcohol every 7 days.

Availability (generic available)

Cream: 0.77% Gel: 0.77% Lotion: 0.77% Nail Lacquer Solution: 8% Shampoo: 1%, 1.5%

Nursing implications

Nursing assessment

Inspect involved areas of skin and mucous membranes before and frequently during therapy. Increased skin irritation may indicate need to discontinue medication.

Potential Nursing Diagnoses

Risk for impaired skin integrity (Indications)
Risk for infection (Indications)

Implementation

Consult physician or other health care professional for proper cleansing technique before applying medication.
Topical: Apply small amount to cover affected area completely. Avoid the use of occlusive wrappings or dressings unless directed by physician or other health care professional.
Nail lacquer: Avoid contact with skin other than skin immediately surrounding treated nail. Avoid contact with eyes or mucous membranes. Removal of unattached, infected nail, as frequently as monthly, by health care professional is needed with use of this medication. Up to 48 wk of daily application and professional removal may be required to achieve clear or almost clear nail. 6 mo of treatment may be required before results are noticed.

Patient/Family Teaching

Instruct patient to apply medication as directed for full course of therapy, even if feeling better. Emphasize the importance of avoiding the eyes.
Caution patient that some products may stain fabric, skin, or hair. Check label information. Fabrics stained from cream or lotion can usually be cleaned by handwashing with soap and warm water.
Patients with athlete’s foot should be taught to wear well-fitting, ventilated shoes, to wash affected areas thoroughly, and to change shoes and socks at least once a day.
Advise patient to report increased skin irritation or lack of response to therapy to health care professional.
Nail lacquer: File away loose nail and trim nails every 7 days after solution is removed with alcohol. Do not use nail polish on treated nails. Inform health care professional if have diabetes mellitus before using.
Inform patient that early relief of symptoms may be seen in 2–3 days but that full therapeutic response may take 3–4 wk. Recurrent fungal infections may be a sign of systemic illness.

Evaluation/Desired Outcomes

Decrease in skin irritation.
Resolution of infection.