Absorption of tacrolimus in the systemic circulation when topically applied is minimal. Most atopic dermatitis patients (adults and children) with a single application or multiple application at 0.03% and 0.1% tacrolimus ointment concentration in blood plasma. Systemic omnadren cycle absorption depends on the area of injury and decreases with the disappearance of clinical manifestations of atopic dermatitis. Drug accumulation with prolonged use (up to 1 year) in children and adults were observed. The distribution in the body. In view of the fact that systemic absorption of tacrolimus ointment is low, a high ability to bind to plasma proteins (98.8% more) is regarded as clinically significant.Metabolism. Tacrolimus is not metabolised in the skin. When injected into the blood system tacrolimus is largely metabolized in the liver by means .Excretion. With repeated topical application of tacrolimus ointment half-life of 75 hours in adults and 65 hours for children.
Indications for use
Ointment is used in a dosage of 0.03% and 0.1% in adults, and only 0.03% for children 2 to 16 years for the treatment of atopic dermatitis (moderate and severe) in the event of resistance to other means of external therapy or contraindications such.
Hypersensitivity to tacrolimus, to excipients, to macrolides.
Pregnancy and breast-feeding.
Do not use in patients with genetic defects in the epidermal barrier, such as Netherton’s syndrome, as well as generalized erythroderma due to the risk of progressive increase systemic absorption of tacrolimus .
The use of Protopic ointment in a dosage of 0.1% is contraindicated in children and adolescents under the age of 16 years, at a dosage of 0.03% – in children younger than 2 years.
Omnadren cycle is largely metabolized in the liver and although its concentration in the blood when applied topically is very low in patients with decompensated hepatic impairment ointment used with caution. Care must be taken when using Protopic in patients with extensive lesions of the skin, especially long courses, and children.
Dosage and administration
Adults and children over 2 years is applied a thin layer on the affected skin. The drug can be used on all body parts, including the face and neck, in the area of skin folds. Do not apply the drug on the mucous membranes and under occlusive dressings. Use in children (2 years and older) and adolescents under 16 years of age Treatment should begin with the application of 0.03% twice a day. The duration of treatment under the scheme should not exceed three weeks. In the future, the frequency of application is reduced to once a day, the treatment can be extended to a complete cleansing of the lesions. The use in adults and adolescents 16 years and older Treatment should be started twice a day and to continue to complete cleansing of foci defeat. As you improve, you can decrease the frequency of application of 0.1% ointment . In the case of recurrence of symptoms should resume treatment 0.1% twice a day. If the clinical picture allows, it should attempt to reduce the frequency of use of the drug, or to use a lower dosage – 0.03% .
Use in the elderly (65 years and older) Features of elderly people are missing. Usually improvement is seen within one week of starting therapy. If symptoms improve with treatment not available for two weeks, you should consider changing treatment strategies. Treatment of exacerbations omnadren cycle can be used for a short or a long time in the form of recurrent courses of therapy. Treatment of affected areas of the skin is carried out to the complete disappearance of clinical manifestations of atopic dermatitis. Generally, improvement is seen during the first week of treatment. If signs of improvement are observed within two weeks from the start of the use of an ointment, other options should be considered for further treatment. Treatment should be resumed at the first signs of exacerbation of atopic dermatitis. Prevention of exacerbations to prevent exacerbations and increase the duration of remission in patients with frequent (more than 4 times per year) exacerbations of the disease in the history ointment recommended maintenance . Feasibility purpose of maintenance therapy depends on the efficiency of the previous treatment by the standard procedure (2 times daily) for up to 6 weeks. When maintenance therapy ointment must be applied two times per week (e.g., Monday and Thursday) at the skin, usually stricken . in exacerbations . The time interval between the application of the drug should be at least 2-3 days in adults and adolescents 16 years and older used . When the manifestation of acute symptoms should go to normal treatment (see section “Treatment of exacerbations”). After 12 months of maintenance therapy is necessary to evaluate the clinical dynamics and decide whether to continue prophylactic omnadren cycle in children to assess the clinical dynamics should temporarily stop the drug and then to consider the need to continue maintenance therapy.