calcipotriol: clinical use

Prescribing considerations

• Confirm the psoriasis type and application site; the selected scalp solution is licensed only for mild to moderate scalp psoriasis.
• Account for all calcipotriol-containing products when assessing systemic calcium risk.
• Avoid facial application and use cautiously in skin folds because local irritation may be greater.
• Limit excessive natural or artificial ultraviolet exposure; combine with UV treatment only after an individual benefit–risk assessment.
• Review pregnancy, breastfeeding, renal or hepatic disease and medicines that increase serum calcium.

Contraindications and cautions

• Hypersensitivity to calcipotriol or a formulation excipient.
• Known disorders of calcium metabolism.
• For the selected scalp solution: hypercalcaemia, severe renal or hepatic impairment, or treatment with another medicine that raises serum calcium.
• Avoid guttate, erythrodermic, exfoliative or pustular psoriasis where specified because supporting data are lacking.

Monitoring

• Routine laboratory monitoring is not specified for uncomplicated limited topical use.
• Consider serum calcium assessment if treatment is extensive, excessive use is suspected, calcium-related symptoms develop or interacting medicines are present.
• Monitor local tolerability, psoriasis response and accidental facial or ocular exposure.

Clinical pharmacology

Calcipotriol is a vitamin D receptor agonist that inhibits keratinocyte proliferation and promotes differentiation. Systemic absorption from ointment appears low, but excessive exposure can disturb calcium homeostasis.

Formulation and product differences

• The ointment is licensed for plaque psoriasis suitable for topical therapy and has product information covering adults and children from six years; experience below six years is limited.
• The scalp solution is licensed for adults with mild to moderate scalp psoriasis and is not recommended below 18 years because of insufficient evidence.
• The ointment contains propylene glycol and paraffin-based excipients; contaminated fabrics burn more easily.
• The scalp solution contains propylene glycol, isopropyl alcohol and levomenthol. It is flammable and should be protected from light and not refrigerated or frozen.
• The stated in-use shelf life differs: six months for the ointment and three months for the scalp solution.

Ointment

Route: Cutaneous

Strengths: 50 micrograms/g