fluocinolone acetonide: clinical use

Prescribing considerations

• Match the topical vehicle to the lesion: cream for moist or flexural disease, ointment for dry or scaly lesions, and gel for scalp or hairy sites.
• Systemic and local corticosteroid risks increase with extensive application, impaired skin barrier, occlusion and paediatric use.
• Treat associated infection appropriately; corticosteroid monotherapy can mask or worsen infection.
• Before an implant, exclude infective uveitis and assess glaucoma history, baseline intraocular pressure, lens status and posterior capsule integrity.
• The implant must be administered by an experienced healthcare professional using aseptic intravitreal technique.

Contraindications and cautions

• Topical products: primary bacterial, fungal or viral skin infection; rosacea; acne; perioral dermatitis; anogenital pruritus; napkin eruption; hypersensitivity; and use in children under one year.
• Implant: pre-existing glaucoma; active or suspected ocular or periocular infection; infectious uveitis; or hypersensitivity to an ingredient.

Monitoring

• For topical use, monitor response, infection, skin atrophy, telangiectasia, striae, withdrawal reactions and evidence of systemic corticosteroid effects where exposure is extensive.
• After implantation, assess promptly for infection, retinal complications and increased or decreased intraocular pressure, followed by continuing pressure and cataract surveillance.
• Evaluate new visual disturbance for cataract, glaucoma, implant migration or retinal pathology.

Clinical pharmacology

A synthetic corticosteroid that suppresses inflammatory mediator production, immune activity, vascular permeability and oedema. Percutaneous absorption varies with the vehicle, skin integrity and occlusion; systemic exposure after intravitreal implantation is very low.

Formulation and product differences

• Cream is less occlusive and particularly suitable for moist or weeping lesions and flexures.
• Ointment is more occlusive and suited to dry, scaly lesions; its lanolin and propylene glycol content may cause local reactions.
• Gel is clear and non-greasy, making it useful for the scalp and hairy areas; it contains propylene glycol and parabens.
• The non-biodegradable intravitreal implant provides sustained local corticosteroid delivery and may migrate anteriorly when posterior lens-capsule support is absent or defective.

Implant

Route: Implant

Strengths: 190 micrograms