tacalcitol monohydrate: clinical use

Prescribing considerations

• Licensed for adults; safety and efficacy have not been established in people under 18.
• Avoid ocular exposure when treating facial psoriasis.
• Consider cumulative tacalcitol exposure if another tacalcitol formulation is also used.
• Provide explicit fire-safety counselling because the ointment contains paraffin.

Contraindications and cautions

• Hypersensitivity to tacalcitol or an excipient.
• Hypercalcaemia or another known disorder of calcium metabolism.
• Use caution in renal impairment and in generalised pustular or erythrodermic psoriasis because hypercalcaemia risk may be greater.

Monitoring

• Monitor albumin-corrected serum calcium in patients at increased risk of hypercalcaemia or taking high-dose vitamin D preparations.
• Monitor serum calcium in renal impairment.
• Stop tacalcitol if hypercalcaemia develops.

Clinical pharmacology

Tacalcitol is a vitamin D3 derivative that activates keratinocyte vitamin D receptors, inhibits hyperproliferation and promotes differentiation. Systemic absorption through psoriatic skin is reported to be very low, but accumulation cannot be excluded in renal failure.

Formulation and product differences

• The selected product is a paraffin-based ointment containing butylhydroxytoluene, which may cause local skin reactions or irritation of the eyes and mucous membranes.
• The ointment may be used on body, facial, scalp and flexural lesions, while avoiding the eyes.