IDAMEN 5mg/5ml Price

Overview

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This medicine contains an important and useful components, as it consists of
Idarubicin hydrochlorideis available in the market in concentration

Name

Gramicidin + Neomycin Sulphate + Nystatin + Triamcinolone Acetonide (Topical)

Precaution

Gramicidin, neomycin sulfate, nystatin, and triamcinolone acetonide are a combination of an antibiotic, antifungal, and corticosteroid used topically, primarily for the treatment of various skin infections that may involve both bacterial and fungal elements. This combination should be used with caution in patients with known hypersensitivity to any of the ingredients. Caution is especially necessary in patients with a history of skin conditions that involve thinning skin or poor wound healing. Prolonged use of topical corticosteroids, such as triamcinolone, can lead to skin atrophy, delayed wound healing, and may increase the risk of secondary infections, including fungal or bacterial superinfection. It is also important to avoid using this combination on large areas of the skin for prolonged periods to minimize the risk of systemic absorption, which can lead to corticosteroid-related side effects like adrenal suppression. Patients should be monitored for signs of local irritation, including redness, itching, or burning, which may indicate an allergic reaction or the development of sensitivity to one of the components. This combination should not be applied to the eyes, as corticosteroids can cause serious eye issues, including glaucoma or cataracts. Use in pregnant or breastfeeding women should be approached with caution, as corticosteroids can pass through the placenta or into breast milk, potentially affecting the fetus or infant.

Indication

This combination of gramicidin, neomycin sulfate, nystatin, and triamcinolone acetonide is primarily indicated for the topical treatment of bacterial and fungal skin infections, often in cases of mixed infections where both bacterial and fungal pathogens are involved. Gramicidin and neomycin are antibiotics that target gram-positive and gram-negative bacterial pathogens, respectively, making this combination effective against a broad range of bacterial skin infections. Nystatin is an antifungal that targets *Candida* species, which are commonly associated with superficial skin fungal infections. Triamcinolone acetonide, a corticosteroid, is included to reduce inflammation, itching, and redness associated with these infections. This combination is frequently used for conditions like superficial skin infections caused by *Staphylococcus aureus* or *Streptococcus pyogenes*, as well as fungal infections such as candidiasis. It may also be prescribed for conditions like contact dermatitis with secondary infections, eczema with fungal involvement, or other inflammatory skin conditions where both fungal and bacterial elements are present. Off-label uses may include the treatment of localized fungal infections in patients who also have secondary bacterial infections or inflammation that would benefit from the corticosteroid component.

Contra indication

This combination product should not be used in individuals who have a known hypersensitivity or allergic reaction to any of the components, including gramicidin, neomycin sulfate, nystatin, or triamcinolone acetonide. It is contraindicated in patients with active viral skin infections, such as herpes simplex or varicella, as corticosteroids can exacerbate viral replication and worsen the infection. The product should also be avoided in patients with known fungal skin infections that are resistant to nystatin or those with significant fungal involvement of deeper tissues. Additionally, the combination should not be applied to broken or injured skin, unless otherwise directed by a healthcare provider, as the absorption of the corticosteroid and antibiotics may be enhanced, potentially leading to systemic side effects. Patients with a history of steroid-induced skin atrophy or thinning should avoid prolonged use. The use of this medication is contraindicated in the eyes, as corticosteroids can cause serious eye complications, including cataracts and glaucoma. It is also contraindicated for use on large areas of the skin for extended periods due to the potential for systemic absorption of the corticosteroid component, which can lead to systemic side effects such as adrenal suppression or hyperglycemia.

Side Effect

The side effects of the combination of gramicidin, neomycin sulfate, nystatin, and triamcinolone acetonide are typically localized, given its topical administration. Common side effects include skin irritation at the application site, such as redness, burning, stinging, or itching. These symptoms are usually mild and resolve with continued use, but they may indicate sensitivity or an allergic reaction to one of the components. More serious side effects can occur with prolonged use, especially due to the corticosteroid component, which can cause skin thinning, atrophy, or delayed wound healing. Overuse of this product on large areas of the skin or under occlusive dressings can increase the risk of systemic absorption of triamcinolone, leading to systemic corticosteroid side effects, including adrenal suppression, hyperglycemia, and increased susceptibility to infections. Prolonged use can also lead to the development of secondary fungal or bacterial infections due to the disruption of normal skin flora. The use of neomycin can also result in local allergic reactions, with symptoms such as itching, swelling, or rash, and in rare cases, neomycin may cause systemic toxicity, such as nephrotoxicity or ototoxicity. If any of these side effects occur, especially if they worsen over time, patients should discontinue use and consult their healthcare provider.

Pregnancy Category ID

0

Mode of Action

The combination of gramicidin, neomycin sulfate, nystatin, and triamcinolone acetonide exerts its therapeutic effects through the combined actions of its components. Gramicidin is a peptide antibiotic that disrupts the bacterial cell membrane, causing leakage of cellular contents and leading to bacterial cell death. Neomycin, an aminoglycoside antibiotic, binds to the bacterial 30S ribosomal subunit, inhibiting protein synthesis, thereby preventing bacterial growth. Nystatin, an antifungal, binds to ergosterol in the fungal cell membrane, leading to the formation of pores and leakage of cellular contents, ultimately killing the fungus. Triamcinolone acetonide is a corticosteroid that works by suppressing the inflammatory response. It inhibits the release of pro-inflammatory cytokines and reduces the accumulation of inflammatory cells at the site of infection, thereby decreasing redness, swelling, and itching. The combination of these agents provides broad-spectrum coverage for both bacterial and fungal infections, while the corticosteroid component helps reduce the inflammation and symptoms associated with the infection. This makes the combination highly effective for treating mixed infections where both bacterial and fungal elements are present.

Interaction

While the topical combination of gramicidin, neomycin sulfate, nystatin, and triamcinolone acetonide is generally unlikely to produce significant systemic interactions due to its localized use, caution should still be exercised when used in conjunction with other topical agents, particularly those containing other corticosteroids, as the risk of systemic corticosteroid side effects (e.g., adrenal suppression, delayed wound healing) may be increased. Combining this medication with other systemic antibiotics or antifungals may not result in direct interactions, but the concurrent use of other topical treatments that affect the skin’s integrity, such as retinoids or certain acne medications, may increase the risk of local irritation or absorption of the corticosteroid component. It is also important to monitor for signs of secondary fungal infections when using topical antibiotics, as prolonged antibiotic use can alter the skin’s microbiome, leading to overgrowth of non-susceptible organisms. The combination of neomycin sulfate with other nephrotoxic or ototoxic drugs should be avoided, although the risk of systemic absorption from topical use is minimal. Alcohol consumption does not directly interact with this topical preparation, but excessive alcohol use can impair immune function, potentially affecting the skin’s ability to heal. Patients should also avoid tight bandaging or occlusive dressings over the application site, as this could increase the absorption of the corticosteroid and the risk of side effects.

Pregnancy Category Note

Information not available

Adult Dose

The recommended adult dosage for the topical combination of gramicidin, neomycin sulfate, nystatin, and triamcinolone acetonide is to apply a thin layer to the affected area of the skin two to three times daily, depending on the severity of the infection and the patient's response. It is important to gently rub the medication in without overapplying, as excessive use of corticosteroids can increase the risk of side effects. In cases of more severe infections, the frequency of application may be increased, but treatment should not exceed 7-14 days to avoid the risk of side effects such as skin thinning or systemic absorption of corticosteroids. If there is no improvement within 1-2 weeks of treatment, the patient should seek medical reevaluation to confirm the diagnosis or consider alternative treatment options. For more localized infections, a small amount of the medication should be applied to the affected area, ensuring that it is only used on the areas of the skin that require treatment.

Child Dose

For pediatric patients, the recommended dose of gramicidin, neomycin sulfate, nystatin, and triamcinolone acetonide is similar to that for adults, though care should be taken to apply a smaller amount of the product, particularly for infants and young children. The frequency of application should generally be two to three times daily, with the goal of applying a thin layer to the affected area. Given that young children’s skin is more sensitive, this combination should be used cautiously to avoid potential side effects, such as skin thinning or systemic absorption of corticosteroids. In children, the duration of treatment should be minimized to avoid these risks, and the condition should be reassessed if no improvement is seen after 7-10 days of treatment. Prolonged use or use on large areas should be avoided. Additionally, children should be monitored for any signs of local irritation or allergic reactions, such as increased redness, itching, or swelling at the site of application.

Renal Dose

Since this medication is used topically, significant systemic absorption is minimal. However, patients with renal impairment should still be monitored for signs of systemic absorption, particularly if the medication is used on large areas of the skin or for prolonged periods. The nephrotoxic potential of neomycin is a concern, especially if large amounts are applied or if the medication is used inappropriately. In patients with significant renal dysfunction, the risk of systemic side effects from neomycin or triamcinolone increases. Therefore, while dose adjustments are generally not required for topical administration, renal function should be monitored in these patients, especially if the product is used for an extended period or over large skin areas.

Administration

Information not available