Triderm ointment: indications, methods of use

Compound

• 1 gram of Triderm ointment contains 10 mg of clotrimazole , 1 mg of gentamicin , 0.5 mg of betamethasone . Additional components: liquid paraffin, soft paraffin.
• 1 gram of Triderm cream also contains 10 mg of clotrimazole , 1 mg of gentamicin , 0.5 mg of betamethasone . Additional components: propylene glycol, petrolatum, liquid paraffin, cetostearyl alcohol, benzyl alcohol, macrogol cetostearate, phosphoric acid, sodium dihydrogen phosphate dihydrate, water, phosphoric acid.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Multicomponent product for external use. Combines the antipruritic, anti-inflammatory, antiallergic and antiexudative effect of betamethasone with the antifungal effect of clotrimazole and the antibacterial activity of gentamicin .

Clotrimazole has an antifungal effect due to its ability to inhibit the biosynthesis of ergosterol , which is an important structural unit of the fungal cell membrane. Effective on Epidermophyton floccosum, Trichophyton rubrum and mentagrophytes, Candida albicans, Microsporum canis, Malassezia furtur.

Gentamicin has a wide spectrum of effects. Exhibits a bactericidal effect and provides local treatment of bacterial skin lesions. Effective on:

• gram-negative bacteria – Proteus vulgaris, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes;
• gram-positive bacteria – Staphylococcus aureus.

Pharmacokinetics

There is no data on the pharmacokinetics of this drug.

What effect does Triderm ointment have?

The instructions for Triderm ointment indicate that the drug belongs to the group of anti-inflammatory, antifungal and antibacterial agents.

The therapeutic effect of the drug is due to the properties of its constituent components:

• clotrimazole – has antifungal activity, promotes the destruction of cells of pathogenic dermatophytes, yeast and mold fungi;
• gentamicin is a broad-spectrum antibiotic that is harmful to gram-positive and gram-negative bacteria (staphylococci, Klebsiella, Escherichia coli, Proteus);
• betamethasone is a glucocorticosteroid that has antiallergic and anti-inflammatory effects, relieves itching and swelling at the site of injury.

Indications for use

What does Triderm ointment and Triderm cream treat and for what? Indications for use of Triderm ointment:

• infections associated with microorganisms sensitive to the drug and frolicking against the background of dermatoses , or suspicion of them, including atopic , allergic and simple dermatitis , diffuse and limited neurodermatitis , dermatomycosis ( candidiasis , dermatophytosis , pityriasis versicolor ), eczema ;
• lichen simplex of a chronic nature.

In what cases will Triderm help?

The drug has a wide range of applications. The ointment can be applied to dermatoses with existing signs of infection or to prevent bacterial complications in dermatological diseases.

The manufacturer indicates the following list of indications:

• dermatitis, simple or allergic in origin;
• eczema;
• atopic dermatitis syndrome, neurodermatitis;
• manifestations of simple chronic lichen;
• diseases of fungal origin, for example, candidiasis, lichen versicolor, located in the groin area and large skin folds.

Contraindications

• skin symptoms of syphilis ;
• chicken pox;
• lupus ;
• post-vaccination skin reactions;
• herpes simplex;
• hypersensitivity to the components of the drug;
• age less than 2 years.

It is recommended to use the drug with caution for long-term therapy, in children over 2 years of age, during pregnancy, on large areas of skin or in the presence of wounds, when applying occlusive dressings.

Contraindications for the use of ointment, possible side effects

Triderm ointment is not used in case of individual intolerance or hypersensitivity to any of the substances in the composition.

Also, the medication is not used:

• skin lesions due to tuberculosis;
• with syphilis;
• chickenpox;
• skin reactions to vaccine administration;
• herpetic rashes;
• chicken pox;
• open wounds;
• in the treatment of children under two years of age.

The ointment can be used with caution during pregnancy, in pediatrics, when using bandages, for long courses and on large areas of the skin.

Adverse reactions occur rarely. These are mainly local unpleasant sensations - burning, itching, severe redness, wetting of the skin at the site of application.

The manufacturer also points out the possibility of side effects that have been recorded when using glucocorticosteroids:

• stretch marks;
• prickly heat;
• feeling of dryness;
• increased hair growth;
• acne;
• secondary infection;
• swelling or atrophy of the skin.

Due to the action of clotrimazole, the following may occur: tingling, blisters, swelling at the site of application, peeling and itching, redness, and urticaria-type rashes.

Side effects

• Local phenomena: erythema , burning sensation, pigmentation disorder, exudation , itching.
• Side effects after using local glucocorticosteroids : itching, burning sensation, folliculitis , dry skin, hypertrichosis, hypopigmentation, acne, allergic contact dermatitis , skin maceration, perioral dermatitis , atrophy , secondary infection, prickly heat , stretch marks .
• Side effects after using clotrimazole : urticaria , tingling sensation, erythema , peeling, blistering, itching, local swelling, irritation.
• Side effects after using gentamicin : temporary erythema and itching, which does not require discontinuation of therapy.

Contraindications and adverse reactions

You should refrain from taking Triderm in the following cases:

• chickenpox;
• tuberculosis of the skin;
• common herpes;
• children under 2 years old;
• skin manifestations of syphilis;
• skin manifestations of the vaccine;
• increased susceptibility to constituent components.

Particular caution should be taken when taking the medicine during long-term treatment, in young children, pregnant women, on large skin areas, or in the presence of injuries.

The following adverse reactions may occur:

• local manifestations: burning, itching, impaired pigmentation;
• negative reactions after taking glucocorticosteroids: burning, itching, dry skin, allergies in the form of a rash;
• undesirable reactions after using clotrimazole: local swelling, skin irritation;
• negative manifestations after taking gentamicin: itching (no need to stop treatment).

Instructions for use of Triderm (Method and dosage)

Triderm ointment, instructions for use

The ointment is for external use only.

The use of Triderm ointment is carried out in the following way: a thin layer is applied to the affected and surrounding skin twice a day (morning and evening). To ensure a therapeutic effect, the product must be applied regularly. The duration of treatment depends on the size and location of the lesion, as well as the response to therapy.

If improvement is registered after 4 weeks of treatment, you should consult a doctor and clarify the diagnosis.

Triderm cream, instructions for use

The cream is for external use only. The method of application and dosage when using the cream are completely consistent with those when using the ointment.

How to take it correctly

Ointment

The medicine in the form of an ointment is used according to the following scheme: applied in a thin layer to the damaged area of ​​​​the skin and around it 2 times a day. To achieve a therapeutic effect, it is important to observe regularity. The duration of the treatment course depends on the degree of infection, as well as the body’s reaction.

If the condition improves after a month, then it is worth informing a specialist so that he can make a diagnosis again.

Cream

The product in cream form is intended for topical use. The application regimen is identical to the ointment.

Overdose

Signs of overdose with local glucocorticosteroids : with long-term use in large doses, suppression of adrenal function with the appearance of adrenal insufficiency and hypercortisolism .

An overdose of clotrimazole when applied locally does not lead to the development of any symptoms.

In case of an overdose of gentamicin, no symptoms are detected either. Long-term treatment with gentamicin in large doses may cause the appearance of insensitive flora.

Overdose therapy: symptomatic. Acute hypercortisolism is usually reversible. If necessary, correct electrolyte imbalance. In case of chronic overdose of local glucocorticosteroids, slow withdrawal is recommended.

Triderm cream 15g No. 1

Name

Triderm cream in tube 15g in pack No. 1

Description

Soft consistency, white or almost white, homogeneous cream, free of foreign inclusions.

Main active ingredient

Betamethasone+gentamicin+clotrimazole

Release form

Cream

Dosage

15g

Pharmacological properties

The mechanism of action of Triderm combines the following mechanisms of action: the anti-inflammatory effect of betamethasone dipropionate, the antibacterial effect of gentamicin and the antifungal effect of clotrimazole.

Pharmacodynamics

Betamethasone in the form of dipropionate is a potent corticosteroid (class III) with anti-inflammatory, antiallergic and antipruritic effects. Gentamicin is an aminoglycoside antibiotic with antibacterial activity. Its action is based on suppressing the synthesis of proteins of sensitive microorganisms. Gentamicin affects many aerobic gram-negative and some gram-positive bacteria. In vitro, gentamicin at concentrations of 1-8 μg/ml inhibits the growth of most sensitive strains of Escherichia coli (Escherichia coli), Haemophilus influenzae (Haemophilus influenzae), Moraxella lacunata (Morax-Axenfeld sticks), Neisseria (Neisseria), indole-positive and indole-negative Proteus, Pseudomonas (pseudomonas), including most strains of Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis and Serratia. Different species and different strains of the same species may exhibit large differences in susceptibility under in vitro conditions. In addition, in vitro sensitivity does not always correlate with in vivo sensitivity. Gentamicin is not effective against most anaerobic bacteria, fungi and viruses. Gentamicin has only minimal effect on streptococci. Resistance to gentamicin can develop in both gram-negative and gram-positive bacteria. Clotrimazole is a synthetic antifungal agent - an imidazole derivative. The spectrum of action covers a number of fungi that are pathogenic for humans and animals. Clotrimazole is effective against dermatophytes, yeasts and molds. In in vitro assays, clotrimazole was effective against the fungi Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis and fungi of the genus Candida, including Candida albicans. According to current knowledge, the antifungal effect of clotrimazole is explained by the inhibition of ergosterol synthesis. Ergosterol is a vital component of the cell membrane of fungi.

Pharmacokinetics

There are no data on the pharmacokinetics of Triderm. Betamethasone Under normal conditions, when applied topically, only a portion of betamethasone enters the systemic circulation. The percentage of penetration and absorption depends on the body area, skin condition, dosage form, age and method of application. Gentamicin When gentamicin is applied to intact skin, absorption is unlikely to be expected. If the keratin layer is damaged, inflamed, used under an occlusive dressing, or applied to a large area, increased percutaneous absorption should be expected. Clotrimazole Most of the applied clotrimazole remains in the stratum corneum, and absorption into the systemic circulation is negligible. 6 hours after applying 1% radioactive clotrimazole to healthy skin, as well as to skin with acute inflammation, the following concentrations could be determined: stratum corneum - 100 μg/cm3, reticular layer - 0.5-1 μg/cm3, subcutaneous tissue - 0.1 µg/cm3.

Indications for use

Triderm is indicated for the treatment of corticosteroid-sensitive dermatoses in which bacterial and/or fungal infection either already exists or is to be feared. First of all, the drug is suitable for use in stages of the disease with weeping lesions.

Directions for use and doses

Adolescents and adults 2 times a day (morning and evening), apply a thin layer to the affected areas of the skin and rub in lightly, covering both the entire affected area and the healthy surface of the skin surrounding it. The duration of treatment depends on the results of both clinical examination and microbiological examination, as well as on the response to treatment. For athlete's foot, the need for longer treatment (2-4 weeks) may be considered. Children from 2 to 12 years Apply a small amount only to affected areas of skin and rub in gently. Apply no more than twice a day, taking a break of at least 6-12 hours between cream applications. Apply the cream to the face, neck, scalp, genital area, rectal area and diaper rash areas under the supervision of a physician. The duration of treatment is limited to 5-7 days. See sections "Precautions" and "Use in pediatric patients".

Use during pregnancy and lactation

Pregnancy: In animal studies, topical corticosteroids have been shown to be teratogenic. There are no data on use in pregnant women. Aminoglycosides cross the placental barrier and may cause fetal harm if taken by pregnant women. There have been reports of complete irreversible bilateral congenital deafness in children whose mothers took aminoglycosides, including gentamicin, during pregnancy. There are no sufficient data on the topical use of gentamicin in pregnant women. There are no sufficient data on the use of clotrimazole in pregnant women. Results from animal studies did not reveal any risks to the fetus. Triderm should only be used in cases where it is absolutely necessary. Triderm should not be used over a large area, in large quantities or for a long time. Breastfeeding There is no data on the excretion of gentamicin, clotrimazole and topical corticosteroids into breast milk, but corticosteroids that enter the systemic circulation also pass into breast milk. When applying Triderm to the mammary glands, breastfeeding is contraindicated. The ability to influence the speed of reaction when driving a vehicle or working with other mechanisms. As a rule, the drug does not affect the speed of reaction when driving a vehicle or working with other mechanisms.

Precautionary measures

If irritation or sensitization occurs due to the use of Triderm, treatment should be discontinued and appropriate therapy should be initiated. The absorption of active substances intended for topical use into the systemic circulation may be enhanced if Triderm is applied over a large area, in particular with long-term use or use on damaged skin. Under these conditions, undesirable effects may occur in the form in which they appear after systemic use of active substances. When used in children in such cases, extreme caution is recommended. In case of simultaneous systemic use of aminoglycoside antibiotics, with increased percutaneous absorption, cumulative toxic effects (ototoxicity, nephrotoxicity) should be expected. The possibility of possible cross-allergy to other aminoglycoside antibiotics should be taken into account. With long-term treatment with drugs containing antibiotics, insensitive microorganisms may appear. In this case or if superinfection occurs, appropriate therapy should be started. High-dose, large-scale or occlusive application of a potent or very potent corticosteroid should only be done under regular medical supervision, especially given the suppression of endogenous corticosteroid production and possible metabolic effects. Avoid use on open wounds and damaged areas of skin. The period of continuous use, if possible, should not exceed 2-3 weeks. Very strong, strong and moderate-acting corticosteroids should be used on the face and genital area with extreme caution and for no longer than 1 week. In principle, only weak corticosteroids are used near the eyes (due to the risk of developing glaucoma). Corticosteroids may mask the symptoms of an allergic skin reaction to the drug's ingredients. The drug contains propylene glycol and cetostearyl alcohol as auxiliary components. When used externally, propylene glycol can cause skin irritation, and cetostearyl alcohol can cause skin reactions (for example, contact dermatitis). The patient should be instructed to use the drug only for the treatment of his current skin condition and not to give the drug to others. When using systemic and local corticosteroids (including intranasal, inhaled and intraocular administration), visual disturbances may occur. If symptoms such as blurred vision or other visual disturbances occur, the patient should be evaluated by an ophthalmologist to evaluate possible causes of the visual disturbance, which may include cataracts, glaucoma, or rare diseases such as central serous chorioretinopathy, which has been reported following the use of corticosteroids systemic and local action. Use in pediatric patients This medicinal product is not recommended for use in children under 2 years of age. Pediatric patients may be more sensitive than adult patients to hypothalamic-pituitary-adrenal axis suppression and exogenous corticosteroid activity caused by topical corticosteroids because the greater ratio of skin surface area to body weight results in greater absorption. Suppression of the hypothalamic-pituitary-adrenal axis, Cushing's syndrome, decreased linear growth, decreased weight gain, and increased intracranial pressure have been reported with the use of topical corticosteroids in children. Symptoms of adrenal suppression in children include, among other things, low plasma cortisol levels and lack of response after adrenocorticotropic hormone (ACTH) stimulation. Symptoms of increased intracranial pressure include bulging fontanel, headaches, and bilateral papilledema, among others.

Interaction with other drugs

Due to the content of white soft paraffin and liquid paraffin, the tensile strength and, therefore, the safety of using latex condoms may be reduced; this should be taken into account when using the ointment in the genital or anal area. When applied topically, clotrimazole may have an antagonistic effect on amphotericin and other polyene antibiotics.

Contraindications

Skin infections (viral, bacterial

incl. tuberculosis

, as well as fungal origin), reactions to vaccines, skin ulcers and acne are contraindications for the use of topical corticosteroids. If you have rosacea or perioral dermatitis, you should avoid applying the cream to your face. Hypersensitivity to one of the active or excipient substances of the drug, to other aminoglycoside antibiotics (cross-allergy with gentamicin) or imidazole derivatives (cross-allergy with clotrimazole). Triderm is not intended for use under an occlusive dressing. Triderm should not be applied to mucous membranes, skin around the eyes or near the eyes.

Compound

1 g of cream contains: active ingredients: 0.5 mg of betamethasone (in the form of betamethasone dipropionate – 0.643 mg); 10.0 mg clotrimazole; 1.0 mg gentamicin (as gentamicin sulfate); excipients: liquid paraffin, white soft paraffin, cetostearyl alcohol, propylene glycol, macrogol cetostearyl ether 20-22, benzyl alcohol, sodium dihydrogen phosphate dihydrate, phosphoric acid, sodium hydroxide, purified water.

Overdose

Symptoms: with prolonged or excessive use of local glucocorticosteroids, suppression of pituitary-adrenal function with the development of secondary adrenal insufficiency and the appearance of symptoms of hypercortisolism, including Cushing's syndrome, are possible. A single overdose of gentamicin is not expected to cause any symptoms. Excessive or prolonged use of gentamicin may lead to overgrowth of microorganisms that are not sensitive to the antibiotic. The use of clotrimazole under an occlusive dressing for 6 hours did not lead to the development of overdose symptoms. Treatment: appropriate symptomatic therapy is prescribed. Symptoms of acute hypercortisolism are usually reversible. If necessary, electrolyte balance is corrected. In case of chronic toxicity, gradual withdrawal of corticosteroids is recommended. If there is excessive growth of resistant microorganisms, it is recommended to stop treatment with Triderm and prescribe the necessary therapy.

Side effect

At the beginning of treatment Skin Rarely: irritation, burning, itching, dryness, hypersensitivity reactions to any of the ingredients of the drug and changes in skin color. When used over large areas, under an occlusive dressing and/or with longer use. When used over large areas, under an occlusive dressing and/or with longer use, local skin changes are possible. When applying the cream over large areas, there is a possibility of systemic effects (suppression of the function of the adrenal cortex). It should be taken into account that due to reduced local resistance to infections, there is an increased risk of secondary infections. Skin Local skin changes such as atrophy (especially on the face), telangiectasias, striae, stripe-like skin atrophy, skin hemorrhages, purpura, steroid acne, rosacea-like or perioral dermatitis, hypertrichosis, and changes in skin color. It is not known whether skin color changes are reversible. Sometimes: contact hypersensitivity to gentamicin. In some patients, possible photosensitivity was observed, which, however, did not resume with repeated application of gentamicin followed by exposure to ultraviolet radiation. Endocrine system Suppression of the synthesis of endogenous corticosteroids, hypercortisolism with edema. Metabolism Diabetes mellitus (manifestation of a previously hidden form). Ear, inner ear/kidney Cumulative ototoxicity/nephrotoxicity should be expected during treatment with wide area cream application or use on broken skin with concomitant systemic use of aminoglycoside antibiotics. Musculoskeletal system Osteoporosis, growth retardation (in children). Systemic adverse reactions, such as blurred vision, have also been reported with the use of topical corticosteroids. If the listed adverse reactions occur, as well as reactions not listed in the instructions for use, you should consult a doctor.

Storage conditions

Store out of the reach of children at a temperature not exceeding 25°C.

special instructions

Triderm ointment and cream are not intended for use in ophthalmic practice.

Prolonged use of local antibiotics in some cases can lead to the emergence of resistant microflora. In such a case, as well as in case of sensitization , irritation or superinfection , Triderm therapy should be stopped and symptomatic treatment should be started. Cross allergic phenomena with aminoglycoside antibiotics cannot be excluded .

All side effects that occur when taking systemic glucocorticosteroids , including suppression of the adrenal cortex, can also develop when using local glucocorticosteroids , especially in children.

The absorption of active substances into the systemic circulation when applied topically is enhanced if treatment is carried out with the application of occlusive dressings or over large areas of the skin, especially during prolonged treatment or when the skin is wounded. It is strongly recommended to avoid contact of gentamicin with open wounds or broken skin, as this may cause adverse reactions characteristic of systemic use of gentamicin .

With long-term use of the drug, its withdrawal should be carried out slowly.

There was no effect of the drug on the ability to drive vehicles.

Additional recommendations

The ointment is not used for infectious diseases of the organs of vision. With long-term use of a local antibiotic, pathogenic microorganisms may develop resistance to it.

Do not apply the product to open wound surfaces or severely damaged skin. The use of dressings and application of the product to large areas of skin contribute to higher absorption of gentamicin and glucocorticosteroids, resulting in an increased risk of adverse reactions.

If use has been long-term, then it should be discontinued gradually.

Triderm's analogs

Level 4 ATX code matches:
Rederm

Losterine

Akriderm SK

Akriderm

Akriderm GK

Akriderm Genta

Elokom S

Diprosalik

Belosalik

Kanizon Plus

Betasalik

Triacutan

Momat-S

Analogues of Triderm cream and ointment: Akriderm (Russian substitute), Kanizon , Triakutan, Betazon Ultra, Lokoid, Diprosalik, Betasalik.

The price of analogues of Triderm ointment, which are listed above, is an order of magnitude lower than the price of the product itself.

Analogs

Proven analogues include:

Kanizon. Available in the form of cream, solution and tablets. The drug is effective for various diseases and joint problems.

Lokoid. It is produced in the form of ointment and cream. It has a local antipruritic and anti-inflammatory effect.

Betasalik. Available in the form of an ointment. It is a drug of combined action. has anti-inflammatory, antiseptic and antiallergic effects.

Triactutan. Sold in the form of ointment and cream. It has antifungal, antibacterial and anti-inflammatory effects.

Basically, the price of analogues will be lower than Triderma.

For children

The medicine is prescribed only to children over 2 years of age, according to strict indications and under the supervision of a doctor, since it is possible that systemic side effects associated with betamethasone appear in this category of patients more often than in adults. Such side effects include: Cushing's syndrome , inhibition of the pituitary-hypothalamic-adrenal system , growth retardation, increased intracranial pressure (as a consequence, headache, swelling of the optic nerve and bulging of the fontanelles), slower growth of body weight.

Reviews about Triderm

Reviews of the cream, as well as reviews of Triderm ointment, report rare cases of ineffectiveness and even more rarely undesirable effects (mainly itching). Otherwise, 90% of reports give an excellent rating to the drug. Due to the complex composition and the possibility of severe side effects, it is not recommended to use this medicine independently and unsupervised.

Is Triderm ointment hormonal or not?

The ointment and cream of the same name contain the hormonal component betamethasone , so they can be called hormonal.

Triderm and balanoposthitis

Despite the good results of treating balanoposthitis with this remedy, many doctors do not recommend its use for this pathology, due to the high probability of damage to the skin of the genitals under the influence of hormones.

Cream or ointment: which is better?

Reviews do not reveal any significant correlation between the effectiveness of these forms of release of the drug.

Is it possible to take Triderm during pregnancy?

During the period of bearing a child, the use of the drug is possible only as prescribed by a doctor and under constant supervision. In this case, the possible beneficial result must significantly outweigh the possible threat to the developing fetus and the expectant mother. It is better not to use the cream for a long time or on large areas of skin.

During breastfeeding, it is strictly forbidden to take the drug, since there is no data regarding the possibility of excretion of the constituent components together with breast milk.

Triderm price, where to buy

The price of Triderm ointment 15 g in Russia is 570-680 rubles, and cream 15 g costs 580-640 rubles. Buying a cream in Moscow (like ointment) will cost a large amount; here its cost reaches 820 rubles.

Ointment 15 g costs 230-300 hryvnia in Ukraine. The price of Triderm cream 15 g is on average 230-290 hryvnia.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

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