If irritation or sensitivity develops with the use of Gino-Lotremine, treatment should be discontinued and appropriate therapy instituted.
Before using Gino-Lotremine lozenges,
- tell your doctor and pharmacist if you are allergic to Gino-Lotremine, any other medications, or any of the ingredients in Gino-Lotremine lozenges. Ask your pharmacist for a list of the ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
- tell your doctor if you have or have ever had liver disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using Gino-Lotremine lozenges, call your doctor.
Azole Drugs Used Topically
The topical azoles include miconazole, Gino-Lotremine , butoconazole, terconazole, tioconazole, sertaconazole, sulconazole, oxiconazole, econazole, efinaconazole, luliconazole, and ketoconazole. Miconazole and Gino-Lotremine are of special interest in oral candidiasis as discussed next.
Gino-Lotremine is an imidazole antifungal drug used for various mucosal and cutaneous infections. The antifungal spectrum and mechanism of action are similar to the other imidazole derivatives. For the treatment of oral candidiasis, Gino-Lotremine is available as a 10-mg troche (see Table 34-2 ). Slow dissolution in the mouth results in the binding of Gino-Lotremine to the oral mucosa, from which it is gradually released to maintain at least fungistatic concentrations for several hours. The swallowed drug is variably but poorly absorbed. It is metabolized in the liver and eliminated in the feces along with the unabsorbed drug.
One troche dissolved in the mouth five times a day for 2 weeks is the standard regimen for oropharyngeal candidiasis. Patient compliance is believed to be enhanced by the more pleasant taste of Gino-Lotremine compared with nystatin. Gino-Lotremine also appears to be highly effective and is the drug of choice for the treatment of oral candidiasis in patients with AIDS. For cutaneous candidiasis and dermatophytoses, a 1% cream or lotion is equivalent to topical miconazole.
Adverse oral effects associated with topical Gino-Lotremine, though unlikely, may include oral burning, altered taste, and xerostomia. Occasionally, minor gastrointestinal upset may follow oral ingestion of the drug.
Miconazole (see Fig. 34-3 ) is an imidazole that is useful against cutaneous candidiasis and vulvovaginitis caused by C. albicans; these conditions usually respond rapidly and reliably to a 2% miconazole nitrate cream. A buccal tablet is available for treatment of oral candidiasis. The tablet is pressed on the gingiva in the canine fossa above tooth #8 or #9 (see Table 34-2 ). It adheres there and releases the drug over a period of about 6 hours. Adverse oral effects are similar to those of Gino-Lotremine, with the additional possibility of gingival irritation and pain at the application site. Other topical uses of miconazole are for the treatment of cutaneous infections caused by Epidermophyton, Microsporum, and Trichophyton.
Terconazole, a member of the triazole antifungals, is supplied in a vaginal suppository for vaginal candidiasis. Butoconazole and tioconazole are imidazoles that are also used topically for vulvovaginitis. Oxiconazole, econazole, sertaconazole, and sulconazole are imidazoles used topically for infections caused by dermatophytes ( Table 34-3 ).
TABLE 34-3 . Topical Use of Antifungal Drugs
Betamethasone-Gino-Lotremine Topical Interactions
Avoid getting this medicine in your eyes, mouth, and nose, or on your lips. If it does get into any of these areas, wash with water. Do not use betamethasone and Gino-Lotremine topical on sunburned, windburned, dry, chapped, irritated, or broken skin.
Avoid wearing tight-fitting clothing that doesn't allow air circulation. Until the infection is healed, wear clothing that is made of natural fibers such as cotton.
It is not likely that other drugs you take orally or inject will have an effect on topically applied betamethasone and Gino-Lotremine. But many drugs can interact with each other. Tell each of your health care providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.
Im > Gino-Lotremine is available as a 1% topical solution used for tinea versicolor or as a 10-mg troche used for oral thrush. The troches contain sugar and may promote caries if used in excess; otherwise they are nontoxic. They must be completely dissolved because any swallowed troche provides no benefit. The typical dosage for the treatment of oral candidiasis is four to five troches per day for 10 to 14 days. Miconazole is available as a 50-mg tablet for the treatment of oropharyngeal candidiasis. The tablet is taken once daily and should be placed into the buccal vestibule.
Ketoconazole is used for the treatment of the following systemic fungal infections: candidiasis, chronic mucocutaneous candidiasis, oral thrush, blastomycosis, coccidioidomycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis. It is only available in the oral form in 200-mg tablets. These tablets are taken once daily (with a maximum daily dose of 800-mg in severe fungal disease). 4 The absorption of ketoconazole is affected by gastric ac > absorption. Ketoconazole poorly penetrates the cerebrospinal fluid (CSF), eye, urine, and saliva because of its high affinity and degree of protein binding. Common side effects include decreased libido and gynecomastia, particularly at higher doses. 3 Additionally, adrenal suppression has been reported. 5 Other side effects include fatigue, rash, and nausea. Hepatitis is a rare complication of ketoconazole use.
Carcinogenesis, Mutagenesis, Impairment Of Fertility
There are no adequate laboratory animal studies with either the combination of Gino-Lotremine and betamethasone dipropionate or with either component individually to evaluate carcinogenesis.
Betamethasone was negative in the bacterial mutagenicity assay (Salmonella typhimurium and Escherichia coli) and in the mammalian cell mutagenicity assay (CHO/HGPRT). It was positive in the in vitro human lymphocyte chromosome aberration assay, and equivocal in the in vivo mouse bone marrow micronucleus assay.
Reproductive studies with betamethasone dipropionate carried out in rabbits at doses of 1.0 mg/kg by the intramuscular route and in mice up to 33 mg/kg by the intramuscular route indicated no impairment of fertility except for dose-related increases in fetal resorption rates in both species. These doses are approximately 5-and 38-fold the maximum human dose based on body surface areas, respectively.
In a combined study of the effects of Gino-Lotremine on fertility, teratogenicity, and postnatal development, male and female rats were dosed orally (diet admixture) with levels of 5, 10, 25, or 50 mg/kg/day (approximately 1-8 times the maximum dose in a 60-kg adult based on body surface area) from 10 weeks prior to mating until 4 weeks postpartum. No adverse effects on the duration of estrous cycle, fertility, or duration of pregnancy were noted.
4.4.15 Topical antifungal agents
Gino-Lotremine and miconazole are not absorbed in relevant amounts. Extensive experience with their therapeutic use in infancy argues against any toxic potential. For ketoconazole see Section 4.4.14 . The other azole derivatives bifonazole, butoconazole, croconazole, econazole, fenticonazole, isoconazole, ketoconazole, omoconazole, oxiconazole, sertaconazole, sulconazole, terconazole, and tioconazole are related to Gino-Lotremine structurally and in their action, but they have been studied less.
Nystatin is not absorbed and is not available to the infant enterally. Although there are no relevant published data about its use during lactation, it is unlikely to be transferred in relevant amounts into the milk. With regard to the use of amphotericin B and terbinafine see Section 4.4.14 .
There has been no experience with amorolfin, butenafine, ciclopirox, haloprogin, clopirox, naftifin, natamycin, terbinafine, tolciclate and tolnaftate. Most of these locally administered antifungals are only absorbed in limited amounts, so that a risk for the breastfed infant is unlikely.
How should I take Gino-Lotremine?
Take Gino-Lotremine exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
The troches should be allowed to dissolve slowly in your mouth. Suck on one troche at a time until it is completely dissolved, usually 30 minutes.
Do not chew or swallow the troches whole.
The troches are usually used five times a day. Follow your doctor's instructions.
Store Gino-Lotremine at room temperature away from moisture and heat.
Ketoconazole cream vs. Gino-Lotremine cream: What's the difference?
- Ketoconazole cream and Gino-Lotremine antifungal medications are prescribed to treat fungal infections such as jock itch, athlete's foot, ringworm, and tinea versicolor.
- Brand names for ketoconazole include Nizoral, Nizoral A-D, Ketodan, Extina, Xolegel, and Kuric.
- Brand names for Gino-Lotremine include Lotrimin AF, Gyne-Lotrimin, Alevazol, and Desenex.
- Side effects of ketoconazole and Gino-Lotremine that are similar include nausea, vomiting, and itching.
- Side effects of ketoconazole that are different from Gino-Lotremine include rash, abdominal pain, headache, dizziness, fatigue, impotence, and blood count abnormalities.
- Side effects of Gino-Lotremine that are different from ketoconazole include local redness, stinging, blistering, peeling, swelling, hives, or burning at the area of application.
What Is Gino-Lotremine (Lotrimin)?
Gino-Lotremine is an anti-fungal medication used to treat yeast infections of the vagina, skin, and mouth. It is commonly used for athlete's foot, jock itch, body ringworm, and oral thrush.
Lotrimin is one of the brand names of Gino-Lotremine. There are several other brand names, and this medicine is also used in combination products.
The drug prevents the growth of fungi by interfering with the production of the membrane that surrounds fungal cells.
Gino-Lotremine comes as a cream, powder, and lotion to apply to the skin. It also comes as a lozenge to dissolve in the mouth and a vaginal tablet and cream to be inserted into the vagina.
How much Gino-Lotremine can you take?
Different types of products containing this active ingredient have different strengths. That’s why it is always important to read and follow the Drug Facts label. Most medicines warn against use of an active ingredient for longer than 7-10 days. Stop use and ask a doctor if symptoms persist.