Quadriderm Cream – Usage,Dosage, Side effects, Precautions

Quadriderm is a topical (applied to skin) dermatological preparation which belongs to a class of steroids. It is a combination of drugs like Betamethasone, Gentamycin, tolnaftate and clioquinol. It is used for treating various skin disorders like microbial infections, fungal infections, dermatitis, eczema, Psoriasis of scalp, feet and hands, Pruritus and groin ringworm infections.

Therapeutic class Antibacterial, Antifungal, Anti-inflammatory (which relieves pain), Antipruritic (which relieves itching) and vasoconstrictive (which narrows blood vessels).
Dosage forms Cream, Ointment, Injection
Available Strengths 5gm,10gm and 15gm
Route of administration Applied topically to the affected area
Prescription Required
Alternatives Mycopar cream, fourdrem cream, Tolbet, ABC derm, Quadrimex.
Cream Validity 36 months
Pharmacokinetics Onset of action: Generally onset is within 1 hour of application of cream.
Pharmacokinetics Duration of action: It depends on the dosage form used and its administration. For cream it is up to 8hours

What is it prescribed for?

It is also used to treat

  • Rheumatoid arthritis (inflammation of joints)
  • Systemic lupus erythematous (it is an inflammation caused when immune system attacks its own tissues)
  • Allergies like asthma, eye disorders
  • Multiple sclerosis (disease of brain and spinal cord)
  • Leukemia (cancer caused by excessive production of white blood cells)
  • Crohn’s disease (inflammatory disease of digestive tract)
  • Folliculitis (infection of hair follicles)
  • Ulcerative colitis (bowel disease that causes inflammation of digestive tract)

Composition of Quadriderm Cream

It contains the following active ingredients.

  • Betamethasone (0.61mg)
  • Clioquinol (10 mg)
  • Gentamycin (1mg)
  • Tolnaftate (10mg)

Dosage

The quantity of cream to be applied for any type of skin infections is as per dermatologist prescription.

A thin film of cream is applied to cover the entire affected area for two to three times daily.

Frequency of applications depends on the condition of disease and its severity.

Duration of treatment depends on the extent and location of infection and response of the patient to the drug. For Tinea pedia, a fungal infection generally two to four weeks of application is required for improvement but if the symptoms were not resolved it can be applied for three to four weeks.

Over Dosage

You should contact your doctor if you take overdose of medicine i.e when the prescribed dose is high. You may experience adverse reactions like thinning of skin, bleeding and adrenal insufficiency etc. by taking overdose of the drug.

Missed a Dose?

If you miss the dose of cream, apply the cream as soon as you remember. If it is nearest time of your next dose skip the dose and apply the next dose. You should not apply the missed dose the next day or double the dose the next day.

Contraindications

  • If you have allergy.
  • If you have fungal infection affecting internal organs.
  • If you take high doses, it suppresses the immune system and this may reduce the body to fight against infections. So this should not be given in patients with active infections.

How it can be stored?

  • It should be stored in a cool place protected from light and moisture.
  • Store between 2° and 30°C.
  • Keep away from direct heat and light.

How to use

  • This medicine is for topical application only.
  • Wash your hands before and after using this cream.
  • Dry the area of your skin before applying the cream.
  • Apply the cream as a thin layer on the affected area.

Information for patients while using this cream

  • Don’t take the medicine by mouth and avoid contact with eyes & nose.
  • Don’t wash the affected area immediately after applying the cream.
  • Don’t apply this cream on open wounds, irritated skin, dry skin and for sun burnt skin.
  • Avoid using other skin care products while using this cream.
  • Excessive amounts of cream shouldn’t be applied to the affected area as it leads to pilling.
  • After applying the cream the affected area shouldn’t be covered with a bandage.
  • If the cram is used for long term patient should be monitored for its side effects.

How it works?

  • It has different active ingredients and each one shows its own action in a different way.
  • Betamethasone: It is a class of steroids which acts by reducing the formation of chemicals which leads to redness, itching and swelling of skin.
  • Clioquinol: It is an antifungal agent which inhibits the synthesis of DNA in fungi thereby killing the fungi responsible for infection
  • Gentamicin: It is an antibiotic which kills the bacteria. It works by binding to 30s ribosomal subunit of bacteria or fungi thereby by preventing the protein synthesis so that they cannot grow and reproduce.
  • It also possesses topical antiseptic activity.

Different brands of Quadriderm:

Brand Name Manufacturer
Quadriderm Fulford (India) Ltd.
Mycopar cream Blue cross laboratories
Tolbet CFL Pharmaceuticals
Fourderm Cream Cipla Ltd
ABC derm Emcure pharmaceuticals
Quadrimex Ind-Swift Ltd.

Side effects

Apart from its therapeutic action it also causes side effects like

  • Increased risks of infections
  • Muscle weakness
  • Allergic reactions at the application site
  • Long term use may cause adrenal insufficiency.
  • Commonly causes Skin irritation and excessive hair growth
  • Increased appetite (hunger)
  • Pruritus (Skin itching)
  • Psychosis
  • Persistent infections
  • Blurred vision
  • Dizziness and drowsiness
  • Thinning of skin
  • Allergic reactions
  • Acne at the site of application
  • Redness
  • Mild depigmentation
  • Nausea (Vomiting Sensation)

Precautions

  • This medicine should be used in caution when you recently suffered from Tuberculosis as this drug may increases the chances of attacking Tuberculosis again. So patients should be closely monitored for symptoms of TB while using this drug.
  • This drug causes imbalances in minerals like calcium, potassium and sodium hence it should be used in caution if you suffer from electrolyte imbalances previously.
  • This drug causes bleeding or perforations in the stomach and intestine so it should be used in caution if you previously have perforations or bleeding from stomach and intestine.
  • It should be used in caution if you have an eye infection caused by herpes simplex virus.

Interactions

  • It interacts with other medicines. So inform your doctor that you are using amlodipine, warfarin, insulin, ciprofloxacin, Ethinyl estradiol.
  • This medicine should not be used with mifepristone as this reduces the effects of betamethasone.
  • It also interacts with acetaminophen, Glucorticoids, Chlorpropamide and atropine.
  • If you use phenobarbital, phenytoin and rifampin along with this cream these drugs decrease the effects of Quadriderm cream by increasing its metabolism.
  • Dosage of anti diabetic drug should be reduced when corticosteroids are given to diabetic patients.

About Abuse and awareness of steroids

A research was conducted in 1000 adult patients to know the usage and awareness of dermatological steroids. In this study it was found that 80% of the patients know at least one of the steroids or its combination. 61.2% of the patients had used this cream. Mostly people use this cream for treatment of acne and pigmentation. 51.9% people experienced any one of the side effects mentioned above.

Finally it was concluded that many people are misusing the topical steroids. It is very important that people who are using this cream should be aware of its side effects.

Topical Steroid Awareness and Abuse: A Prospective Study among Dermatology Outpatients. Indian J Dermatol. 2016 Nov-Dec; 61(6): 618–621.

FAQ’S:

Is it safe during pregnancy and breastfeeding?

Thisis generally not recommended during pregnancy and for breastfeeding mothers. If it is really required stop breast feeding.

Can it be used for minor bacterial and fungal infections?

Yes it can be used to treat minor bacterial and fungal infections. Consult your doctor before using this cream.

Can it be used for inner ear fungal infection?

Yes it can be used to treat fungal infection of the inner ear. Apply this cream with an ear bud inside by twisting round so that the cream reaches your ear canal.

Can it be used for children and infants?

Yes it can be used to treat infections in children and infants upon consultation from doctor.

Pediatrics are more sensitive to any exogenous topical steroids as they have lesser surface area of skin than adults. So it should be used only by consulting doctor.

Can this cream used on face?

Yes, it can be used on face but shouldn’t be used for more than five days.

When is the frequency of application of Quadriderm cream?

It can be applied once a day or twice a day but one should follow the doctor’s advice. As frequency of application depends on the severity of infection.

How long this cream has to be used for better results?

This cream is generally applied for 1 week to relieve the infection but this depends on how one uses it. Consult your dermatologist if infection still persists after two weeks.

When can be a Quadriderm cream applied? It can be applied Before or after food as it passes first pass metabolism (i.e bypasses liver and gastrointestinal tract for metabolism) and shows its systemic action on the skin.

References

Product information – Quadriderm Cream

http://www.meppo.com/pdf/drugs/1459-QUADRIDERM-1321612536.pdf

https://pharma.knoji.com/quadriderm-cream/

https://glowpink.com/meds/quadriderm-cream/

https://www.liveitbeautiful.com/quadriderm/

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