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Clotrimazole Betamethasone Dipropionate Cream ( Lotrimin AF )

What is clotrimazole?

Clotrimazole (brand names Lotrimin AF, Lotrisone, Lotriderm) is a topical antifungal drug available by prescription most frequently used to treat dermatological fungal infections such as ringworm, athlete’s foot, and jock itch.

In this medicinal cream or lotion form, the fungal inhibitor clotrizone is combined with betamethasone dipropionate, a corticosteroid that reduces the swelling, itching, and redness caused by infection.

In the family of azole antifungals, clotrimazole operates by inhibiting an enzyme which controls the production of an essential component in the fungal cell membrane, resulting in the depletion of that component and thus the death of the fungal cell.

In the family of corticosteroids (along with cortisone, hydrocortisone, and prednisone), betamethasone dipropionate operates by mimicking the effects of certain hormones (such as cortisol) naturally produced by the adrenal glands, which reduce inflammation.

When combined in a medicinal cream or lotion, these two drugs work both to ease the symptoms of infection and to eliminate it at its roots. While betamethasone dipropionate reduces the rash, itching, and swelling generated by a present infection, clotrimazole attacks the fungus and prevents new growth.

This medication is for topical use only and should not be applied to the eye, mouth, or vagina. Because of potential side effects, typically, clotrimazole betamethasone dipropionate cream should not be prescribed to those under 17 years of age, nor should it be used to treat diaper rash.


Clotrimazole Side Effects

Many of those who use topical clotrimazole betamethasone dipropionate do so without experiencing side effects. Among those who have reported side effects, however, the most common are dermatological. If any of the following conditions persist in the affected area, grow worse, or spread to new areas, consult your doctor immediately:

  • blistering, stinging, burning, itching, numbness, prickling, or tingling
  • dryness, redness, peeling, or other signs of skin irritation
  • chills
  • rash
  • fever
  • cough
  • hoarseness
  • lower back pain, side pain
  • difficulty urinating
  • swelling

 

Less common but more serious side effects include the following. If you experience any of them in your use of this drug, be sure to seek medical attention right away:

  • fatigue or extreme tiredness
  • fast, irregular, or pounding heartbeat
  • weight loss
  • headache
  • blurred or decreased vision
  • increased thirst and/or urination
  • swelling ankles or feet
  • extreme hair growth
  • skin discoloration or thinning
  • acne
  • stretch marks
  • folliculitis (inflamed hair follicules)

 

The use of a topical corticosteroid has been linked to increased risk of cataracts and glaucoma. Contact your doctor immediately if you experience any alteration in vision.

Because this medication contains a corticosteroid which suppresses the immune system, it could, if absorbed into the bloodstream, interfere in the operation of the adrenal gland, which naturally regulates metabolism, immune system, blood pressure, and response to stress. This condition, called hypothalamic-pituitary-adrenal (HPA) axis suppression, can occur either during treatment or after it has ended.

Patients who over 65 are at greater risk of HPA axis suppression due to thinning skin. Additional factors which increase risk of HPA axis suppression include:

  • the use of a corticosteroid for a long period of time and/or over a large area of skin
  • the use of other steroids
  • the presence of an occlusive dressing over the area of application
  • liver failure
  • any condition that weakens the skin

It is important that your doctor identify adrenal suppression right away. When you report symptoms, your doctor may administer an adrenal test (adrenocorticotropic hormone stimulation test).

Although unproven at this point, in patients under the age of 17, the irregular absorption of a corticosteroid resulting in adrenal suppression could inhibit growth and development. Pediatric patients who have used corticosteroids have exhibited delayed growth and weight gain, Cushing’s syndrome, and intracranial hypertension. It is not recommended, therefore, that doctors prescribe this drug to patients under 17. Nor is advised to pregnant or breast-feeding mothers. In some cases, however, a doctor may decide that the benefits of this drug outweigh the risks. While similar medications have been shown to transmit negative effects to the fetus or nursing child, this medication has not yet been conclusively tested. If you are pregnant, planning to become pregnant, or breast-feeding, consult your doctor before using this drug to discuss the benefits and risks.

While serious allergic reactions to clotrimazole betamethasone dipropionate are rare, should one occur, immediate medical attention is required. Before using this or any medication, be sure to tell your doctor of any existing allergies you have, especially if they have ever manifested in your use of other azole antifungal drugs (such as fluconazole or ketoconazole), or of corticosteroids (such as cortisone, hydrocortisone, or prednisone, triamcinolone). Be particularly cautious if currently using the following medications, which should not be combined with clotrimazole betamethasone dipropionate:

  • Desmopressin
  • Rotavirus Vaccine, Live

 

If you experience any of the following symptoms while using this medication, seek immediate medical attention:

  • rash
  • itching and swelling of the face, tongue, or throat
  • severe dizziness
  • difficulty breathing

 

Certain underlying conditions could influence the effects of this medication, as well. Be sure to tell your doctor if you have a history of any of the following:

  • immune deficiencies or poor circulation
  • bacterial or viral infections of the skin
  • tuberculosis (TB) of the skin
  • cataracts
  • Cushing’s syndrome
  • diabetes
  • glaucoma
  • hyperglycemia (high blood sugar)
  • intracranial hypertension (increased pressure in the head)
  • diaper dermatitis (diaper rash)
  • herpes
  • vaccinia (cowpox)
  • varicella (chickenpox)
  • skin sores or injury at the place of application
  • liver failure

 

In addition, if you are preparing to undergo any kind of surgery, be sure to inform your doctor if you are using or have used this medication within the last several months. Because of its effects on the adrenal gland, the corticosteroid contained in the combination cream could inhibit your ability to respond to the physical stress of a surgical procedure.


Clotrimazole Dosage

Every prescription is written uniquely by a doctor for a particular patient in light of that patient’s specific health history. Dosage amount, frequency, and duration will therefore vary from patient to patient. Always take a medication prescribed to you exactly as instructed by your physician. Consult the label and your pharmacist if you have any questions.

Clotrimazole betamethasone dipropionate is prescribed in either lotion or cream form, generally in the following dosages. These details are for informational purposes only. Do not assume that they represent your doctor’s prescription.

Whether using the lotion or cream, right before applying the medication, thoroughly clean and dry the affected area. Then, apply a thin layer of the medication to the affected area and rub it into the skin.

For ringworm or jock itch, generally, those over 17 years of age are instructed to apply the topical lotion or cream to the affected area twice a day, for the duration of one-to-two weeks.

For athlete’s foot, those over 17 years of age are instructed to apply the topical lotion or cream to the affected area twice a day, for two-to-four weeks.

Clotrimazole betamethasone dipropionate is not recommended for patients under the age of 17.

In the case of a missed application, apply the medication as soon as possible unless approaching the time when you should take your next dose. In that case, skip the missed dose and keep to your regular schedule.

After applying the medication, be sure to wash your hands so as to avoid exposing more of the skin to the corticosteroid than is necessary. Never apply this medication to the eyes, mouth, or vagina. Unless instructed by your doctor, do not dress, wrap, or otherwise occlude the affected area (with clothes, a diaper, plastic pants, etc.). Occlusion can cause skin atrophy and other negative conditions.

If you must cover the affected area, such as by wearing socks or underwear, be sure to wear clothing that is clean, loose-fitting, made of cotton, and changed at least daily. Avoid materials that will trap heat and moisture, such as wool, polyester, nylon, and rayon.

If treating athlete’s foot or another fungal infection of the foot or toenail, wear shoes that allow for ventilation, such as sandals.

To keep the affected area dry, it is often recommended to use a talcum or antifungal powder up to twice per day on the affected area, as well as on socks, shoes, or underwear. Be sure, however, that the clotrimazole betamethasone dipropionate lotion or cream has been fully absorbed before applying the powder.

Do not use cosmetics on any affected area.

Typically, you should see improvement within one week for jock itch and ringworm, and within two weeks for athlete’s foot. Tell your doctor if you do not notice improvement. Regardless of your progress, be sure to finish out the entirety of your prescription. If you terminate the dosage early, you may be at risk of reinfection.