The following tests may be helpful in evaluating patients for HPA
axis suppression:
- Cosyntropin stimulation test
- AM plasma cortisol test
- Urinary free cortisol test
Carcinogenesis, Mutagenesis, Impairment of
FertilityLong-term animal studies have not been performed to evaluate the
carcinogenic potential of clobetasol propionate.
Clobetasol propionate was non-mutagenic in three different test systems: the
Ames test, the Saccharomyces
cerevisiae gene conversion assay, and the E.
coli B WP2 fluctuation test.
Studies in the rat following subcutaneous administration at dosage levels up
to 50 μg/kg per day revealed that the females exhibited an increase in the
number of resorbed embryos and a decrease in the number of living fetuses at the
highest dose.
PregnancyTeratogenic effectsPregnancy Category CCorticosteroids have been shown to be teratogenic in laboratory
animals when administered systemically at relatively low dosage levels. Some
corticosteroids have been shown to be teratogenic after dermal application to
laboratory animals.
Clobetasol propionate is absorbed percutaneously, and when administered
subcutaneously it was a significant teratogen in both the rabbit and the mouse.
Clobetasol propionate has greater teratogenic potential than steroids that are
less potent.
Teratogenicity studies in mice using the subcutaneous route resulted in
fetotoxicity at the highest dose tested (1 mg/kg) and teratogenicity at all dose
levels tested down to 0.03 mg/kg. These doses are approximately 1.4 and 0.04
times, respectively, the human topical dose of CLOBEX®
(clobetasol propionate) Lotion, 0.05%. Abnormalities seen included cleft palate
and skeletal abnormalities.
In rabbits, clobetasol propionate was teratogenic at doses of 3 and 10 μg/kg.
These doses are approximately 0.02 and 0.05 times, respectively, the human
topical dose of CLOBEX® (clobetasol propionate) Lotion,
0.05%. Abnormalities seen included cleft palate, cranioschisis, and other
skeletal abnormalities.
A teratogenicity study in rats using the dermal route resulted in dose
related maternal toxicity and fetal effects from 0.05 to 0.5 mg/kg/day of
clobetasol propionate. These doses are approximately 0.14 to 1.4 times,
respectively, the human topical dose of CLOBEX®
(clobetasol propionate) Lotion, 0.05%. Abnormalities seen included low fetal
weights, umbilical herniation, cleft palate, reduced skeletal ossification, and
other skeletal abnormalities.
There are no adequate and well-controlled studies of the teratogenic
potential of clobetasol propionate in pregnant women. CLOBEX® (clobetasol propionate) Lotion, 0.05% should be used during
pregnancy only if the potential benefit justifies the potential risk to the
fetus.
Nursing MothersSystemically administered corticosteroids appear in human milk
and could suppress growth, interfere with endogenous corticosteroid production,
or cause other untoward effects. It is not known whether topical administration
of corticosteroids could result in sufficient systemic absorption to produce
detectable quanitities in breast milk. Because many drugs are excreted in human
milk, caution should be exercised when CLOBEX® Lotion,
0.05% is administered to a nursing woman.
Pediatric UseUse of CLOBEX® Lotion, 0.05% in pediatric
patients is not recommended due to the potential for HPA axis suppression (see
PRECAUTIONS:
General).
The HPA axis suppression potential of CLOBEX® Lotion,
0.05% has been studied in adolescents (12 to 17 years of age) with moderate to
severe atopic dermatitis covering a minimum of 20% of the total body surface
area. In total 14 patients were evaluated for HPA axis function. Patients were
treated twice daily for 2 weeks with CLOBEX® Lotion,
0.05%. After 2 weeks of treatment, 9 out of 14 of the patients experienced
adrenal suppression. One out of 4 patients treated with CLOBEX® Lotion, 0.05% who were retested remained suppressed two weeks
post-treatment. In comparison, 2 of 10 of the patients treated with clobetasol
propionate cream, 0.05% demonstrated HPA axis suppression. One patient who was
retested recovered.
None of the patients who developed HPA axis suppression had concomitant
clinical signs of adrenal suppression and none of them was discontinued from the
study for reasons related to the safety or tolerability of CLOBEX® Lotion, 0.05%. However patients with acute illness or injury
may have increased morbidity and mortality with intermittent HPA axis
suppression.
Because of a higher ratio of skin surface area to body mass, pediatric
patients are at a greater risk than adults of HPA axis suppression and Cushing’s
syndrome when they are treated with topical corticosteroids. They are therefore
also at greater risk of glucocorticosteroid insufficiency during and/or after
withdrawal of treatment. Adverse effects including striae have been reported
with inappropriate use of topical corticosteroids in infants and children.
HPA axis suppression, Cushing’s syndrome, linear growth retardation, delayed
weight gain, and intracranial hypertension have been reported in children
receiving topical corticosteroids. Manifestations of adrenal suppression in
children include low plasma cortisol levels and absence of response to ACTH
stimulation. Manifestations of intracranial hypertension include bulging
fontanelles, headaches, and bilateral papilledema.
Geriatric UseClinical studies of CLOBEX® (clobetasol
propionate) Lotion, 0.05% did not include sufficient numbers of patients aged 65
and over to determine whether they respond differently than younger patients. In
general, dose selection for an elderly patient should be made with caution,
usually starting at the low end of the dosing range, reflecting the greater
frequency of decreased hepatic, renal or cardiac function, and of concomitant
disease or other drug therapy.