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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Duobrii (Halobetasol and Tazarotene) - Uses, Dose, Side effects, MOA

The drug Duobrii (Halobetasol and Tazarotene) combines a retinoid and a topical corticosteroid with significant efficacy. Plaque psoriasis patients utilise it as a topical therapy.

Halobetasol and Tazarotene Uses:

Plaque psoriasis:
- Adults with plaque psoriasis should use it to treat the condition.

Duobrii (Halobetasol and Tazarotene) Dose in Adults

Duobrii (Halobetasol and Tazarotene) Dose in the therapy of Plaque psoriasis:

Topical:
- Apply a thin layer of the lotion to the affected areas once a day.
- The total dosage should not exceed 50 gms per week.
- The treatment should be discontinued when control is achieved.

Use in Children:

Not indicated.

Pregnancy Risk Category: X

Tazarotene should not be used during pregnancy. Before starting treatment, it is important to evaluate pregnant women with reproductive potential.
Within two weeks of treatment starting, females must have a negative pregnancy test.
Female patients who are susceptible to becoming pregnant should use appropriate contraception.

Use of halobetasol or tazarotene during breastfeeding

Breastmilk can excrete systemic corticosteroids. It is unknown if tazarotene gets excreted in breastmilk.
While breastfeeding, it should not be applied directly to the breasts or nipples.
It is recommended that you use it with caution, considering the potential benefits to the mother as well as the possible risks for the infant.

Dose in Kidney disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Side effects of Duobrii (Halobetasol and Tazarotene):

See individual agents for side effects:

Contraindications to Duobrii (Halobetasol and Tazarotene):

Tazarotene is contraindicated during pregnancy. Female patients of reproductive potential should be evaluated for pregnancy before treatment initiation.
Females should have a negative pregnancy test within two weeks of treatment initiation.
Adequate contraception should be used in female patients who may become pregnant.

Halobetasol and tazarotene: Drug Interaction

Risk Factor C (Monitor therapy)
Corticorelin	The therapeutic benefit of corticorelin may be reduced by corticosteroids. In particular, recent or ongoing corticosteroid medication may reduce the plasma ACTH response to corticorelin.
Deferasirox	Corticosteroids may intensify Deferasirox's negative/toxic effects. Particularly, there may be a higher risk of GI bleeding or ulcers.
Ritodrine	Corticosteroids may intensify Ritodrine's harmful or hazardous effects.
Risk Factor D (Consider therapy modification)
Hyaluronidase	The therapeutic benefit of hyaluronidase may be reduced by corticosteroids. Treatment: Standard doses of hyaluronidase may not produce the desired clinical response in patients using corticosteroids (especially at higher doses). Hyaluronidase may be needed at higher doses.
Risk Factor X (Avoid combination)
Aldesleukin	The anti-cancer effects of corticosteroids may be diminished by aldesleukin.

Monitoring parameters:

Monitor for the clinical features of adrenal insufficiency and HPA axis suppression.
Observe for fungal and bacterial infections especially when the treatment is prolonged.
Monitor disease severity in patients with plaque psoriasis during the treatment. observe for improvement in skin induration, scaling, and reduction in the redness and erythema.
Monitor for tolerance and the clinical response to the therapy.
All female patients of reproductive potential should undergo a pregnancy test within two weeks before treatment initiation.

How to administer Duobrii (Halobetasol and Tazarotene)?

It is indicated for external (topical) use only.
Avoid applying it in or around the eyes, oral cavity, or for intravaginal use.
Avoid applying occlusive dressings over the area unless advised by an expert.
The areas should be cleaned and dried before applying them.
A thin layer should be applied over the affected area and rubbed gently.
Hands should be washed after applying it except when the hands are affected too.

Mechanism of action of Duobrii (Halobetasol and Tazarotene):

Halobetasol is a strong topical corticosteroid that reduces inflammation by causing the production of arachidonic acid and lipocortins, which are phospholipase A2 inhibitory proteins. It causes a decrease in endogenous chemical mediators such as histamine, liposomal enzymes and prostaglandins. It acts as an anti-inflammatory drug that has vasoconstricting and antipruritic properties.
Tazarotene is a synthetic, acetylenic retinoid that has some immunomodulatory and anti-inflammatory effects, however, it exerts its effects primarily via modulating the differentiation and proliferation of epithelial tissues.

See individual agents.