Ciclopirox is an antifungal medication used to treat fungal infections of the skin and nails. It belongs to the class of drugs known as antifungals. Ciclopirox works by disrupting the fungal cell wall, ultimately leading to the death of the fungus. It is commonly used to treat conditions such as athlete's foot (tinea pedis), ringworm (tinea corporis), and fungal infections of the nails (onychomycosis). Ciclopirox is available in various forms, including creams, lotions, and nail lacquers.

Ciclopirox (olamine) disrupts the DNA synthesis of fungal cells. It is used for the following Dermatologic conditions (infectious and seborrheal):

• Gel:
  • For the topical therapy of interdigital tinea pedis, tinea corporis, and seborrheic dermatitis of the scalp caused by
    • T. mentagrophytes
    • T. rubrum
    • E. floccosum
• Cream and suspension:
  • Topical treatment
    • Tinea pedis, Tinea cruris, and Tinea corporis because of
      • Candidiasis (moniliasis) due to Candida albicans
      • Trichophyton rubrum,
      • Microsporum canis
      • Tinea (pityriasis) versicolor due to Malassezia furfur.
      • Trichophyton mentagrophytes
      • Epidermophyton floccosum
• Shampoo:
  • in order to treat people with adult seborrheic dermatitis of the scalp topically.
• Nail lacquer topical solution:
  • For the topical management of immunocompetent individuals suffering from mild to severe onychomycosis of the fingernails and toenails, without lunula involvement, as a result of:
    • Trichophyton rubrum

Ciclopirox dose in adult

Ciclopirox dose in Onychomycosis of the fingernails and toenails:  

• Use Ciclopirox as a lacquer solution.
• Apply it to the skin around the affected nails and the nails themselves every day.
• It's part of a broader treatment plan for onychomycosis.
• Remove the solution with alcohol every 7 days to keep the treatment effective.

Ciclopirox dose in Tinea cruris, cutaneous candidiasis, and tinea versicolor:  

• Use Ciclopirox as a cream, gel, or suspension.
• Apply it twice a day.
• Gently massage it into the affected areas and the skin around them.
• If you don't see any improvement after using it for 4 weeks, talk to your doctor again to make sure the diagnosis is correct.

Ciclopirox in treatment in patients with Tinea pedis and tinea corporis:

• Use Ciclopirox as a cream or suspension.
• Apply it twice a day.
• Gently massage it into the affected areas and the skin around them.
• If you don't see any improvement after using it for 4 weeks, check back with your doctor to confirm the diagnosis.

Ciclopirox dose in Seborrheic dermatitis (scalp):  

Use Ciclopirox as a gel or shampoo.

• For the gel, apply it twice daily to the affected area, gently massaging it in.
• If using the shampoo, apply about 5 mL to wet hair, lather, and leave it on the hair and scalp for around 3 minutes before rinsing. If you have longer hair, you may need up to 10 mL.
• Repeat the shampoo treatment twice a week for 4 weeks, making sure to wait at least 3 days between applications.
• If you don't notice any improvement after 4 weeks, talk to your doctor again to confirm the diagnosis.

Ciclopirox dose in children

Ciclopirox dose in Cutaneous candidiasis, tinea cruris, and tinea versicolor:  

For children aged 10 years and above, as well as adolescents:

• Use Ciclopirox as a cream or suspension lotion.
• Apply it twice a day, once in the morning and once in the evening, to the affected area.
• If there's no improvement after using it for 4 weeks, it's time to revisit the treatment plan with your healthcare provider to make sure it's still the right approach.

Ciclopirox use in patients with Tinea corporis and tinea pedis:

For tinea corporis (ringworm) and tinea pedis (athlete's foot):

• Children aged 10 years and adolescents should use Ciclopirox as a cream or suspension lotion.
• Apply it twice daily, once in the morning and once in the evening, to the affected area.
• If there's no improvement after using it for 4 weeks, it's time to reassess the treatment plan with your healthcare provider.

Additionally, adolescents aged 16 years and above can use Ciclopirox as a gel.

• Apply the gel twice daily to affected areas and the surrounding skin.
• Again, if there's no improvement after 4 weeks, it's important to reevaluate the diagnosis with your doctor.

Ciclopirox dose in Onychomycosis of the fingernails and toenails:  

in children aged 12 years and above, as well as adolescents:

• Use Ciclopirox as a lacquer solution.
• Apply it once daily to the skin around the affected nails and the nails themselves.
• It's best to apply it at bedtime or at least 8 hours before washing.
• As part of the treatment, remove the solution with alcohol every 7 days.
• Remember, this treatment is part of a broader management plan for onychomycosis.

Ciclopirox dose in Seborrheic dermatitis of the scalp:  

For adolescents aged 16 years and above dealing with seborrheic dermatitis on the scalp:

• Use Ciclopirox as a gel or shampoo.
• If using the gel, apply it twice daily to the affected areas and gently massage it into the scalp and surrounding skin.
• If using the shampoo, apply about 5 mL to wet hair, lather it up, and leave it on for around 3 minutes before rinsing. For longer hair, you may need up to 10 mL.
• Repeat the shampoo treatment twice a week for 4 weeks, making sure to wait at least 3 days between applications.
• If there's no improvement after 4 weeks of treatment, it's time to reassess the diagnosis with your healthcare provider.

Pregnancy Risk Factor B

• For pregnant individuals, Ciclopirox carries a Pregnancy Risk Factor of B, which means that no adverse effects were seen in animal studies on reproduction.

Ciclopirox use during breastfeeding

• It's uncertain if Ciclopirox passes into breast milk, as there's no clear information available.
• The manufacturer advises caution when using Ciclopirox in nursing mothers, highlighting the need for careful consideration of potential risks and benefits before its administration during breastfeeding.

Ciclopirox Dose in Renal Disease:

• The manufacturer's instructions do not include specific dosage adjustments for individuals with renal impairment.

Ciclopirox Dose in Liver Disease:

• The manufacturer's labeling does not specify any dosage adjustments for individuals with hepatic impairment.

Common Side Effects of Ciclopirox:

• Central nervous system:
  • Headache
• Cardiovascular:
  • Facial edema,
  • Ventricular tachycardia (shampoo)
• Dermatologic:
  • Skin rash,
  • Xeroderma
  • Erythema,
  • Hair discoloration
  • Localized erythema,
  • Nail disease 
  • Acne vulgaris,
  • Alopecia,
  • Contact dermatitis,
  • Pruritus,
• Ophthalmic:
  • Eye pain
• Local:
  • Local irritation,
  • Application site burning,
  • Local pain

Contraindications to Ciclopirox include:

• Ciclopirox should not be used by individuals who have a known hypersensitivity or allergy to Ciclopirox or any other component present in the formulation.

Warnings & Precautions

Irritation

• If you experience sensitivity or irritation while using Ciclopirox, it's important to stop using it and seek appropriate medical advice.

Use it in the right way:

• It should only be utilised for current affairs. Keep your distance from your eyes and mucous membranes. Use of occlusive dressings and wrappings should be avoided.

Monitoring Parameters:

Not recommended.

How to use Ciclopirox?

Ciclopirox should be used for topical purposes only. It should not be administered in the eyes, taken orally or used for intravaginal purposes.

Topical Use Only

• Ciclopirox is meant for use on the skin only and should not be used in the eyes, mouth, or vagina.

Cream

• Apply the cream to affected areas and the skin around them in the morning and evening. Gently massage it in.

Gel

• Use the gel on clean affected areas or the scalp and nearby skin in the morning and evening. Gently massage it in.

Lacquer (Solution)

• Apply the solution evenly over the entire nail, including the nail bed and under the nail surface, before bedtime or at least 8 hours before washing.
• Apply daily for 7 days, then remove with alcohol and continue the cycle.
• Every 7 days, after removing Ciclopirox with alcohol, file away loose nail material and trim nails as needed or as directed by a healthcare professional.

Shampoo

• Wet your hair and apply the shampoo to your scalp.
• Lather and leave it on for about 3 minutes, then rinse it off. Be careful to avoid getting it in your eyes.

Suspension

• Shake the suspension well before use.
• Apply it to affected areas and the surrounding skin in the morning and evening, gently massaging it in.

Mechanism of action of Ciclopirox:

• Ciclopirox works by interfering with the transport of essential elements within fungal cells.
• This disruption hampers the synthesis of crucial molecules such as DNA, RNA, and proteins, vital for the growth and survival of the fungus.
• By disrupting these essential processes, Ciclopirox effectively inhibits the growth and spread of the fungal infection.

Absorption:

• Cream and suspension: About 1.3% of Ciclopirox is absorbed through intact skin. Absorption increases with gel application. Lacquer absorption is less than 5%.

Distribution:

• Scalp application: Ciclopirox is distributed to the epidermis, dermis (corium), including hair, hair follicles, and sebaceous glands.

Metabolism:

• Ciclopirox is metabolized in the body by conjugation with glucuronic acid.

Half-life elimination:

• Biologic half-life for cream and suspension is about 1.7 hours, while gel has a longer elimination half-life of about 5.5 hours.

Excretion:

• Ciclopirox is excreted from the body primarily through urine, with gel excreting around 3% to 10%, and shampoo less than 0.5%. Cream and suspension excrete about 0.01% through urine. Small amounts may also be excreted in feces.

International Brands of Ciclopirox:

• Batrafan
• Batrafen
• Batrafen Gel
• Batrafen Nail Lacquer
• Brumixol
• Canolen
• Ciclochem
• Cicloderm
• Clopirox
• Funginail
• Fungirox
• Gidacid
• Huanli
• Loprox
• Loprox Laca
• Loprox Naillacquer
• Miclast
• Micopirox
• Micoxolamina
• Myconail
• Mycoster
• Nail Batrafen
• Nobiprox
• Olamin
• Onytec
• Oxpiroborg
• Penlac
• Primax
• Stieprox
• Stiprox
• Tineapirox

Ciclopirox Brands in Pakistan: