Trimovate® Cream Alternatives

There has been a problem with supply of Trimovate® Cream for a number of months, as the rights have been sold to another company who are due to bring it back onto the market in late 2018. There is currently an unlicensed product available at a significantly inflated price. Therefore the APC has taken the decision to re-classify Trimovate® Cream as Grey on the Barnsley Area Formulary. The following alternatives should therefore be considered, depending on the condition being treated. Other topical steroid preparations which include both an antibacterial and antifungal component include Timodine® (which contains a mild steroid) and Synalar C® (which contains a potent steroid):

Cost per Steroid (in potency order) Antibacterial Antifungal Notes 30g* Mild steroid Hydrocortisone 1% "Mild" - Hydrocortisone 1% £1.88 (Cream or ointment) Also contains Timodine® "Mild" - Hydrocortisone Benzalkonium Nystatin Dimeticone £3.37 (Cream) 0.5% Chloride 0.2%, 100,000 units/g, 10% Daktacort® "Mild" - Hydrocortisone 1% Miconazole 2% £2.50 (Ointment & Cream) Terra-Cortril Oxytetracycline "Mild"- Hydrocortisone 1% £5.01 Ointment 3% Canestan HC® "Mild" - Hydrocortisone 1% Clotrimazole 1% £2.42 (Cream) Moderate steroid Eumovate® "Moderately potent" - £1.86 (Cream & Ointment) Clobetasone 0.05% Trimovate® "Moderately potent" - Oxytetracycline Nystatin Unlicensed Variable (Cream) – 30g Clobetasone 0.05% 3% 100,000 units/g import (> £50) Potent steroid £1.64 Betamethasone "Potent" - Betamethasone (Oint) Valerate 0.1% Valerate 0.1% £2.09 (Cream & Ointment) (Cream) Lotriderm® "Potent" - Betamethasone Clotrimazole 1% £6.34 (Cream) Dipropionate 0.064% Synalar® £4.14 "Potent"- Fluocinolone (Cream, Ointment & £5.56 acetonide 0.025% Gel) (Gel) Synalar C® "Potent"- Fluocinolone £2.66 Clioquinol 3% Clioquinol 3% (Cream & Ointment) acetonide 0.025% (per15g) No steroid Clotrimazole £0.95 Clotrimazole 1% (Cream) (20g) *Price taken from MIMs. Correct as of September 2018

Produced by Medicines Information, BHNFT. Approved by the APC: 12th September 2018 Adapted from a Document Produced by NHS Shropshire CCG. Review date: September 2020

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Notes on antimicrobial ingredients:  Benzalkonium chloride is active against bacteria and some viruses, fungi, and protozoa. [ref]  Chlorhexidine is an antiseptic that is active against a wide range of bacteria, fungi and yeasts. [ref]  Clioquinol has both antibacterial and antifungal activity. [ref]  Clotrimazole is active against fungi and yeasts. [ref]  Miconazole is a wide antifungal spectrum and has some antibacterial activity. [ref]  Neomycin is active against Gram-negative bacteria, and is partially effective against Gram-positive bacteria. [ref]  Nystatin is active against fungi and yeasts. [ref]  Oxytetracycline is an antibacterial with a wide spectrum of activity. [ref]

Produced by Medicines Information, BHNFT. Approved by the APC: 12th September 2018 Adapted from a Document Produced by NHS Shropshire CCG. Review date: September 2020

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