Butenafine Hydrochloride/Climbazole 529 to be reduced in patients with hepatic impairment (see Profile solution in water has a pH of 8.0 to 9.0. Protect from light. below). Chlormidazole hydrochloride is an imidazole antifungal used USP 31 (Ciclopirox Olamine). A white to slightly yellowish- topically as the hydrochloride in the treatment of fungal infec- white, crystalline powder. Slightly soluble in water; very soluble ◊ Reviews. tions of the skin. in alcohol and in dichloromethane; practically insoluble in cy- 1. Letscher-Bru V, Herbrecht R. Caspofungin: the first representa- For a discussion of the caution needed when using azole antifun- clohexane. pH of a 1% solution in water is between 8.0 and 9.0. tive of a new antifungal class. J Antimicrob Chemother 2003; 51: gals during pregnancy, see under Pregnancy in Precautions of Store in airtight containers at a temperature of 5° to 25°. Protect 513–21. Fluconazole, p.532. from light. 2. Deresinski SC, Stevens DA. Caspofungin. Clin Infect Dis 2003; 36: 1445–57. Preparations Adverse Effects 3. Denning DW. Echinocandin antifungal drugs. Lancet 2003; 362: Proprietary Preparations (details are given in Part 3) Irritation and pruritus have been reported after topical applica- 1142–51. Pol.: Unifungicid. tion of ciclopirox. 4. McCormack PL, Perry CM. Caspofungin: a review of its use in the treatment of fungal infections. Drugs 2005; 65: 2049–68. Multi-ingredient: Austria: Myco-Synalar; Pol.: Polfungicid; Switz.: Antimicrobial Action 5. Morris MI, Villmann M. Echinocandins in the management of Myco-Synalar†. Ciclopirox has a wide spectrum of antifungal activity. It inhibits invasive fungal infections, part 1. Am J Health-Syst Pharm 2006; most Candida, Epidermophyton, Microsporum, and Trichophy- 63: 1693–1703. ton spp. and is also active against Malassezia furfur. It has some 6. Morris MI, Villmann M. Echinocandins in the management of invasive fungal infections, part 2. Am J Health-Syst Pharm 2006; Chlorphenesin (BAN, pINN) antibacterial activity. 63: 1813–20. Chlorphénésine; Chlorphenesinum; Clorfenesina; Kloorifenesiini; Uses and Administration 7. Falagas ME, et al. Caspofungin for the treatment of fungal infec- Klorfenesin. 3-(4-Chlorophenoxy)propane-1,2-diol. Ciclopirox is an antifungal that is applied topically in the treat- tions: a systematic review of randomized controlled trials. Int J ment of fungal skin and nail infections, including cutaneous can- Antimicrob Agents 2007; 29: 136–43. Хлорфенезин 8. Hope WW, et al. The pharmacology and clinical use of caspofun- didiasis (p.518), dermatophytosis, pityriasis versicolor (see Skin C9H11ClO3 = 202.6. Infections, p.521), and seborrhoeic dermatitis (p.1584). It has gin. Expert Opin Drug Metab Toxicol 2007; 3: 263–74. CAS — 104-29-0. 9. Waters L, Nelson M. The use of caspofungin in HIV-infected in- also been used in the treatment of vaginal candidiasis. dividuals. Expert Opin Invest Drugs 2007; 16: 899–908. ATC — D01AE07. ATC Vet — QD01AE07. It is applied twice daily for skin infections, as a cream, gel, sus- Administration in children. Caspofungin is not licensed for pension, solution, or powder; both the base and the olamine salt use in paediatric patients, but has been prescribed.1 A retrospec- have been used, with products containing the equivalent of tive study2 of 25 immunocompromised children with a median OH 0.77% ciclopirox base. age of 9.8 years, given at least one dose of caspofungin, found A lacquer containing 8% ciclopirox base is applied once daily for that it appeared to be safe and well tolerated. Patients weighing O OH nail infections. less than 50 kg had a dose of 0.8 to 1.6 mg/kg daily, while those A shampoo containing 1% ciclopirox base is used twice weekly over 50 kg were given 50 to 75 mg daily. Another retrospective for the treatment of seborrhoeic dermatitis. 3 review of 64 immunocompromised children with a median age Cl of 11.5 years, reported a success rate of 67.7% with caspofungin ◊ References. at a median daily maintenance dose of 1.07 mg/kg, either as 1. Gupta AK, Skinner AR. Ciclopirox for the treatment of superfi- monotherapy or with another antifungal. A case series4 of 10 ne- Profile cial fungal infections: a review. Int J Dermatol 2003; 42 (suppl onates (9 preterm) with invasive candidiasis not responsive to Chlorphenesin has antifungal and antibacterial properties. It has 1): 3–9. been applied locally in mild uncomplicated dermatophyte and 2. Gupta AK, Nicol KA. Ciclopirox 1% shampoo for the treatment amphotericin B and/or fluconazole reported that Candida spp. of seborrheic dermatitis. Int J Dermatol 2006; 45: 66–9. were cleared from the blood in all patients in a mean of 4.3 days other cutaneous infections and in vaginal infections. after starting caspofungin therapy. Nine neonates were given an Chlorphenesin carbamate (p.1894) is used as a skeletal muscle Preparations initial dose of 1 mg/kg daily for the first 2 days followed by relaxant. USP 31: Ciclopirox Olamine Cream; Ciclopirox Olamine Topical Suspen- 2 mg/kg daily for 15 to 21 days; the other was given a lower Preparations sion. dose. Proprietary Preparations (details are given in Part 3) Proprietary Preparations (details are given in Part 3) 1. Lehrnbecher T, Groll AH. Experiences with the use of caspofun- Canad.: Mycil†; Ger.: Soorphenesin†; India: Dermicil†. Arg.: Dermaflor†; Loprox; Micopirox; Stieprox; Austral.: Stieprox; Aus- gin in paediatric patients. Mycoses 2008; 51 (suppl 1): 58–64. tria: Batrafen; Stieprox; Braz.: Fungirox†; Gino Loprox; Loprox; Micolami- Multi-ingredient: Austral.: ZSC; Austria: Aleot; Braz.: Oto Betnovate. 2. Franklin JA, et al. Retrospective study of the safety of caspofun- na; Micoliv†; Stiprox; Canad.: Loprox; Penlac; Stieprox; Chile: Batrafen; gin in immunocompromised pediatric patients. Pediatr Infect Fungopirox; Mikium†; Stiprox; Cz.: Batrafen; Dafnegin; Stieprox; Denm.: Dis J 2003; 22: 747–9. Mycofen; Stieprox; Fin.: Stieprox; Fr.: Mycosquam; Mycoster; Sebiprox; Sti- prox; Ger.: Batrafen; Ciclopoli; Inimur Myko; Nagel Batrafen; Sebiprox; Gr.: 3. Groll AH, et al. Treatment with caspofungin in immunocompro- Ciclopirox (BAN, USAN, rINN) Candimyc; Dafnegin†; Myclopir; Mycomycen; Neo-botacreme; Neo-myco- mised paediatric patients: a multicentre survey. J Antimicrob dermol; Rozolam; Stieprox; Hong Kong: Batrafen; Stieprox; Hung.: Batraf- Chemother 2006; 57: 527–35. Ciclopiroxum; Ciklopiroksas; Ciklopirox; Hoe-296b; Siklopiroksi. en; India: Olamin; Onylac; Indon.: Batrafen; Loprox; Irl.: Batrafen†; Oila- 4. Odio CM, et al. Caspofungin therapy of neonates with invasive 6-Cyclohexyl-1-hydroxy-4-methyl-2-pyridone. tum Scalp Treatment; Stieprox; Israel: Batrafen; Cicloderm; Ital.: Batrafen; candidiasis. Pediatr Infect Dis J 2004; 23: 1093–7. Biroxol†; Brumixol; Dafnegin; Miclast; Micomicen; Micoxolamina; Sebiprox; Циклопирокс Stiprox; Malaysia: Stieprox; Mex.: Loprox; Stiprox; Neth.: Loprox; Sebi- Patients with mild Administration in hepatic impairment. C H NO = 207.3. prox; Norw.: Stieprox; NZ: Batrafen; Stieprox; Philipp.: Stieprox; Pol.: hepatic impairment do not require dosage adjustment. In patients 12 17 2 CAS — 29342-05-0. Batrafen; Dafnegin; Hascofungin; Pirolam; Stieprox; Port.: Batrafen; My- with moderate hepatic impairment, a daily dose of caspofungin coster; Sebiprox; Rus.: Batrafen (Батрафен); Singapore: Stieprox; Spain: ATC — D01AE14; G01AX12. 35 mg should be used after the initial dose of 70 mg; appropriate Batrafen; Ciclochem; Fungowas; Rimafungol†; Sebiprox; Switz.: Batrafen; ATC Vet — QD01AE14; QG01AX12. Dafnegil Neo; Thai.: Cicloderm†; Loprox; Stieprox; Turk.: Canolen; Nibu- doses for patients with severe hepatic impairment have not been len; UK: Oilatum Scalp Treatment; USA: Loprox; Penlac; Venez.: Batrafen. established. Multi-ingredient: Arg.: Derm’s Shampoo; Stieproxal; Fr.: Novophane; Preparations Novophane S; Stiproxal; India: Flucort-C; Israel: Cicloderm-C; UK: Oila- OH tum Scalp Intensive. Proprietary Preparations (details are given in Part 3) Arg.: Cancidas; Austral.: Cancidas; Belg.: Cancidas; Braz.: Cancidas; Ca- N O nad.: Cancidas; Chile: Cancidas; Cz.: Cancidas; Denm.: Cancidas; Fin.: Cancidas; Fr.: Cancidas; Ger.: Cancidas; Gr.: Cancidas; Hong Kong: Can- Climbazole (BAN, rINN) cidas; Hung.: Cancidas; Irl.: Cancidas; Israel: Cancidas; Ital.: Cancidas; Malaysia: Cancidas; Neth.: Cancidas; Norw.: Cancidas; NZ: Cancidas; Bay-e-6975; Climbazol; Climbazolum; MEB-6401. 1-(p-Chlo- Philipp.: Cancidas; Pol.: Cancidas; Port.: Cancidas; Rus.: Cancidas rophenoxy)-1-imidazol-1-yl-3,3-dimethyl-2-butanone. (Кансидас); Singapore: Cancidas; Spain: Cancidas; Swed.: Cancidas; CH Switz.: Cancidas; Thai.: Cancidas; Turk.: Cancidas; UK: Cancidas; USA: 3 Климбазол Cancidas; Venez.: Cancidas. C15H17ClN2O2 = 292.8. Pharmacopoeias. In Eur. (see p.vii) and US. CAS — 38083-17-9. Ph. Eur. 6.2 (Ciclopirox). A white or yellowish-white, crystal- line powder. Slightly soluble in water; freely soluble in alcohol Chlormidazole Hydrochloride (BANM, rINNM) and in dichloromethane. Protect from light. O Chlormidazole, Chlorhydrate de; Chlormidazoli Hydrochlori- USP 31 (Ciclopirox). A white to slightly yellowish white, crys- CH3 dum; Clomidazole Hydrochloride; Hidrocloruro de clormidazol. talline powder. Slightly soluble in water; freely soluble in dehy- O 1-(4-Chlorobenzyl)-2-methylbenzimidazole hydrochloride. drated alcohol and in dichloromethane; soluble in ether. Store at a temperature of 15° to 30°. Protect from light. CH3 Хлормидазола Гидрохлорид N H3C Cl C15H13ClN2,HCl = 293.2. Ciclopirox Olamine (BANM,