For topically applied fusidic acid, no information concerning potential symptoms and signs due to overdose administration is available. Cushing's syndrome and adrenocortical insufficiency may develop following topical application of corticosteroids in large amounts and for more than 3 weeks.
Systemic consequences of an overdose of the active substances after accidental oral intake are unlikely to occur. The amount of fusidic acid in one tube of Gelbiotic Plus does not exceed the oral daily dose of systemic treatment. A single oral overdose of corticosteroids is rarely a clinical problem.
Due to the content of corticosteroid, Gelbiotic Plus is contraindicated in the following conditions:
Systemic fungal infections.
Primary skin infections caused by fungi, virus or bacteria, either untreated or uncontrolled by appropriate treatment.
Skin manifestations in relation to tuberculosis or syphilis, either untreated or uncontrolled by appropriate therapy.
Perioral dermatitis and rosacea.
Not applicable.
The estimation of the frequency of undesirable effects is based on a pooled analysis of data from clinical studies and spontaneous reporting.
The most frequently reported adverse reaction during treatment is pruritus.
Undesirable effects are listed by MedDRA SOC and the individual undesirable effects are listed starting with the most frequently reported. Within each frequency grouping, adverse reactions are presented in the order of decreasing seriousness.
Very common >1/10
Common >1/100 and <1/10
Uncommon >1/1,000 and <1/100
Rare > 1/10,000 and < 1/1,000
Very rare <1/10,000
| Immune system disorders | |
| Uncommon: (>1/1,000 and <1/100) | Hypersensitivity |
| Skin and subcutaneous tissue disorders | |
| Uncommon: (>1/1,000 and <1/100) | Dermatitis contact Eczema (condition aggravated) Skin burning sensation Pruritus Dry skin |
| Rare: (>1/10,000 and <1/1,000) | Erythema Urticaria Rash (including rash erythematous and rash generalised) |
| General disorders and administration site conditions | |
| Uncommon: (>1/1,000 and <1/100) | Application site pain Application site irritation |
| Rare: (>1/10,000 and <1/1,000) | Application site swelling Application site vesicles |
Systemic undesirable class effects of corticosteroids like betamethasone valerate include adrenal suppression especially during prolonged topical administration.
Raised intra-ocular pressure, glaucoma and cataract may also occur after topical use of corticosteroids near the eyes, particularly with prolonged use and in patients predisposed to developing glaucoma and cataract.
Dermatological undesirable class effects of potent corticosteroids include: Atrophy, dermatitis (including dermatitis contact and dermatitis acneiform), perioral dermatitis, skin striae, telangiectasia, rosacea, erythema, hypertrichosis, hyperhydrosis and depigmentation. Ecchymosis may also occur with prolonged use of topical corticosteroids.
Class effects for corticosteroids have been uncommonly reported for Gelbiotic Plus as described in the frequency table above.
Paediatric population
The observed safety profile is similar in children and adults.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
Studies of corticosteroids in animals have shown reproductive toxicity (e.g. cleft palate, skeletal malformations, low birth weight).
Gelbiotic Plus Lipid cream is indicated for the treatment of eczematous dermatoses including atopic eczema, discoid eczema, stasis eczema and seborrhoeic eczema when secondary bacterial infection is confirmed or suspected.
ATC code: D07CC01
Pharmacotherapeutic group: Betamethasone and antibiotics.
Gelbiotic Plus Lipid cream combines the well-known anti-inflammatory and antipruritic effects of betamethasone with the potent topical antibacterial action of fusidic acid. Betamethasone valerate is a topical steroid rapidly effective in those inflammatory dermatoses which normally respond to this form of therapy. More refractory conditions can often be treated successfully. When applied topically, fusidic acid is effective against Staphyloccus aureus, Streptococci, Corynebacteria, Neisseria and certain Clostridia and Bacteroides. Concentrations of 0.03 to 0.12 microgram per ml inhibit nearly all strains of S. aureus. The antibacterial activity of fusidic acid is not diminished in the presence of betamethasone.
There are no data which define the pharmacokinetics of Gelbiotic Plus Lipid cream, following topical administration in man.
However, in vitro studies show that fusidic acid can penetrate intact human skin. The degree of penetration depends on factors such as the duration of exposure to fusidic acid and the condition of the skin. Fusidic acid is excreted mainly in the bile with little excreted in the urine.
Betamethasone is absorbed following topical administration. The degree of absorption is dependent on various factors including skin condition and site of application. Betamethasone is metabolised largely in the liver but also to a limited extent in the kidneys, and the inactive metabolites are excreted with the urine.
Long-term continuous topical therapy with Gelbiotic Plus should be avoided.
Depending on the application site, possible systemic absorption of betamethasone valerate should always be considered during treatment with Gelbiotic Plus.
Due to the content of corticosteroid, Gelbiotic Plus should be used with care near the eyes. Avoid getting Gelbiotic Plus into the eyes.
Reversible hypothalamic-pituitary-adrenal (HPA) axis suppression may occur following systemic absorption of topical corticosteroids.
Gelbiotic Plus should be used with care in children as paediatric patients may demonstrate greater susceptibility to topical corticosteroids-induced HPA axis suppression and Cushing's syndrome than adult patients. Avoid large amounts, occlusion and prolonged treatment.
Due to the content of betamethasone valerate, prolonged topical use of Gelbiotic Plus may cause skin atrophy.
Bacterial resistance has been reported to occur with the topical use of fusidic acid. As with all antibiotics, extended or recurrent application may increase the risk of developing antibiotic resistance. Limiting therapy with topical fusidic acid and betamethasone valerate to no more than 14 days at a time will minimise the risk of developing resistance.
This also prevents the risk that the immunosuppressive action of corticosteroid might mask any potential symptoms of infections due to antibiotic-resistant bacteria.
Due to the content of corticosteroid having immunosuppressant effect, Gelbiotic Plus may be associated with increased susceptibility to infection, aggravation of existing infection, and activation of latent infection. It is advised to switch to systemic treatment if infection cannot be controlled with topical treatment.
Gelbiotic Plus Lipid cream contains methyl and propyl parahydroxybenzoate (E218 and E216), cetostearyl alcohol and potassium sorbate as excipients. Methyl and propyl parahydroxybenzoate may cause allergic reactions (possibly delayed). Potassium sorbate and cetostearyl alcohol may cause local skin reactions (e.g. contact dermatitis).
Gelbiotic Plus Lipid cream has no or negligible influence on the ability to drive or to use machines.
Posology
Adults and children aged 6 years and over:
A small quantity should be applied to the affected area twice daily until a satisfactory response is obtained. A single treatment course should not normally exceed 2 weeks. In the more resistant lesions the effect of Gelbiotic Plus Lipid cream can be enhanced by occlusion with polythene film. Overnight occlusion is usually adequate.
Method of administration
Cutaneous use.
No special requirements for disposal
Any unused medicinal product or waste material should be disposed of in accordance with local requirements.
