Rexgard
Rexgard Uses, Dosage, Side Effects, Food Interaction and all others data.
Rexgard topical cream is a broad-spectrum antimycotic which offers a high antifungal activity against dermatophytes, yeasts and other phyco-Asco and Adelomycetes, with a potent antibacterial activity against Gram-positive bacilli and cocci. Rexgard topical cream proved to be markedly effective in secondary infected mycoses, which under other treatments were resistant or reappeared. Rexgard topical cream does not stain skin or clothes.
The active ingredient, Rexgard, is a synthetic imidazole anti-fungal agent with a broad spectrum of activity against pathogenic fungi (including yeast and dermatophytes) and gram-positive bacteria (Staphylococcus and Streptococcus spp). It may act by interfering with the permeability of the fungal cell membranes. When administered orally, Rexgard is incompletely absorbed from the gastrointestinal tract, peak plasma levels of about 1 µg per ml have been achieved after a dose of 1 gm per day. Rexgard is inactivated in the body and 10-20% of an oral dose is excreted in the urine, mainly as metabolites, within 6 days. About 50% of an oral dose may be excreted unchanged in the faeces.
Rexgard is an azole antifungal that functions primarily through inhibition of a specific demethylase within the CYP450 complex. As miconazole is typically applied topically and is minimally absorbed into the systemic circulation following application, the majority of patient reactions are limited to hypersensitivity and cases of anaphylaxis. Patients using intravaginal miconazole products are advised not to rely on contraceptives to prevent pregnancy and sexually transmitted infections, as well as not to use tampons concurrently.
| Trade Name | Rexgard |
| Availability | Prescription only |
| Generic | Miconazole |
| Miconazole Other Names | Miconazol, Miconazole, Miconazolum |
| Related Drugs | fluconazole, nystatin, clotrimazole, Diflucan, itraconazole, amphotericin b |
| Type | Cream |
| Formula | C18H14Cl4N2O |
| Weight | Average: 416.129 Monoisotopic: 413.986023908 |
| Protein binding | In vitro data suggests that miconazole binds human serum albumin, however, the clinical significance of this observation is unclear. |
| Groups | Approved, Investigational, Vet approved |
| Therapeutic Class | Topical Antifungal preparations |
| Manufacturer | Novartis India Ltd |
| Available Country | India |
| Last Updated: | September 19, 2023 at 7:00 am |
Uses
Rexgard Topical Cream has an antibacterial effect on Gram-positive bacteria, it may be used in mycoses secondarily infected with such bacteria. Skin and nail infections due to dermatophytes, yeasts and other fungi such as: Tinea capitis, corporis, manuum, pedis, barbae, cruris, unguium or onychomycosis. Pityriasis versicolor, candidiasis of skin and nails, stomatitis angularis, otitis externa.
Rexgard Oral treatment and prevention of fungal infections of the oropharynx and gastrointestinal tract, and of super infections due to Gram-positive bacteria.
Rexgard is also used to associated treatment for these conditions: Acne Vulgaris, Dermatophytosis, Dermatophytosis of nail, Diaper Dermatitis, Excessive sweating and body odor, Fungal skin infection, Gastrointestinal candidiasis, Infection Mixed, Infections, Fungal of the Skin Folds, Nail candida, Oropharyngeal Candidiasis, Pityriasis versicolor, Ringworm, Seborrheic Dermatitis, Skin candida, Tinea Capitis, Tinea Corporis, Tinea Cruris, Tinea Pedis, Vaginal Candidiasis, Cutaneous candidiasis
How Rexgard works
Rexgard is an azole antifungal used to treat a variety of conditions, including those caused by Candida overgrowth. Unique among the azoles, miconazole is thought to act through three main mechanisms. The primary mechanism of action is through inhibition of the CYP450 14α-lanosterol demethylase enzyme, which results in altered ergosterol production and impaired cell membrane composition and permeability, which in turn leads to cation, phosphate, and low molecular weight protein leakage.
In addition, miconazole inhibits fungal peroxidase and catalase while not affecting NADH oxidase activity, leading to increased production of reactive oxygen species (ROS). Increased intracellular ROS leads to downstream pleiotropic effects and eventual apoptosis.
Lastly, likely as a result of lanosterol demethylation inhibition, miconazole causes a rise in intracellular levels of farnesol. This molecule participates in quorum sensing in Candida, preventing the transition from yeast to mycelial forms and thereby the formation of biofilms, which are more resistant to antibiotics. In addition, farnesol is an inhibitor of drug efflux ABC transporters, namely Candida CaCdr1p and CaCdr2p, which may additionally contribute to increased effectiveness of azole drugs.
Dosage
Rexgard dosage
For oral administration: Dosage is based on 15 mg/kg/day.
- Adults: 1-2 tea-spoonfuls of gel four times daily
- Children aged 6 years and over: One tea-spoonful of gel four times daily
- Children aged 2-6 years: One tea-spoonful of gel twice daily
- Infants under 2 years: Half tea-spoonful of gel twice daily.
For localised lesions of the mouth:
A small amount of gel may be applied directly to the affected area with a clean finger. For topical treatment of the oropharynx, the gel should be kept in the mouth for as long as possible. Treatment should be continued for up to 2 days after the symptoms have cleared.
For oral candidasis, dental prostheses:
Should be removed at night and brushed with the gel.
The dosage is same for all the ages.
For skin infections: Apply some cream to the lesions twice daily and rub it well with finger until it has fully penetrated the skin. All lesions usually disappear after 2 to 5 weeks. Prolong treatment for some 10 days to prevent relapse.
For nail infections: Clip infected nail as shortly as possible. Apply some cream once daily to the infected nail and rub with your finger, cover nail with a non-perforated occlusive plastic bandage.
Also after loosening of the infected nail (from 2-3 weeks onwards) uniterrupted treatment should be continued until the growth of a new nail has set in and definite cure can be observed (usually after seven months or more).
Side Effects
Topical application of Rexgard Nitrate has almost no side effect.
For oral gel: Occasionally, nausea and vomiting have been reported, and with long term treatment, diarrhoea. In rare instances, allergic reactions have been reported. There are isolated reports of hepatitis, for which the causal relationship with Rexgard has not been established.
Toxicity
Rexgard overdose has not been reported. Patients experiencing an overdose are at an increased risk of severe adverse effects such as headache, skin irritation, diarrhea, nausea, vomiting, abdominal pain, and dysgeusia. Symptomatic and supportive measures are recommended.
Rexgard has an oral LD50 of 500 mg/kg in rats.
Precaution
If the concomitant use of Rexgard and anticoagulants is envisaged, the anticoagulant effect should be carefully monitored and titrated. It is advisable to monitor Rexgard and phenytoin levels, if they are used concomitantly. Particularly in infants and young children, caution is required to ensure that the gel does not obstruct the throat. Hence, the gel should not be applied to the back of the throat and the full dose should be divided into smaller portions. Observe the patient for possible choking.
Interaction
Rexgard can inhibit the metabolism of drugs metabolised by the Cytochrome P450-3A and -2C9 families. This can result in an increase or prolongation of their effects, including side effects. Rexgard Oral Gel should not be used during treatment with the following drugs: terfenadine, astemizole,mizolastine, cisapride, triazolam, oral midazolam, dofetilide, quinidine, pimozide, CYP3A4 metabolised HMG-CoA reductase inhibitors such as simvastatin and lovastatin.
Food Interaction
No interactions found.Rexgard Cholesterol interaction
[Minor] Elevations in cholesterol and triglyceride levels may occur in patients receiving intravenous miconazole and are attributed to the drug vehicle, Cremophor EL (polyethoxylated castor oil).
These increases are reversible upon discontinuation of miconazole therapy.
Clinicians should be cognizant of these effects when interpreting lab results of hyperlipidemic patients during treatment with miconazole.
Rexgard Drug Interaction
Moderate: fluconazole, alprazolamUnknown: ibuprofen, lorazepam, amoxicillin / clavulanate, diphenhydramine, omega-3 polyunsaturated fatty acids, fluticasone nasal, metoprolol, polyethylene glycol 3350, acetaminophen, bifidobacterium infantis / lactobacillus acidophilus, acetaminophen, cyanocobalamin, ascorbic acid, cholecalciferol, ranitidine, ondansetron, sertraline, cetirizine
Rexgard Disease Interaction
Volume of Distribution
A 1200 mg miconazole vaginal suppository resulted in a calculated apparent volume of distribution of 95 546 L while a 100 mg vaginal cream yielded an apparent volume of distribution of 10 911L.
Elimination Route
Rexgard given to healthy volunteers as a single 50 mg oral tablet produced a mean Cmax of 15.1 ± 16.2 mcg/mL, a mean AUC0-24 of 55.2 ± 35.1 mcg*h/mL, and a median Tmax of 7 hours (range 2.0-24.1). In these patients measurable plasma concentrations ranged from 0.5 to 0.83 mcg/mL.
Topical miconazole is absorbed poorly into the systemic circulation. In pediatric patients aged 1-21 months given multiple topical applications of miconazole ointment for seven days, the plasma miconazole concentration was less than 0.5 ng/mL in 88% of the patients, with the remaining patients having a concentration of 0.57 and 0.58 ng/mL, respectively. Similarly, patients. administered with a vaginal 1200 mg ovule had a mean Cmax of 10.71 ng/mL, mean Tmax of 18.4 hours, and mean AUC0-96 of 477.3 ng*h/mL.
Half Life
Rexgard has a terminal half-life of 24 hours.
Elimination Route
Rexgard is excreted through both urine and feces; less than 1% of unchanged miconazole is recovered in urine.
Pregnancy & Breastfeeding use
In animals, Rexgard has shown no teratogenic effects but is foetotoxic at high oral doses. The significance of this to man is unknown. However, as with other imidazoles, Rexgard Oral Gel should be avoided in pregnant women if possible. The potential hazards should be balanced against the possible benefits. It is not known whether Rexgard is excreted in human milk. Caution should be exercised when prescribing Rexgard Oral Gel to nursing mothers.
Only small amounts of Rexgard cream are absorbed following local administration. However as with other imidazoles, Rexgard nitrate should be used with caution during pregnancy.
Contraindication
Rexgard is contraindicated in patients with known hypersensitivity to the active drug.
Acute Overdose
In general, Rexgard is not highly toxic. In the event of accidental overdosage, vomiting and diarrhoea may occur.
Storage Condition
Store away from direct heat. Keep out of reach of children.
Innovators Monograph
You find simplified version here Rexgard
Rexgard contains Miconazole see full prescribing information from innovator Rexgard Monograph, Rexgard MSDS, Rexgard FDA label
FAQ
What is Rexgard used for?
Rexgard is an antifungal medication used to treat ring worm, pityriasis versicolor, and yeast infections of the skin or vagina. It is used for ring worm of the body, groin (jock itch), and feet (athlete's foot). It is applied to the skin or vagina as a cream or ointment.
How safe is Rexgard?
Rexgard topical is for use only on the skin. Rexgard may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing.
How does Rexgard work?
Rexgard works by stopping the growth of yeast (fungus) that causes the infection.
What are the common side effects of Rexgard?
Common side effects of Rexgard are include:
Burning, stinging, swelling, irritation, redness, pimple-like bumps, tenderness, or flaking of the treated skin may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
Is Rexgard safe during pregnancy?
Yes, you can use during pregnancy.
Is Rexgard safe during breastfeeding?
There are currently no studies looking at Rexgard use during breastfeeding. However, because only small amounts of the medication could pass into breastmilk Rexgard is used on the skin or in the vagina, breastfeeding is not expected to be a concern.
Can I take alcohol with Rexgard?
You should not drink alcohol if you are feeling sick or uncomfortable while fighting off a fungal infection because alcohol can have adverse effects that may make you feel worse. Alcohol, as with some other foods and beverages, can affect your body's yeast infection.
What happens after taking Rexgard?
Headache, vaginal/urethral burning/itching/pain, or lower abdominal cramps may occur.
How long does it take Rexgard to start working?
You should begin to feel better during the first three days of treatment with Rexgard.
How often can I take Rexgard?
The cream is used twice a day for up to 7 days, on the skin around the outside of the vagina. Follow the directions on the package or as directed by your doctor carefully, and ask your doctor or pharmacist to explain any part you do not understand.
How long can I use Rexgard for?
Do not use for more than 4 weeks without advice.
Who should not take Rexgard?
You should not take Rexgard If you have any of the following health problems, consult your doctor or pharmacist before using this medication: diabetes, immune system problems , frequent vaginal yeast infections.
What happens if I stop Rexgard early?
No you should continue until treatment is finished. Vaginal yeast infections respond best to 7-day treatments and tend to come back if medicine is stopped early.
What happens if I miss a dose?
Apply the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed and apply only the next regularly scheduled dose. Do not use a double dose of this medication.
What happens if I overdose?
An overdose of Rexgard vaginal is unlikely. If you do suspect that a much larger than normal dose has been used or that Rexgard vaginal has been ingested, contact an emergency room or a poison control center.
How well does Rexgard work?
Rexgard topical has an average rating of 3.0 out of 10 from a total of 4,019 ratings on Drugs.com. 15% of reviewers reported a positive effect, while 72% reported a negative effect.
When should I use Rexgard?
Use the medication usually once daily at bedtime for 1 to 7 nights depending on the product used, or as directed by your doctor.
Can Rexgard affect my liver?
Cause liver damage or failure, especially when combined with alcohol or certain medicines.
Can Rexgard affects my heart ?
Rexgard should be given with caution to patients with underlying heart disease.
