Glevate Special Precautions

Clobetasol Propionate is a highly potent topical corticosteriod that has been shown to suppress the HPA axis at doses as low as 2 grams per day. Systemic absorption of topical corticosteriods has resulted in reversible hypothalamic pituitary adrenal (HPA) axis suppression, manifestations of Cushing's Syndrome, hyperglycaemia and glucosuria in some patients.
Conditions which augment systemic absorption include the application of the more potent corticosteroids, use over large surface areas, prolonged use and the addition of occlusive dressings. Therefore, patients receiving a large dose of a potent topical steroid applied to large surface area should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application or to substitute a less potent steroid.
Recovery of HPA axis function is generally prompt and complete upon discontinuation of the drug. Infrequently, signs and symptoms of steroid withdrawal may occur requiring supplement systemic corticosteroids.
If applied to the eyelids, care is required to ensure that the preparation does not enter the eye, as glaucoma might result.
If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted.
In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. If a favourable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled.
Bacterial infection is encouraged by the warm, moist conditions induced by occlusive dressings and the affected area should be cleansed before a fresh dressing is applied. Certain areas of the body such as the face, groin and axillae, are more prone to atrophic changes than other areas of the body following treatment with corticosteroids. Frequent observation of the patient is important when these areas are to be treated. Topical steroids should not be used extensively in pregnancy i.e. in large amounts or prolonged periods.