Dovonex (Calcipotriene) Formulation and Usage
Dovonex (calcipotriene) is a synthetic vitamin D3 analog available in ointment form at 0.005% concentration (50 mcg/g) for the treatment of plaque psoriasis in adults, applied as a thin layer once or twice daily with gentle rubbing for complete absorption. 1
Formulation Details
Calcipotriene ointment 0.005% contains:
- Active ingredient: Calcipotriene 50 mcg/g
- Inactive ingredients: disodium phosphate dihydrate, edetate disodium, mineral oil, white petrolatum, propylene glycol, dl-alpha-tocopherol, steareth-2, and purified water 1
Calcipotriene is also available in other formulations:
- Cream (0.005%)
- Foam
- Solution (for scalp)
- Combination products with betamethasone dipropionate 2
Mechanism of Action
Calcipotriene works by:
- Binding to vitamin D receptors
- Inhibiting keratinocyte proliferation
- Enhancing keratinocyte differentiation
- Normalizing skin cell growth in psoriatic plaques 2
Usage Guidelines
Dosing
- Apply a thin layer once or twice daily 1
- Maximum weekly dose should not exceed 100 g to avoid hypercalcemia 2
- For body coverage estimation:
- Approximately 400 g is required to cover the entire body surface of an average adult when used twice daily for 1 week 2
- Specific body areas require different amounts (measured in fingertip units):
- Scalp: 3 units (6% BSA)
- Face and neck: 2.5 units (5% BSA)
- Trunk (anterior): 8 units (16% BSA)
- Trunk (posterior): 8 units (16% BSA) 2
Treatment Duration
- Efficacy is typically observed after 8 weeks of treatment, not at 4 weeks 2
- Can be used for long-term management (up to 52 weeks) 2
Clinical Efficacy
- In clinical trials, calcipotriene foam showed significantly better results than vehicle, with 27% vs 16% of patients achieving clear or almost clear skin after 8 weeks 2
- Calcipotriene cream has demonstrated efficacy as maintenance therapy following initial treatment with combination calcipotriene/betamethasone dipropionate, with a mean percentage change in PASI of -44.5% 3
- Calcipotriene has comparable efficacy to mid-potency topical corticosteroids but without causing skin atrophy 4
Optimal Usage Strategies
Combination Therapy
Body Site-Specific Recommendations
- Body and limbs: Standard application of calcipotriene ointment or cream
- Face and intertriginous areas: Calcipotriene cream is preferred over ointment due to lower irritation potential 6
- Scalp: Solution or foam formulations are more appropriate 2
Precautions and Side Effects
- Most common side effect: Local irritation (especially on face and intertriginous areas) 6, 4
- Potential for reversible elevation of serum calcium when used in quantities >100 g/week 2
- Photosensitivity considerations:
- UVA radiation can decrease calcipotriene concentration on skin
- Thick layers of calcipotriene can block UVB radiation
- When combining with phototherapy, apply after the phototherapy session 2
- Pregnancy category C 2
Patient Preference Considerations
- Cream formulation is generally preferred over ointment by patients 6
- Morning-cream and evening-ointment regimen is equally effective as twice-daily ointment and better accepted by patients 6
- Cream formulation leads to improved patient compliance compared to ointment 6
Comparative Efficacy
- Calcipotriene is more effective than coal tar or salicylic acid but less effective than liquor carbonis detergens (LCD) 15% solution 2, 7
- In a direct comparison study, LCD 15% solution showed greater mean reductions in PASI scores (58%) compared to calcipotriene cream (37%) after 12 weeks of treatment 7
When prescribing Dovonex, consider the body site being treated, potential for irritation, and the benefits of combination therapy with topical corticosteroids for optimal management of plaque psoriasis.