What is the recommended treatment and dosage for mild to moderate psoriasis using Dovonex (calcipotriene)?

Dovonex (Calcipotriene) for Mild to Moderate Psoriasis

For mild to moderate plaque psoriasis, apply calcipotriene ointment 0.005% once or twice daily as a thin layer, rubbed in gently and completely, with treatment duration supported up to 52 weeks. 1, 2

Dosing and Application

• Apply calcipotriene ointment as a thin layer once or twice daily and rub in gently and completely 1
• Maximum weekly dose should not exceed 100g/week in adults to prevent hypercalcemia 3, 4
• For children, limit dosing to 50g per week per m² body surface area 4

Expected Clinical Efficacy

• 65-70% of patients experience marked improvement or clearing with calcipotriene monotherapy 2
• Clinical improvement can be observed as early as week 1, with 70% of patients showing 75% or more improvement by week 8 5
• For scalp psoriasis specifically, calcipotriene foam achieves clear or almost clear status in 40.9% of patients after 8 weeks 2

Combination Therapy Recommendations

Combining calcipotriene with betamethasone dipropionate is superior to either agent alone and represents the preferred approach for enhanced efficacy. 6, 2, 3

• The combination of calcipotriene 0.005% with betamethasone dipropionate 0.064% once or twice daily achieves clear or almost clear skin in 69-74% of patients versus 27% with placebo 7
• When using combination therapy, apply both products separately at different times of the day 7
• For sensitive areas (face, ears, intertriginous zones), consider calcipotriene combined with lower-potency hydrocortisone instead of betamethasone, with treatment duration of 8 weeks 7
• Combination with medium- or high-potency topical corticosteroids for 8-16 weeks is recommended by the American Academy of Dermatology-National Psoriasis Foundation 6

Long-Term Maintenance Strategy

After initial 4-week treatment with calcipotriene/betamethasone combination, transition to maintenance with calcipotriene cream on weekdays and the combination product on weekends for optimal long-term control. 8

• This alternating regimen resulted in -58.4% mean change in PASI score versus -33.1% with vehicle over 8 weeks of maintenance 8
• Long-term use up to 52 weeks is supported by guidelines without serious adverse events including striae or HPA axis suppression 2

Critical Drug Interactions and Application Timing

Never apply salicylic acid simultaneously with calcipotriene—the acidic pH completely inactivates calcipotriene and eliminates its effectiveness. 2, 3

• If using phototherapy, apply calcipotriene AFTER UV treatment, as UVA radiation decreases calcipotriene concentration on skin 2, 3
• Calcipotriene combined with tacrolimus is more efficacious than tacrolimus alone 6

Safety Monitoring and Contraindications

• Use with caution in patients with calcium metabolism disorders or renal disease 2
• Monitor for hypercalcemia and hypercalciuria, particularly if exceeding 100g/week dosing 9, 4
• Contraindicated in pregnancy and nursing 4
• Most common adverse effects are mild to moderate lesional or perilesional irritation (approximately 20% of patients), which is transient 9, 4
• Avoid facial application due to increased risk of irritant dermatitis 10
• Unlike topical corticosteroids, calcipotriene does not cause skin atrophy or tachyphylaxis 10

Comparative Efficacy Context

• Calcipotriene demonstrates superior efficacy to twice-daily placebo, fluocinonide 500 mcg/g, once-daily tacalcitol 4 mcg/g, and coal tar preparations 9
• Efficacy is comparable to mid-potency topical corticosteroids but without the atrophy risk 10, 9