How much calcipotriene should I prescribe per day for an adult with mild‑to‑moderate plaque psoriasis?

Calcipotriene Daily Dosing for Mild-to-Moderate Plaque Psoriasis

For adults with mild-to-moderate plaque psoriasis, prescribe calcipotriene ointment 0.005% applied twice daily to affected areas, with a maximum weekly dose not exceeding 100 grams per week to avoid hypercalcemia risk.

Standard Dosing Regimen

• Apply calcipotriene ointment 0.005% twice daily (morning and evening) to psoriatic plaques for up to 52 weeks 1
• The maximum safe weekly dose is 100 grams per week to minimize risk of hypercalcemia or hypercalciuria 2
• Treatment duration can extend up to 52 weeks for long-term maintenance therapy 1

Application Guidelines by Body Site

• For scalp psoriasis: Use calcipotriene foam or calcipotriene plus betamethasone dipropionate gel for 4-12 weeks 1, 3
• For facial psoriasis: Combine calcipotriene with hydrocortisone for 8 weeks, as this combination is more effective than calcipotriene alone on facial skin 1
• For body psoriasis: Apply calcipotriene ointment 0.005% twice daily as monotherapy 1

Combination Therapy to Enhance Efficacy

• Combine calcipotriene with high-potency topical corticosteroids (betamethasone dipropionate) for superior efficacy compared to either agent alone 1
• Apply calcipotriene in the evening and high-potency corticosteroid in the morning as an effective treatment regimen 1
• Alternatively, apply vitamin D analogues twice daily on weekdays with high-potency corticosteroids twice daily on weekends for maintenance 1
• When combining with biologics like adalimumab or etanercept, add calcipotriene/betamethasone to augment efficacy 1, 4

Critical Prescribing Precautions

• Never prescribe calcipotriene with salicylic acid simultaneously, as the acidic pH inactivates calcipotriene and reduces effectiveness 1, 3
• If using phototherapy, instruct patients to apply calcipotriene AFTER phototherapy treatment, not before, as UVA radiation decreases calcipotriene concentration on skin and thick layers can block UVB 1, 3
• Monitor for hypercalcemia if patients exceed 100 grams per week, though this risk is low when dosing guidelines are followed 2

Expected Clinical Response

• Patients should show significant improvement by week 2, with 70% achieving 75% or greater improvement by week 8 with twice-daily application 5
• Calcipotriene demonstrates superior efficacy to fluocinonide (a potent corticosteroid) by week 2 for scaling and plaque elevation 6
• When combined with betamethasone dipropionate, 69-74% of patients achieve clear or almost clear status over 52 weeks without serious adverse events including striae or HPA axis suppression 1

Common Adverse Effects

• Most adverse events are mild, transient local reactions including lesional or perilesional irritation 2
• Skin irritation and pruritus are the most common complaints 7
• Hypercalcemia is rare when the 100 gram per week limit is respected 2