For an adult with psoriasis, how many grams per day of calcipotriene (calcipotriene) and betamethasone dipropionate cream should be prescribed?

Daily Dosing of Calcipotriene/Betamethasone Cream for Psoriasis

Recommended Daily Amount

Apply calcipotriene/betamethasone cream once daily with a maximum weekly limit of 100 grams per week in adults to prevent hypercalcemia and corticosteroid-related adverse effects. 1

Specific Dosing Guidelines by Patient Population

Adults (Body/Trunk/Limbs)

• Maximum: 100 grams per week (approximately 14 grams per day if used daily, though typically less is needed) 1
• Apply once daily for initial 4-week treatment period 1, 2
• Can extend up to 52 weeks with appropriate monitoring and as-needed dosing 1
• The 100 g/week limit specifically prevents reversible hypercalcemia, which is more likely when this threshold is exceeded 1

Adolescents (≥12 years)

• Maximum: 80 grams per week for scalp formulations 2, 3
• Apply once daily for up to 4-8 weeks 2
• Lower weekly maximum reflects smaller body surface area and increased risk of systemic absorption 3

Scalp Psoriasis (All Adults)

• Apply once daily using gel or suspension formulation 1, 2
• Treatment duration: 4-12 weeks initially 1, 3
• Same 100 g/week maximum applies 3

Critical Safety Thresholds

The 100 gram per week limit is not arbitrary—it represents the threshold above which reversible hypercalcemia becomes clinically significant. 1 This translates to roughly 14 grams daily if treating every day, though most patients use considerably less based on affected body surface area.

Why This Limit Matters

• Calcipotriene is a vitamin D analogue that can elevate serum calcium when absorbed systemically 1
• Betamethasone dipropionate is a high-potency corticosteroid (Class II) that carries risks of HPA axis suppression, skin atrophy, and striae with excessive use 1
• The 52-week safety study of 828 patients showed no serious adverse events when used as-needed within these limits 1

Practical Application Strategy

Initial 4-Week Phase

• Apply once daily to affected areas 1, 2
• 69-74% of patients achieve clear or almost clear status during this period 1
• Track weekly usage to ensure <100 g/week threshold 1

Maintenance Beyond 4 Weeks

• Avoid continuous daily high-potency corticosteroid use beyond 2-4 weeks 2
• Transition to one of these evidence-based maintenance strategies:
  • Weekend pulse therapy: Apply twice daily on weekends only, with vitamin D analogue twice daily on weekdays 1, 2
  • Morning-evening split: High-potency corticosteroid in morning, vitamin D analogue in evening 1, 2
  • As-needed dosing: Apply only to active lesions once daily 1

Common Pitfalls to Avoid

Never Exceed Weekly Maximums

• Hypercalcemia risk increases substantially above 100 g/week in adults 1
• Monitor patients with renal disease or calcium metabolism disorders more closely 3

Avoid Simultaneous Salicylic Acid Use

• Never combine calcipotriene with salicylic acid simultaneously—the acidic pH completely inactivates calcipotriene and eliminates effectiveness 4, 3
• If descaling is needed, apply salicylic acid separately and wash off before applying calcipotriene/betamethasone 3

Do Not Apply to Wet or Moist Skin

• Increases systemic absorption and irritation risk 4
• Apply to completely dry skin for optimal safety and efficacy 4

Monitoring Requirements

During Treatment

• Track total grams used per week (each pump or application delivers approximately 0.05 g) 5
• Assess for local irritation, which occurs in lesional and perilesional skin but is typically transient 1
• Monitor for corticosteroid-related effects: skin atrophy, telangiectasia, striae 1

For Extended Use (>4 weeks)

• Consider checking serum calcium if approaching or exceeding 100 g/week 1
• Evaluate for HPA axis suppression if using continuously rather than as-needed 1, 2
• Reassess need for continued high-potency corticosteroid versus transition to maintenance strategy 2