Effects on endocrine system: Adverse reactions found in connection with systemic corticosteroid treatment, such as adrenocortical suppression or impact on the metabolic control of diabetes mellitus may occur also during topical corticosteroid treatment due to systemic absorption.
Application under occlusive dressings should be avoided since it increases the systemic absorption of corticosteroids. Application on large areas of damaged skin, or on mucous membranes or in skin folds should be avoided since it increases the systemic absorption of corticosteroids.
In a study in patients with both extensive scalp and extensive body psoriasis using a combination of high doses of Xamiol Gel (scalp application) and high doses of Daivobet Ointment (body application), 5 of 32 patients showed a borderline decrease in cortisol response to adrenocorticotropic hormone (ACTH) challenge after 4 weeks of treatment.
Effects on calcium metabolism: Due to the content of calcipotriol, hypercalcaemia may occur if the maximum daily dose (15g) is exceeded. Serum calcium is normalised when treatment is discontinued. The risk of hypercalcaemia is minimal when the recommendations relevant to calcipotriol are followed.
Local adverse reactions: Xamiol Gel contains a potent group III-steroid and concurrent treatment with other steroids must be avoided.
Skin of the face and genitals are very sensitive to corticosteroids. The medicinal product should not be used in these areas.
The patient must be instructed in correct use of the product to avoid application and accidental transfer to the face, mouth and eyes.
Hands must be washed after each application to avoid accidental transfer to these areas.
Concomitant skin infections: When lesions become secondarily infected, they should be treated with antimicrobiological therapy. However, if infection worsens, treatment with corticosteroids should be stopped.
Discontinuation of treatment: When treating psoriasis with topical corticosteroids, there may be a risk of generalised pustular psoriasis or of rebound effects when discontinuing treatment.
Medical supervision should therefore continue in the post-treatment period.
Long-term use: With long-term use there is an increased risk of local and systemic corticosteroid adverse reactions. The treatment should be discontinued in case of adverse reactions related to long-term use of corticosteroid.
Unevaluated use: There is no experience with the use of Xamiol Gel in guttate psoriasis.
Concurrent treatment and UV exposure: Daivobet Ointment for body psoriasis lesions has been used in combination with Xamiol Gel for scalp psoriasis lesions but there is limited experience of combination of Xamiol with other topical anti-psoriatic products at the same treatment area, other antipsoriatic medicinal products administered systemically or with phototherapy.
During Xamiol Gel treatment, physicians are recommended to advise patients to limit or avoid excessive exposure to either natural or artificial sunlight. Topical calcipotriol should be used with UVR only if the physician and patient consider that the potential benefits outweigh the potential risks.
Adverse reactions to excipients: Xamiol Gel contains butylated hydroxytoluene (E321) as an excipient, which may cause local skin reactions (e.g. contact dermatitis), or irritation to the eyes and mucous membranes.
Effects on ability to drive and use machines: Xamiol Gel has no or negligible influence on the ability to drive and use machines.