VANOS
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VANOS (VANOS).
VANOS (fluocinonide 0.1% cream) is a corticosteroid that binds to glucocorticoid receptors, leading to inhibition of phospholipase A2 and reduction of prostaglandin and leukotriene synthesis, resulting in anti-inflammatory, antipruritic, and vasoconstrictive effects.
| Metabolism | Hepatic metabolism; fluocinonide is primarily metabolized via reduction, hydrolysis, and conjugation in the liver. The exact enzymes are not fully characterized, but CYP450 enzymes may be involved. |
| Excretion | Primarily renal excretion (glucuronidation and sulfation); minimal biliary elimination (<5%). Approximately 60-70% of the dose is excreted in urine as metabolites, with <1% unchanged. |
| Half-life | The terminal elimination half-life is approximately 7.5 hours (range 5-12 hours). This supports twice-daily or once-daily dosing for sustained local effect. |
| Protein binding | >99% bound to plasma proteins, primarily albumin and corticosteroid-binding globulin. |
| Volume of Distribution | The volume of distribution (Vd) is not well-established for topical corticosteroids. For systemically absorbed fraction, Vd is estimated to be 0.1-0.5 L/kg due to high protein binding and lipophilicity. |
| Bioavailability | Topical: Systemic bioavailability is low (approximately 1-5%) through intact skin, but can increase to 30-50% with occlusion or compromised skin barrier (e.g., inflammation, excoriation). |
| Onset of Action | Topical: Clinical improvement (reduction of erythema and scaling) typically observed within 1-2 weeks of regular application. |
| Duration of Action | Duration of therapeutic effect after discontinuation is variable; with chronic use, effects may last several weeks to months. The duration is influenced by disease severity and skin barrier integrity. |
| Molecular Weight | 470.54 |
Apply a thin layer to affected areas once or twice daily. Not for use longer than 2 weeks; maximum 15 g per day.
| Dosage form | CREAM |
| Renal impairment | No dosage adjustment required for topical use; systemic absorption is minimal. |
| Liver impairment | No dosage adjustment required for topical use; systemic absorption is minimal. |
| Pediatric use | Not recommended for use in children under 18 years due to risk of adrenal suppression. |
| Geriatric use | Use with caution; apply smallest amount for shortest duration due to increased risk of skin atrophy and systemic effects. |
| 1st trimester | Topical corticosteroids should be used during first trimester only if potential benefit justifies potential risk to fetus; minimal systemic absorption expected with short-term, limited-area use. |
| 2nd trimester | Use with caution; avoid prolonged use or application to large areas; potential for fetal growth restriction with extensive use. |
| 3rd trimester | Avoid use in last trimester if possible due to risk of low birth weight; minimal absorption with short-term use. |
Clinical note
Comprehensive clinical and safety monograph for VANOS (VANOS).
| Placental transfer | Minimal systemic absorption after topical application; if absorbed, corticosteroids cross placenta. Degree depends on extent of use and skin integrity. |
| Breastfeeding | Topical application to small areas for short duration likely results in negligible systemic absorption; avoid application to breasts or large areas. Use only if clearly needed and monitor infant for skin irritation or systemic effects. |
■ FDA Black Box Warning
No FDA black box warning identified.
| Serious Effects |
Hypersensitivity to any component of formulationUntreated bacterial, fungal, or viral skin infections at application site
| Precautions | Hypothalamic-pituitary-adrenal (HPA) axis suppression, especially with prolonged use, large surface area, or occlusive dressings, Cushing syndrome and hyperglycemia from systemic absorption, Local adverse reactions including atrophy, striae, telangiectasias, and infection risk, Use caution in pediatric patients due to higher skin surface-to-body weight ratio, Avoid use on face, axillae, or groin unless directed by physician |
| Food/Dietary | No known food interactions. Avoid excessive alcohol consumption as it may worsen psoriasis. |
Loading safety data…
| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | Pregnancy Category C. Topical corticosteroids have shown teratogenicity in animal studies; however, adequate human studies in pregnant women are lacking. Although systemic absorption is minimal, use only if potential benefit justifies risk. No specific trimester risk data; avoid prolonged use, especially in first trimester. |
| Fetal Monitoring | Monitor for signs of fetal growth restriction if used extensively. Assess maternal adrenal suppression if used on large areas or under occlusion. Evaluate for local adverse effects (atrophy, striae). |
| Fertility Effects | No known effects on fertility in humans. Animal studies not reported. |
| Clinical Pearls | VANOS (fluocinonide 0.1%) is a high-potency topical corticosteroid. Use for short-term (≤2 weeks) treatment of plaque psoriasis in adults. Limit application to no more than 60 g per week. Avoid use on face, groin, axillae, or intertriginous areas due to increased risk of atrophy. Taper gradually if used on large areas. Do not use with occlusive dressings. Monitor for HPA axis suppression with prolonged use. |
| Patient Advice | Apply a thin layer only to affected areas, not to normal skin. · Use for a maximum of 2 continuous weeks unless directed otherwise. · Do not cover treated area with bandages or dressings. · Avoid contact with eyes, mouth, and mucous membranes. · Do not use on face, groin, or armpits without doctor approval. · Wash hands after applying, unless treating hands. · Report any signs of skin thinning, burning, or infection. · Do not use more than prescribed; do not use for other conditions. |