Calcipotriol/Calcipotriene (Dovonex®, Daivonex®)

Calcipotriol/calcipotriene (Dovonex®, Daivonex®) is a derivative of vitamin D that is available as a cream, ointment, and scalp solution. It is an established effective topical therapeutic option for the management of mild-to-moderate psoriasis.

How the treatment works

Although the exact mechanism of action is unknown, its effects slow the excessive turnover of skin cells, called keratinocyes, in the eipdermis, the outermost layer of the skin.

Advantages/Benefits

• Well tolerated with few side-effects.
• Improvement usually starts within 2-3 weeks. The full effect may require up to 2 months.
• It is usually effective and safe for long-term use.
• It can be used in combination with other topical agents (corticosteroids), phototherapy (PUVA or UVB), and systemic therapies (such as cyclosporine A or acitretin).
• Combination use of calcipotriol with other medicines can improve treatment outcomes and allow for dosage reduction of other drugs.

Disadvantages/Risks

• There is a risk of hypercalcaemia (elevation of calcium in the blood) if calcipotriol is used extensively, but at dosages of less than 100 gm per week, calcium metabolism is not affected.
• It takes longer to work than topical corticosteroids.
• Due to the potential to cause irritation, it is generally not used on the face, genitals, or in skin folds.
• Do not combine with salicylic acid.
• Common side-effects may include burning, itching, skin irritation, and tingling.
• Less common side-effects may include dry skin, peeling, rash, redness, inflammation, skin discoloration, and worsening of psoriasis.
• Since the stability of marketed formulations of calcipotriol may be affected by other compounds, mixing calcipotriol with other topical agents is not recommended.

Comments & Suggestions

• Because of the longer time that it takes for calcipotriol to work, patients may become dissatisfied with the rate of improvement and discontinue therapy before the full benefits are realized. It takes roughly in 8-12 weeks to see the optimal results.
• Local irritation from the product can also affect adherence to the therapy.
• Using topical calcipotriene in combination with a topical corticosteroid can produce a better and quicker rate of improvement and reduce the severity of side-effects.