Ingenol (Topical)

Ingenol is primarily used to treat actinic keratosis, which encompasses, scabby, scaly, flat skin growths that ensue after prolonged exposure to harsh sunlight.

Overview

Ingenol induces cell death. This property stems from the origin of the drug which is the sap of the plant Euphorbia peplus. The sap extract has antineoplastic characteristics that trigger a selection of protein kinase isoforms prompting apoptosis in various cells including tumor cells, carcinoma cells, basal cells, and melanoma cells.

Conditions Treated

  • Actinic keratosis/solar keratosis
  • Pre-cancerous skin growths
  • Cancerous skin growths

Type of Medicine:

  • cytotoxic agent

Side Effects

Due to the cytotoxic ability of Ingenol, some unwanted side effects have been observed in patients who have used the topical gel. The more common side effects of Ingenol are scaling, blistering and loosening of the skin around the affected area. This has been attributed to cell death that Ingenol induces on the area of application.

Another common side effect is pain around the area of application and itching. Doctors who have prescribed Ingenol also report that patients complain of severe redness of the skin around the application site. Furthermore, patients also report that after application, the site started to swell and developed skin ulcers. Contact your doctor to mitigate these symptoms in case you experience any of them.

Less common side effects of the application of the Ingenol gel is associated with when the gel happens to get into your eye or mucous membrane. Eye problems may ensue that include severe pain in the local area of contact, swelling around the area of contact, drooping of eyelids, tearing excessively, and discharge from the affected eye. If you accidentally get Ingenol into your eye, immediately flush the area with running cold water. Consult your doctor for further advice.

The occurrence of some side effects does not require the intervention of a medical practitioner. These undesirable secondary effects usually go away as your body acclimatizes to the medicine. The more common side effects that fall in this category encompasses mild redness of the application site and local scaling and flaking of the skin. On the contrary, the less common side effect in this bracket are headaches, sore throat, and sinus pain.

Variant side effects may occur in patients. It is prudent to inform your doctor in case you experience any side effects. Your healthcare provider may advise on ways to prevent or alleviate some of the side effects of Ingenol topical application use.

Dosage

As with the axiom with prescription drugs, it is pivotal to strictly use the medication as prescribed by a healthcare practitioner. Strict guidelines on the frequency and amount of drug should be adhered to so as not to compromise the efficacy of the drug. Furthermore, patients should finish the prescribed dosage even when it vivid the symptoms of an ailment have been alleviated.

Ingenol is topical medicine. This translates to mean that is it used only on the skin. Do not make contact with your eyes, mouth, vagina, and nose. Ingenol should not make contact with any mucous membrane. Ingenol should not make contact with open or vulnerable locations of the skin. This entails scrapes, scalds, burns, or cuts. If contact is accidentally made, immediately flush the area with large amounts of cold water.

As aforementioned, if Ingenol gets into your eye follow the above procedure to flush the gel out of the affected area lest the patient may suffer a myriad of eye disorders such as severe eye pain, redness, slumping of the eyelids, and swelling of the inner eyelids.

It is prudent to read the patient application leaflet contained within the product packaging and follow the instructions listed in the pamphlet to avoid any mishaps. Ingenol should only be used to treat skin conditions that a medical practitioner has prescribed to treat. Do not use Ingenol to address any other skin conditions.

The proper use of the gel is as follows:

  • Firstly, prepare for the administration of Ingenol gel by washing your hands with soap and clean water
  • Proceed to smear a thin layer of Ingenol of the affected area and rub it in gently in a cyclic manner. Rewash your hands as stated above.
  • Let the drug settle in and dry for 15 minutes
  • Proper practice dictates that you should avoid washing or be touching the affected area to allow the drug to take effect. Moreover, restrict participation in activities that warrant the production of heavy sweating for a minimum of six hours.
  • You are free to wash the affected area with mild soap and lukewarm water after six hours.
  • Do not cover the application site with a bandage unless advised to do so by a medical practitioner
  • Dispose of the single-dose tube after use.

The dosage of Ingenol is rooted in the different circumstances of different patients. It is advised to adhere to the doctor's orders, coupled with the directions on the label written on the patient application leaflet.

Ignenol has two strengths. The prescription strength and duration of treatment depends on the site of application, the condition of treatment, and, the health of the patient. Application sites are divided into two facets, namely, face or scalp and trunk or extremities. Ingenol dosage strength also depends on the age of the patient.

    • For actinic keratosis treatment on the face and scalp proceed as follows:

1. Use in children- the dose must be determined by a medical practitioner. Alternatives are encouraged.
2. Use in Adults- for three consecutive days, apply a thin film of Ingenol gel, 0.015%, once daily.

    • For actinic keratosis treatment on the trunk and extremities proceed as elucidated:

1. Use in children- the dose must be determined by a medical practitioner
2. Use in Adults- a thin film of 0.015% Ingenol gel should be applied to the affected area, once daily, for two consecutive days.

Do not use more gel than is prescribed to cover the affected area or tinker with the dosage to catalyze healing. The affected area will not heal faster, and this only increases the risk of severe skin infections.

If you miss a dose of Ingenol gel application, apply the gel as soon as you remember. However, if the time of the next application is fast approaching, forget the skipped application and wait for the next anticipated application.

Drug Interactions:

Sometimes certain medicines can be used together albeit the axiom that dictates medications should not be administered concurrently. In some instances, two different medicines have a synergetic effect in the body, and the presence of a drug may amplify the potency of another. It is imperative to provide your doctor with information on any other prescribed medicines you may be taking to tinker your prescription accordingly.

To date, no Ingenol drug interactions have been discerned. Notwithstanding, it is provident to inform your medical practitioner of any over-the-counter, prescription drugs, supplements, and vitamins, that you may be taking. Furthermore, tell your doctor of whether you have been treated for AK with surgery before.

Some drugs also interact with ingested food and thus should not be administered at the time of having a meal. Consuming alcohol and smoking tobacco may also have adverse effects on the body of a patient due to interactions with prescribed medicine.

Ingenol has no known food interactions. As such there are no foods that one must exclude during the administration of this medicine.

Warnings

Ingenol has been reported to cause severe allergic reactions in sporadic cases. Terminate the use of the gel and seek immediate medical attention if you experience any of the below;

  • Breathing difficulty
  • Light-headedness
  • Hives
  • Severe itching
  • Severe skin rash
  • Swelling of tongue and lips
  • A tight throat

Make sure you apply ingenol gel only as directed by your doctor. The application of the gel to the eye causes severe eye injuries and skin reactions.

Do not use the gel if you are allergic to ingenol mebutate. Furthermore, inform your doctor of any allergies you might have no matter how trivial you might think it is. Ingenol may contain inactive ingredients which may cause severe allergic reactions.

Inform the attending medical practitioner of your medical history that entails previous treatments of actinic ketosis or therapy of other skin conditions around the affected area. Divulge information of previous actinic ketosis treatments such as surgery and whether you intend to have surgery shortly.

There is no scientific evidence dismissing the use of ingenol in pregnant and lactating women. Notwithstanding, this medication should only be used when it is necessary. Tell your doctor whether you are pregnant or intend to get pregnant shortly to discuss the risk and benefits of Ingenol use.

Avoid the use of cosmetic or other skin care products on the affected area during the administration of Ingenol. Consult your doctor for further advice.

Ensure to regular schedule visits to the doctor to monitor the progress of the drug and scrutinize unwanted effects of the drug if any.

Storage

Manufacturers of Ingenol advice that the tube should be stored in the refrigerator. This is at a temperature of between 2-degree Celsius and 8 degrees Celsius. This translates to 36 to 46 Fahrenheit measurements. Do not freeze the medicine.

Just like all medicines, keep out of reach of children to avoid accidental ingestion and wrong application.

The tube that encapsulates comes with an expiration date, stamped at the end of the tube. Do not use the tube after this period is due.

Once you have finished your dosage, safely dispose of the remaining medicine.Do not preserve tube for future use.Consult with your doctor on the proper disposal of the remaining supply of Ingenol.

Summary

Ingenol being medication hailing from the family of cytotoxins is an adept treatment for actinic ketosis which is associated with extensive exposure to sunlight. Ingenol has known side effects that can be mitigated through consulting a medical practitioner the minute they ensure after use. Ingenol is a topical application drug that should only be used on affected skin. Patients should exercise caution to make sure their eyes, nose, mouth, and vagina do not come into contact with the drug.

Although Ingenol has no known drug and food interactions, patients are advised to inform the attending doctor of any allergies they have and previous treatments of actinic ketosis they have undergone.

Ingenol relieves the symptoms of actinic ketosis by inducing apoptosis of abnormal cells on the skin thus restoring the skin back to its normal healthy state. Patients who use Ingenol experience relief within a week of use. Ergo, their confidence is boosted as their skin develops a healthy glow.