This is a combination product that contains 2 medications: Calcipotriol and betamethasone. Enstilar is used to treat psoriasis. Calcipotriol belongs to the class of medications known as vitamin D analogues and works by controlling the excessive production of skin cells seen in psoriasis. Betamethasone belongs to the class of medications known as corticosteroids and works by reducing itching and inflammation.

All forms of Enstilar are used to treat psoriasis that develops on the body. The gel and foam forms of Enstilar may also be used to treat psoriasis that has developed on the scalp.

Enstilar may be available under multiple brand names and/or in several different forms. Any specific brand name of Enstilar may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of Enstilar may not be used for all of the conditions discussed here.

Your doctor may have suggested Enstilar for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given Enstilar, speak to your doctor. Do not stop using Enstilar without consulting your doctor.

Do not give Enstilar to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use Enstilar if their doctor has not prescribed it.

Enstilar is applied once daily to affected areas and gently rubbed in. Do not apply the medication to areas that do not have psoriasis.

The maximum adult weekly dose of calcipotriol - betamethasone combined is 100 grams. When used on the scalp, the gel may be used for up to 4 weeks. If it is being used on the body, the gel may need to be used for up to 8 weeks. The recommended treatment period for the ointment is 4 weeks. Most people will notice a benefit during this time. Some people may require treatment for longer than 4 weeks. The medication can be stopped once your condition has improved.

Calcipotriol - betamethasone gel should not be applied from 12 hours before to 12 hours after chemical hair treatments such as dyes or perms.

After applying the medication to the affected areas, do not wash it off. The medication needs to stay in contact with the affected areas in order to work.

Do not apply Enstilar on the face, large areas of damaged skin, in skin folds, the underarms, genitals, groin, or under dressings that do not breathe. Wash your hands after applying calcipotriol - betamethasone so that you do not get the medication on other parts of your body. Avoid getting the medication in your eyes or on your face. If the medication gets on your face, wash it off. If it gets in your eyes, flush the eyes with plenty of water. Do not take Enstilar by mouth.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use Enstilar exactly as prescribed by your doctor. If you miss a dose, apply it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not apply more than one dose on any given day. Do not apply a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Do not use the ointment from any tube that has been open for longer than 12 months. Do not use the gel from any bottle that has been open for longer than 6 months. The foam should be used within 6 months of opening. 

Store Enstilar at room temperature and keep it out of the reach of children. The aerosol foam is flammable. It should be stored away from sources of heat, open flames or sparks.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is used in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who uses Enstilar. If you are concerned about side effects, discuss the risks and benefits of Enstilar with your doctor.

The following side effects have been reported by at least 1% of people using Enstilar. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• burning, dryness, irritation, peeling, or redness of skin
• increased sensitivity to sunlight
• itching

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• acne or oily skin
• burning and itching of skin with pinhead-sized red blisters
• delayed healing of skin wounds
• eye irritation
• flushing
• folliculitis (tiny skin rashes with pimply appearance around the hair roots)
• hair loss
• headache
• skin infection
• skin rash
• symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
• symptoms of high blood calcium levels (e.g., Constipation, Depression, fatigue, loss of appetite, mental confusion, nausea, vomiting)
• symptoms of high levels of corticosteroids in the blood stream (e.g., fatigue, increased thirst and urination, irritability, muscle weakness)
• symptoms of long-term use of corticosteroids (e.g., thinning or softening of skin, unusual bruising or skin discoloration, irritation of skin around the mouth, reddish-purple lines (stretch marks), skin colour changes)
• worsening of psoriasis

Stop using the medication and seek immediate medical attention if any of the following occur:

• symptoms of a serious allergic reaction (e.g., difficulty breathing, dizziness, itching, rash, swelling)
• symptoms of pustular psoriasis (e.g., chills, feeling unwell, Fever, headache, muscle pain, loss of appetite, nausea)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Enstilar.

Each gram of white-to-off-white, flat, non-expanding foam contains 50 µg of calcipotriol plus 0.5 mg of betamethasone (as dipropionate). Nonmedicinal ingredients: all-rac-α-tocopherol, butylhydroxytoluene, liquid paraffin, polyoxypropylene-11-stearyl ether, and white soft paraffin; propellants: butane and dimethyl ether.

Do not use Enstilar if you:

• are allergic to calcipotriol, betamethasone, or any ingredients of Enstilar
• have a disorder related to calcium metabolism
• have perioral dermatitis (skin lesions around the mouth), ichthyosis (dry, scaly skin), Acne, Rosacea, ulcers, or broken skin
• have severe forms of psoriasis (e.g., guttate, exfoliative, erythrodermic, and pustular psoriasis)
• have severe kidney dysfunction
• have severe liver dysfunction
• have thin skin, easily damaged veins, or stretch marks
• have Tuberculosis skin lesions or skin infections related to Syphilis
• have viral diseases such as herpes simplex, varicella (Chickenpox), and vaccinia
• have viral, fungal, or bacterial skin infections

Do not use Enstilar in or around your eyes.

There may be an interaction between calcipotriol - betamethasone and any of the following:

• Aldesleukin
• aluminum hydroxide
• calcium supplements (e.g., calcium carbonate, calcium citrate)
• Deferasirox
• Digoxin
• hyaluronidase
• multivitamin supplements with minerals
• other topical (skin-applied) medications that contain corticosteroids
• Sucralfate
• thiazide diuretics (water pills; e.g., Hydrochlorothiazide, Indapamide, Metolazone)
• vitamin D supplements

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Enstilar. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Enstilar.

Absorption: Applying Enstilar over large areas of damaged skin, in skin folds, or under dressings that do not breathe could promote the absorption of betamethasone into the blood. This could cause unwanted effects similar to those that happen after taking oral (by mouth) corticosteroid medications for long periods of time. If you notice symptoms of using steroid medications for long periods of time, such as weakness, increased urination, increased thirst, fatigue, or weight loss, contact your doctor as soon as possible.

High calcium in the blood: If Enstilar is used for severe psoriasis over a large area of skin or is used more than the maximum recommended weekly amount of 100 g of ointment, gel, or foam, there is a risk of developing high calcium levels in the blood. Your doctor may monitor your blood calcium levels regularly by doing blood tests while you are using Enstilar.

Kidney function: If you have decreased kidney function or Kidney Disease, discuss with your doctor how Enstilar may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Enstilar, and whether any special monitoring is needed.

Liver function: If you have decreased liver function or liver disease, discuss with your doctor how Enstilar may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Enstilar, and whether any special monitoring is needed.

Medical treatment: Inform all health professionals involved in your care that you have been using a topical (skin-applied) corticosteroid.

Prolonged use: Using topical corticosteroid medications for a long period of time can cause skin to thin or soften or cause stretch marks. Your doctor may recommend you stop using Enstilar once in a while or to apply to one area of the body at a time. Suddenly stopping corticosteroid medication may cause psoriasis to return.

Skin Cancer: When calcipotriol is used with ultraviolet radiation (some psoriasis treatments use light therapy), there may be an increased risk of developing skin cancer caused by ultraviolet radiation. Calcipotriol alone does not cause cancer. While using Enstilar, avoid exposure to sunlight and artificial ultraviolet light (e.g., tanning beds).

Use on the face: Enstilar should not be used on any part of the face since this may cause redness, irritation, and itchiness. If any of these skin reactions develop, you should stop using Enstilar and contact your doctor immediately. Wash your hands thoroughly after applying Enstilar to the affected areas and avoid touching any part of your face with your hands.

Using other corticosteroids: Betamethasone dipropionate is a potent corticosteroid and should not be used at the same time as other corticosteroid medications, particularly on the scalp. If you have been prescribed another scalp product containing corticosteroids, contact your doctor to determine which product you should be using.

Pregnancy: Enstilar should not be used during pregnancy. If you become pregnant while using Enstilar, contact your doctor immediately.

Breast-feeding: Betamethasone passes into breast milk. It is not known if calcipotriol passes into breast milk. If you are a breast-feeding mother and are using Enstilar, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Enstilar have not been established for children.