Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Aerosol, spray, topical:
Granulex: Trypsin 0.12 mg, balsam Peru 87 mg, and castor oil 788 mg per gram (60 g [DSC], 120 g [DSC])
TBC: Trypsin 0.1 mg, balsam Peru 72.5 mg, and castor oil 650 mg per 0.82 mL (60 g [DSC], 120 g [DSC])
Pharmacology
Mechanism of Action
Trypsin may be used to debride necrotic tissue; balsam peru stimulates circulation at the wound site and may be mildly bactericidal; castor oil improves epithelialization, acts as a protectant covering and helps reduce pain
Use: Labeled Indications
Granulex: Treatment of decubitus ulcers, varicose ulcers, debridement of eschar, dehiscent wounds and sunburn; promote wound healing; reduce odor from necrotic wounds
Vasolex: Treatment of decubitus ulcers, varicose ulcers, and dehiscent wounds; promote wound healing; reduce odor from necrotic wounds
Contraindications
There are no contraindications listed in the manufacturer's labeling.
Dosage and Administration
Dosing: Adult
Dermatologic conditions: Topical: Apply a minimum of twice daily or as often as necessary
Dosing: Geriatric
Refer to adult dosing.
Administration
Do not apply on fresh arterial clots.
Aerosol spray: Shake can well before spraying; hold can upright ~12” from area to be treated, and spray and coat wound rapidly (temporary stinging may occur). May be used with appropriate wet dressing if needed or wound may be left unbandaged. To remove, wash gently with water.
Ointment: Apply a thin film over the area being treated. May be used with appropriate dressing if needed or wound may be left unbandaged. To remove, wash gently with appropriate wound cleanser.
Storage
Aerosol spray: Store at room temperature; do not expose to fire, open flame, or temperatures >120°F.
Ointment: Store at 25°C (77°F): excursions permitted to 15°C to 30°C (59°F to 86°F). Do not freeze.
Drug Interactions
There are no known significant interactions.
Adverse Reactions
Frequency not defined.
Central nervous system: Transient stinging of the skin (at application site)
Warnings/Precautions
Disease-related concerns:
- Hemoglobin deficiency: Wound healing may be retarded in the presence of hemoglobin deficiency.
- Zinc deficiency: Wound healing may be retarded in the presence of zinc deficiency.
Dosage form specific issues:
- Aerosol: Flammable; do not expose to high temperatures or flame.
Other warnings/precautions:
- Appropriate use: For external use only; avoid contact with eyes. Do not apply to fresh arterial clots.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience stinging. Have patient report immediately to prescriber severe skin irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
