Psorizide Ultra (potassium bromide 1 [hp_x] nickel sulfate 1 [hp_x] zinc bromide 4 [hp_x] lactose 264.27 mg magnesium stearate 3 mg) Dailymed

CAUTION:Federal law prohibits dispensing without a prescription.

Description

PSORIZIDE ^®ULTRA is a biochemical homeopathic medication indicated for the treatment of eczema and seborrhea. ^24-26The active ingredients in each PSORIZIDE ^®ULTRA tablet consist of the following: Potassium Bromide (Kali Bromatum) 1X, Nickel Sulphate (Niccolum Sulphuricum) 1X and Zinc Bromide (Zincum Bromatum) 4x. These drug ingredients are uled in the Homoeopathic Pharmacopoeia of the United States (HPUS). ¹

Inactive ingredients: Lactose and Magnesium Stearate.

Pharmacological class:Homeopathic drug

Dosage form:Oral 300 mg scored tablet. May be swallowed whole, chewed or dissolved in the mouth and swallowed.

Clinical Pharmacology

The active ingredients in PSORIZIDE ^®ULTRA are inorganic soluble mineral salts. The exact mechanism of action is unknown; however, it is believed PSORIZIDE ^®ULTRA addresses a primary genetic biochemical defect.

POTASSIUM BROMIDEdissolves and dissociates in the digestive tract into its ionic constituents. Each tablet contains approximately 15 mg bromide (calculated). Ionic bromide is rapidly and completely absorbed from the intestine and distributed almost exclusively in the extracellular fluids. ^7,8Bromide is eliminated by the kidneys and the elimination half-life is 11-12 days. "Once a day" dosing will lead to a steady state concentration in about seven weeks. ⁷

NICKEL SULPHATEdissolves and dissociates in the digestive tract into its ionic constituents. Each tablet contains approximately 1.5 mg of ionic nickel (calculated). According to studies, 15% to 50% of ionic nickel is absorbed on a fasted stomach. ²Food markedly decreases the rate and extent of nickel absorption. ^3,4Clinical studies show that serum concentrations of nickel are variable among patients after administering the same dosage. ⁵Peak serum nickel concentration is reached about two hours after oral administration. "Once a day" dosing leads to steady state serum concentrations in approximately one week. Nickel is in its highly stable divalent cation state and is therefore not expected to be metabolized to any significant degree in the body. Absorbed nickel is primarily excreted in the urine and elimination half-life is about 21 hours. ^3,5Renal clearance is rapid and efficient, and nickel does not accumulate in the body. ⁶

Clinical Studies

A variety of controlled clinical studies have been performed using various sources of both nickel and bromide in over 300 subjects. Clinical efficacy and safety have been documented in a significant number of subjects. Published and unpublished reports are available upon request. ^9,22,23

Indications

PSORIZIDE ^®ULTRA is indicated for the treatment of moderate to severe eczema, atopic dermatitis, seborrhea and seborrheic dermatitis. It has been found to work well with variety of combination therapies. Psoriasis also responds, but generally has a more favorable response to PSORIZIDE ^®Forte (NDC 61480-255-05.)

Contraindications

Although there are no known contraindications, patients who are allergic to any PSORIZIDE ^®ULTRA ingredient should consult a physician prior to taking the medication. (Refer to Section on Hypersensitivity)

Warning

Do not use if imprinted seal under bottle cap is missing or broken. Do not use if pregnant or nursing. If allergic to nickel or metal objects such as jewelry or if there is a history of bulering hand eczema, see PRECAUTIONSfor hypersensitivity information. Lactose intolerant patients may have gastrointestinal difficulty. This has very rarely been reported at the doses used.

Precautions

Carefully adjust dosage to weight when treating young children. Do not use in cases of kidney disease. If skin rash appears or if nervous symptoms persist, recur frequently, or are unusual, discontinue use.

Hypersensitivity

Caution should be used when administering to patients with a history of contact sensitivity to nickel (common metal exposure) or if there is a history of vesicular hand eczema (dyshidrosis, pomphylox). Nickel allergy may be confirmed by a positive nickel patch test. Most patients with hand eczema, positive nickel allergy history, or a positive nickel patch test do nothave any untoward reaction to administration of PSORIZIDE ^®ULTRA. If there is a history of nickel sensitivity or dyshidrotic hand eczema, begin with a very low dose and slowly increase to a recommended starting dose over a period of 5 weeks as tolerated, thus allowing progressive GI absorption*.

*Nickel desensitization schedule:

Week	Amount of Time to Take Medication Prior to Breakfast
Week 1	With Breakfast
Week 2	15 min
Week 3	30 min
Week 4	45 min
Week 5 and thereon	1 hour

If new pruritic rashes occur or persist, discontinue PSORIZIDE ^®ULTRA and treat appropriately. Do not use if there is a history of extra-cutaneous hypersensitivity to nickel or bromide.

Information for patients

Patients using PSORIZIDE ^®ULTRA should receive the following information and instructions:

• This medication is to be used as directed by a physician.
• It is important to take orally at the beginning of the day on an empty stomach (or any convenient time after having taken nothing but water for at least 7 hours) and to eat or drink nothing but water for at least one hour afterwards to avoid interference with absorption.

Drug interactions

There are no known drug interactions.

Carcinogenesis, mutagenesis, impairment of fertility

No studies have been done on the carcinogenesis or mutagenesis, or impairment of fertility of PSORIZIDE ^®ULTRA. No carcinogenesis or mutagenesis has been reported in multiple animal studies for oral administration of soluble nickel and bromide salts (active ingredients) even at very high doses. ^10-16

Effects of soluble potassium bromide

KBr is not uled as a carcinogen by the NTP, IARC, and OSHA. ¹⁸

Effects of soluble nickel sulphate

Studies on experimental animals have never indicated that nickel, at any dose, is a carcinogen when introduced to the body orally. Furthermore, Nickel sulphate and other highly water soluble nickel salts, have never been known to induce carcinogenesis via any route of introduction including: oral, inhalation, cutaneous, IM, or IP. ^10-12,17No adverse effects were noted on fertility or reproduction in a 3-generational study of albino Wistar rats fed up to 1000 ppm Ni per day, which is equivalent to 50 mg/kg body weight per day Ni. ¹⁷

Pregnancy

Pregnancy category C

Animal reproduction studies have not been conducted with PSORIZIDE ^®ULTRA. PSORIZIDE ^®ULTRA should not be given to a pregnant woman.

Nursing mothers

It is not known whether this drug is excreted in human milk. However, since many drugs are excreted in human milk, caution should be exercised when PSORIZIDE ^®ULTRA is administered to a nursing woman.

Pediatric use

Carefully adjust dosage to weight when treating young children.

Adverse Reactions

PSORIZIDE ^®ULTRA contains low doses of active ingredients. Therefore there are minimal known side effects. (see PRECAUTIONSfor hypersensitivity information)

Overdosage

Potassium bromide toxicity

Indications of toxicity due to oral overdosage of bromide may include nausea, vomiting, apathy, disturbed coordination, loss of memory, drowsiness, loss of emotional control, agitation, hallucination, tremors, depressed reflexes, stupor, and coma. Acute toxic reactions in humans have been reported at doses as low as 1000 mg. ²¹This level is 67 times the dose received in one tablet of PSORIZIDE ^®ULTRA.

Nickel sulphate toxicity

The oral rat LD ₅₀for nickel sulphate hexahydrate is 275 mg/kg. ¹⁹Symptoms of toxicity due to oral overdosage of nickel sulphate may include nausea, vomiting, abdominal discomfort, diarrhea, giddiness, lassitude, headaches, cough, and shortness of breath. ²⁰The lowest observed transitory toxic effects from human ingestion of soluble nickel salts is approximately 8 mg nickel/kg body weight. ²⁰This is 80 times the maximum dose recommended for PSORIZIDE ^®ULTRA. (See below).

Dosage And Administration

Absorption of nickel sulphate is variable among individuals. For maximum absorption, tablets should be taken orally at the beginning of the day (or any convenient time after having taken nothing but water for at least 7 hours). Take nothing but water for one hour after taking medication to aid absorption.

Weight	Starting Dose	Max. Dose
50-100 lbs	½ tablet	1 tablet
100-150 lbs	1 tablet	2 tablets
150-200 lbs	2 tablets	4 tablets
over 200 lbs	3 tablets	6 tablets

In the setting of renal impairment, dosage should be adjusted and serum nickel and bromide levels should be followed.Steady state trough level should be drawn priorto ingesting the day's dose after one week of dosing or at appropriate intervals. Target trough serum nickel level is 20-40 mcg/L. (Warning: post dose peak levels are unreliable.) Treatment duration depends on the individual. Increase dose as needed on a monthly basis.

Maintenance phase

In order to maintain symptomatic relief, medication may be continued at the same or reduced initial phase dose level.