RING GUARD: IS IT SAFE? USES, SIDE EFFECTS, DOSAGE

What is Ring guard?

Ring guard is an anti-fungal cream used to treat ring worm and many other skin infections. It is used for topical application.

It is manufactured by Paras Pharmaceuticals Ltd.

 

What are the Generic name(s)?

Its generic name is Miconazole.

What is its composition?

Ring guard contains effective proven anti-fungal and antibiotic compounds.

Each 100 gm contains:

The active ingredients are:

• Miconazole Nitrate– 2% w/w (broad spectrum anti-fungal compound- imidazole derivative)
• Neomycin Sulfate– 0.5% w/w (aminoglycoside derived antibiotic agent effective against gram positive and gram negative bacteria)

Inactive Ingredients are:

• Chlorocresrol – 0.1% w/w (used as a preservative)
• Cream base Q.S

w/w= by weight

How does it work?

Active ingredient Miconazole has anti-fungal action which enables it to damage the cell membranes of the fungus causing its death. The damage is done by inhibiting synthesis of Ergosterol which is an integral component of cell membrane. In its absence, the cell membrane permeability will increase leading to leaking of the essential nutrients causing death of the cell.

Neomycin is an antibiotic which will stop the production of proteins that are required for survival of bacteria present in body. It will be effective in destroying a wide range of bacteria like Escherichia coli, Epidermophyton, Microsporum, Staplylococcus Aureus, Candida Albicans and Trichophyton.

What are its uses?

This cream is used to treat skin infections like:

• Ringworm- rings are formed with normal skin in between. It can be caused by touching infectious person, damp surfaces, in public showers and locker rooms, etc.
• Vaginal yeast infections
• Jock’s itch (it causes infection in inner thighs, buttock and the genital skin)
• Eczema
• Napkin rash
• Mouth ulcers
• Cutaneous candidiasis
• Few bacterial infections
• Psoriasis
• Oral thrush caused by Candida Albicans fungus
• Vaginal candidiasis also caused by fungus Candida Albicans
• Tinea cruris or Dhobi’s itch (fungal infection of the groin; seen commonly in men)
• Pityriasis (causes either darkening or lightening of neck, arms and legs)
• Athlete’s foot or Tinea pedis (characterized by itching, burning in the foot)
• Tinea corporis (infection seen in arms, legs, or any other part of body; seen commonly in children)
• Fungal infections in other body parts like nails,toe bed, etc.
• Dermatitis
• Also used for treatment of fungal infections in pets.

Who should not use Ring guard?

Using this medication is contraindicated in patients with following conditions:

• Hypersensitivity
• Dehydration
• Open wounds in the affected area.
• Sun burned skin
• Myaestina gravis
• Abdominal pain
• Ulcerative colitis
• Parkinson’s disease
• Secondary infection in the affected.
• Diabetes
• High cholesterol
• Gastritis

How effective is this medicine?

The onset of action of ring guard can be seen in about 7 hours of the normal dosage. Its duration of action is about 24 hours.

This cream has a pretty good success rate. It is a decent and safe option used very commonly to treat infections. Its composition consists of pretty mild chemicals incapable of causing any harm and do not react with normal skin.

The formulation of this medication is simple but still it is proved effective by many clinical studies in treating many harsh skin infections which are chronic in nature and have persisted for a long period of time. This guarantee is not provided by numerous other skin care products.

 Is it addictive?

No, this medicine does not have reported habit forming tendencies. Thus it is not addictive in nature.

What is the dosage?

The dosage of the cream will vary for different conditions. It will also change according to severity, duration and area of infection.

Usually, the cream has to be applied on the affected area twice in a day, once in morning and then once in evening. The amount of cream should cover the whole affected area.

This should be continued for 7-10 days or as said so by the doctor. If the infection does not fade even after the treatment course, consult medical professionals.

How to use Ring guard?

• This cream is available in a tube with different quantities available. (12 gm, 12 gm, 20 gm and 25 gm). Buy accordingly.
• Wash the affected area with warm water and a harmless cleanser which does not contain any strong chemical.
• Dry the part completely. Do not leave behind any moisture as it will further facilitate the infection.
• Wash your hands before and after applying the cream.
• Apply the cream as a thin layer onto the fungal infection and the adjacent areas.
• Rub the cream in a circular manner gently using your fingers.
• Do not wash the affected area immediately after applying the cream. This will render the effectiveness of the cream to nil.
• Continue full course of the treatment. It is recommended to use this cream till 10 days after the lesion has disappeared.

What if I miss a dose?        

In case of missed dose, take up the dose as soon as you remember. Do not take double dose if it’s near the next dose. Also, there is no need to apply excessive cream for the next dose.

What to do in case of over dosage?

Over dosage with this cream is highly unlikely especially if you apply a thin layer of cream. But sometimes using excessive amount can cause pilling. Should a scenario of overdose arise, seek medical help immediately or call local poison center.

What to do if there is an allergic reaction?

Allergic reaction may be caused due to allergy to ring guard or any of its active or inactive ingredients. The reaction can arise even due to allergy to milk protein (present in Miconazole). Do not take this medicine if you have above allergies or even to any related medicine like other anti-fungal medicines.

Allergic reactions symptoms will manifest as:

• Scaly regions
• Red bumps
• Blisters
• Rashes
• Severe burning and itching
• Hives
• Inflammation
• In case of severe reaction, even contact dermatitis can result.

Measures to be taken:

• Do not scratch your skin in case of reactions it can increase the reaction.
• Wash the affected part of skin thoroughly with water and soap.
• Use lotions or moisturizers for immediate relief for itching and burning sensation. Alovera gel can be used too.
• Get medical help in case of severe allergy. Take the cream packet with you to show to the doctor.
• The doctor can prescribe topical hydrocortisone cream to bring down the reaction. Use it as per the instructions given by the doctor.

What are the side effects?

Side effects are not seen in every patient and are rare but are reported in individuals. These include:

• Nausea
• Vomiting
• Weakness
• Irritation
• flaking of the skin
• Headache or cerebral pain
• Diarrhea
• Fever and chills
• Redness
• Swelling
• Uneasiness or heaving
• Tingling of skin
• Stomach ache

Severe side effects include:

• Body pain
• Black or tar like stools
• Loss of appetite
• Changes in taste
• Difficulty in breathing
• Blistering
• Open spores
• Oozing

Contact your dermatologist or doctor when any of these effects are seen. Also report immediately if the side effects persist for a longer time or worsens over time.

Does this medicine has any drug interactions?

Ring guard can interact with following drugs:

• Atorvastatin
• Blood thinners like Warfarin, Coumadin and Jantoven.
• Regorafenib
• Alprazolam
• Phenytoin
• Medroxyprogesterone
• Anti-diabetic drugs like Metformin, Pramlintide, oral hypoglycemics, etc.
• Trizolam
• Midazolam
• Methotraxate
• Ergot alkaloids like dihydroergotamine, ergonovine ergotamine and methylergonovine.
• Amlodipine
• Sorafenib
• Anticoagulants like Heparin, Dalteparin, Enoxaparin, etc.
• Cyclosporine
• Nifedipine
• Ethinyl estradiol
• Digoxin
• Amiodarone
• Flucytosine
• Nystatin
• Fentanyl

Precautions

• For external use only. Do not swallow the cream ,
• Do not bandage the affected area or cover it using gauze or any other material.
• Do not apply it on your lips, genital and inside your mouth.
• Do not apply the cream if its color looks different. Buy another tube as a safety measure.
• Pay special attention to your personal hygiene during the treatment course to get better and faster results.
• Illuminate your specialist about all the medications, Herbal supplements and vitamins that you take before starting this medicine. Also tell about your present status like pregnancy, upcoming surgeries, etc.
• Do not use other products like balms, creams, lotions, etc. on the area where this cream is applied unless told so by doctor
• For better results, apply the cream at the same time twice every day. (Morning as well as evening).
• This product is to not meant to be used on face.
• Wearing loose, light and breathable clothes can help in treating the infection by absorbing perspiration of the body. Wearing tight clothes will worsen the infection.
• Consult your medical professional before applying the cream on dry, chapped or burnt areas or places with surgical sutures.
• Do not share your personal belongings like soap, towel, toothbrush, etc. with other people to prevent spreading of infection.

Is it safe to use if I am pregnant?

Safety of ring guard in pregnant ladies is not established. It is usually contraindicated in first trimester of pregnancy. For this reason, it is usually not recommended in pregnancy and is used when no other alternatives are available.

Is it safe to use if I am breastfeeding?

There is no substantial research to provide data of using this cream in breastfeeding women. First, discuss with your doctor or dermatologist regarding the potential benefits and risks of this medicine. Only then decide whether the cream is to be used or not. As a precaution, use this medicine with utmost caution and avoid using it near chest area.

Can this medicine be given to children and infants?

Ring guard is not given to children under age of 2 years since their skin is very sensitive and will undergo damage despite the mild ingredients of Ring guard.

For individuals under 16 years of age, the effectiveness and action of this cream has not been established and thus should be avoided and substitutes should be used. If there is no other alternative and if doctor has prescribed the medicine, only then it can be given to this age group.

Is this medicine available as over the counter product?

Yes. Ring guard is available in many pharmacies and is approved as OTC product in many countries including India, USA, Japan, etc. But it is advisable to consult your doctor or dermatologist first to know the dosage and duration of treatment according to the condition.

Frequently asked questions

Q: What are the substitutes of ring guard cream?

Commonly used anti-fungal creams (with their manufacturers) are:

• Dermizole cream- by Alkem Laboratories Ltd.
• Candizol cream- by Micro labs Ltd.
• Rivizole cream- by Lupin Ltd.
• Micogel cream – by Cipla Ltd
• Relin Guard – by Wockhardt Ltd
• Fungitop cream- manufactured by Micro labs Ltd.
• Candistat- by Merck Consumer Health Care Ltd
• Miconazole cream- Cipla Ltd.
• Pevesca – by Usv Ltd
• Rexgard- by Novartis India Ltd

Q: What is the cost of Ring guard cream?

One tube of the cream of 12 gm costs for about 56 INR. Tube of 20 gm costs around 73 INR.

Q: How to store ring guard?

• Keep out of reach of children.
• Store in a cool place devoid of moisture.
• Do not store in a washroom.
• Always store it at around 15-30 degrees (Celsius) and away from exposure to direct sunlight.
• Do not freeze the medicine.

Q: I applied expired ring guard cream. What should I do?

Applying expired medicine is usually not harmful in any way. Wash it with water and soap and then dry it with a clean cloth.

Q: Can I drive after applying Ring Guard?

Yes. There is no issue in driving or operating any heavy machinery after using this cream. But sometimes you can feel drowsiness as a side effect. Please refrain from driving in this case.

Q: Can I use this cream if I have Liver Cirrhosis?

Yes, you can. One of the active ingredients of Ring Guard is Miconazole. It is primarily metabolized by liver. It can increase the levels of Liver enzymes of the body. Topical application of this medicine mostly might not have these hepatic effects in patients with liver diseases. Even then, use the cream with utmost caution. Also liver function test should be monitored while the treatment course is ongoing.

Q: Can this medicine treat acne?

No. This is an anti-fungal cream. It will not have any effect on acne formation or reduction.

Q: Can I stop using this cream if the infection disappears?

No. Do not practice this. If the infection is not visible, it does not mean that the fungi has been eradicated. If you stop on using the cream on your body just in between the treatment course, the fungi might return with even more severe infection than before. Therefore, always complete your treatment course and then consult your doctor or dermatologist regarding what is to be done.

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