Generic Heximar Ointment ( Calcipotriol )

Buy Generic Heximar Ointment (Calcipotriol) without prescription in Canada

In our Canadian pharmacy, you can buy Heximar Ointment (Calcipotriol) without a prescription, with delivery across Canada within 5‑14 days. Discreet and anonymous packaging.

Heximar Ointment (calcipotriol) is a topical vitamin D analogue used to treat mild to moderate plaque psoriasis, a chronic inflammatory skin condition characterised by raised, red, scaly patches. It works by binding to vitamin D receptors on skin cells, which helps to slow down the excessive production of keratinocytes, the primary cell type involved in the formation of psoriatic plaques. This action normalises skin cell growth, reduces scaling and thickness, and flattens the raised lesions, providing effective long‑term control of psoriasis symptoms.

Usual adult dose: Apply a thin layer of Heximar Ointment to the affected areas of the skin once or twice daily, as directed by a physician. The maximum recommended weekly dose should not exceed 100 g of ointment to avoid potential effects on calcium metabolism. The ointment should be gently rubbed into the plaques until it is absorbed. Hands must be washed thoroughly after each application, unless the hands are the treatment site. Treatment is usually continued until the plaques have cleared significantly, which may take several weeks; ongoing maintenance therapy can help prevent recurrence. Buy Flagyl (Metronidazole)

Dosage form: Topical ointment containing 50 mcg of calcipotriol per gram, supplied in 15 g and 30 g tubes.

Onset of action: Initial improvement in scaling, thickness, and redness may be seen within the first 2 weeks of treatment. Significant lesion clearance typically occurs after 4 to 6 weeks of regular application, with maximum benefit often achieved after 8 to 12 weeks of continuous therapy.

Duration of action: Calcipotriol is metabolised rapidly in the skin, and its clinical effect is local. When the ointment is discontinued, psoriatic plaques may gradually return over several weeks to months. Long‑term maintenance therapy can be used to sustain remission.

Alcohol recommendation: Alcohol consumption does not directly interfere with the topical action of Heximar Ointment. However, as excessive alcohol intake can trigger or worsen psoriasis in some individuals and may impair the body’s immune response, limiting alcohol consumption is advisable to support the overall effectiveness of treatment.

Most common side effects: Local skin reactions at the application site, including mild burning, itching, redness, irritation, and dryness. These effects are usually transient and diminish with continued use. Applying the ointment to the face, flexures, or genital areas should be avoided unless specifically instructed by a physician, as these areas are more sensitive and prone to irritation. Rarely, excessive use over large body surface areas can lead to hypercalcaemia (elevated blood calcium levels), which may cause nausea, vomiting, weakness, and confusion.

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General Information about Heximar Ointment (Calcipotriol)

• INN (International Nonproprietary Name): Calcipotriol (also known as calcipotriene in the United States)
• Brand names available in Canada: Heximar® Ointment is not a marketed brand in Canada. The active ingredient calcipotriol is available in Canada under the brand name Dovonex® (Leo Pharma Inc.) as a cream, ointment, and scalp solution, and in combination with betamethasone dipropionate as Dovobet® or generic calcipotriol/betamethasone. Calcipotriol ointment (50 mcg/g) is also available as a generic product. Our pharmacy supplies the internationally sourced Heximar brand through the international supply chain for personal importation.
• ATC code: D05AX02 (calcipotriol; antipsoriatics, other)
• Dosage forms and strengths: Ointment, 50 mcg calcipotriol per gram, in 15 g and 30 g tubes.
• Manufacturers in Canada: Leo Pharma Inc. manufactures Dovonex. Generic calcipotriol ointment is produced by various manufacturers. Heximar is manufactured internationally and imported for personal use.
• Registration status in Canada: Approved by Health Canada for calcipotriol as Dovonex (DIN 02080256 for ointment) and generic equivalents. The specific Heximar brand has not been issued a Notice of Compliance but contains the identical active ingredient.
• OTC / Rx classification: Prescription only (Rx). Schedule I drug under the Controlled Drugs and Substances Act. A valid prescription from a licensed Canadian healthcare professional is required. Our pharmacy fulfills this prescription for the internationally sourced product.

Mechanism of Action and Pharmacology

Calcipotriol is a synthetic vitamin D3 analogue that acts by binding to the vitamin D receptor (VDR) in the nuclei of keratinocytes and immune cells in the skin. In psoriasis, keratinocytes proliferate excessively and differentiate abnormally, leading to the accumulation of thick, scaly plaques. Calcipotriol normalises this process by inhibiting keratinocyte proliferation and promoting terminal differentiation, thereby reducing the number of hyperproliferating cells. It also has immunomodulatory effects: it reduces the infiltration and activation of T‑lymphocytes and other inflammatory cells in the psoriatic plaque, decreasing the production of pro‑inflammatory cytokines such as interleukin‑8 and tumour necrosis factor‑α. Additionally, calcipotriol restores the normal expression of markers of differentiation, such as involucrin and transglutaminase, in psoriatic skin, leading to a more normal epidermal architecture.

When applied topically, calcipotriol is absorbed through the skin in small amounts, with systemic absorption estimated at about 5‑6% of the applied dose. The absorbed drug is rapidly metabolised in the liver to inactive metabolites, which are excreted in the bile and urine. The elimination half‑life of calcipotriol after topical application is short (minutes to hours), and the drug does not accumulate significantly in the body with normal therapeutic use. However, excessive application (more than 100 g per week) can lead to systemic absorption sufficient to affect calcium metabolism, causing hypercalcaemia. The local concentration of the drug in the skin, however, is sufficient to exert its anti‑psoriatic effects over a prolonged period. Because calcipotriol is a vitamin D analogue, it should not be used concurrently with other topical or systemic vitamin D preparations unless specifically prescribed, to avoid additive hypercalcaemic effects.

Indications

• Topical treatment of mild to moderate plaque psoriasis (psoriasis vulgaris) in adults. Heximar Ointment is effective on the body, limbs, and scalp (though a scalp solution is often preferred for hair‑bearing areas). It can be used as monotherapy or in combination with other topical therapies, such as corticosteroids.
• Not indicated for the treatment of guttate, pustular, erythrodermic, or inverse psoriasis, or for psoriasis involving the face, flexures, or genital areas, because of an increased risk of irritation in these sensitive sites.
• Not recommended for use in children under 6 years of age; safety and efficacy in paediatric populations have not been established. Caution is advised in older children and adolescents.

Important Warnings and Precautions

At‑risk groups

• Pregnancy: The safety of calcipotriol during pregnancy has not been established. It should be used during pregnancy only if the potential benefit clearly outweighs the potential risk to the foetus. Systemic absorption is low, but as a vitamin D analogue, it could theoretically affect calcium metabolism. Pregnant women should avoid applying the ointment over large body surface areas and should consult their physician.
• Breastfeeding: It is not known whether calcipotriol is excreted in human breast milk after topical application. Because many drugs are excreted in breast milk, caution should be exercised when Heximar Ointment is administered to a nursing mother. It should not be applied to the breast or nipple area to avoid accidental ingestion by the infant. A decision should be made whether to discontinue breastfeeding or to discontinue the drug, taking into account the importance of the medication to the mother.
• Paediatrics (< 6 years): Safety and efficacy have not been established in children under 6 years of age. Use in paediatric patients should be managed by a specialist. Children have a higher body surface area to weight ratio, which may increase the risk of systemic absorption and hypercalcaemia.
• Elderly: No specific dose adjustment is required for age alone. However, elderly patients are more likely to have renal impairment, which could increase the risk of hypercalcaemia if excessive amounts of ointment are used. Renal function and serum calcium should be monitored if large areas are treated.
• Hypercalcaemia: Excessive use of calcipotriol (more than 100 g of ointment per week) can lead to systemic absorption sufficient to cause hypercalcaemia. Symptoms of hypercalcaemia include nausea, vomiting, constipation, muscle weakness, fatigue, confusion, and cardiac arrhythmias. If hypercalcaemia develops, the drug should be discontinued, and serum calcium levels should be monitored until they return to normal. Patients with impaired renal function, those taking calcium or vitamin D supplements, and those with disorders of calcium metabolism are at increased risk.
• Photosensitivity: Calcipotriol may increase the sensitivity of the skin to ultraviolet (UV) light. Patients should avoid excessive exposure to natural or artificial sunlight, including tanning beds and sunlamps, while using this medication. If sun exposure is unavoidable, the treated areas should be protected with clothing, and the ointment should be removed beforehand.
• Facial and intertriginous use: Heximar Ointment is not recommended for use on the face, flexures (skin folds), or genital areas because of an increased risk of irritation and perioral dermatitis. If treatment of these areas is necessary, a less irritating formulation (such as a cream or a lower‑strength preparation) should be used, and application should be carefully monitored.
• Allergy: Do not use Heximar Ointment if you have a known hypersensitivity to calcipotriol, other vitamin D analogues, or any excipient in the ointment base.

Driving and alcohol

Topical application of Heximar Ointment has no known influence on the ability to drive or operate machinery. There is no clinically relevant interaction between topically applied calcipotriol and ingested alcohol. However, excessive alcohol consumption can trigger or worsen psoriasis in some individuals, so moderate intake is advised to support the effectiveness of treatment.

Dosage Instructions

• Standard adult dose: Apply a thin layer of Heximar Ointment to the affected psoriatic plaques once or twice daily. The ointment should be gently rubbed into the skin until it disappears. Do not apply to unaffected skin. The maximum recommended dose is 100 g of ointment per week; for the 30 g tube, this is approximately three tubes, and for the 15 g tube, approximately six tubes. Higher doses increase the risk of hypercalcaemia. Use the smallest amount necessary to cover the plaques.
• Duration of therapy: Heximar Ointment is suitable for both short‑term treatment of acute flares and long‑term maintenance therapy to keep psoriasis under control. Patients typically see initial improvement within 2 weeks, and significant lesion clearance may take 4‑8 weeks. Once the plaques have cleared or improved, treatment frequency may be reduced to a maintenance schedule (e.g., once daily or every other day) as directed by a physician. If there is no improvement after 12 weeks of regular use, treatment should be re‑evaluated.
• Combination therapy: Heximar Ointment can be used in combination with topical corticosteroids (e.g., applied in the morning and evening, respectively) to enhance efficacy and reduce the risk of corticosteroid‑induced skin atrophy. A fixed‑dose combination product (calcipotriol/betamethasone dipropionate) is also available for convenience. Heximar Ointment should be applied at a different time of day than the corticosteroid, unless directed otherwise.
• Administration: Wash and dry the affected skin thoroughly before applying the ointment. Squeeze a small amount onto the fingertip and apply a thin layer only to the psoriatic plaques. Avoid contact with the eyes, mouth, and mucous membranes. Wash hands immediately after use, unless the hands are the treatment site. Do not cover the treated area with occlusive dressings (bandages, plastic wrap) unless directed by a physician.
• Missed dose: If a dose is missed, apply it as soon as remembered and then continue with the regular schedule. Do not apply a double amount to make up for a missed dose.

Side Effects and Contraindications

• Very common side effects (≥ 10%): Local skin irritation, including burning, stinging, itching, erythema (redness), and dryness at the application site. These reactions are usually mild to moderate, most common during the first few weeks of therapy, and often diminish with continued use.
• Common side effects (1‑10%): Rash, dermatitis, worsening of psoriasis, and folliculitis. Perilesional irritation (irritation of the skin surrounding the plaque) can occur if the ointment spreads onto healthy skin.
• Uncommon but serious side effects: Hypercalcaemia (elevated serum calcium) can occur if the recommended weekly dose of 100 g is exceeded. Symptoms may include nausea, vomiting, constipation, muscle weakness, fatigue, and confusion. Allergic contact dermatitis and photosensitivity reactions have been reported. Very rarely, angioedema and facial oedema may occur.
• Contraindications: Known hypersensitivity to calcipotriol, other vitamin D analogues, or any component of the ointment. Hypercalcaemia or other disorders of calcium metabolism. Severe renal impairment or a history of calcium‑containing renal stones. Not for ophthalmic, oral, or intravaginal use. Application to the face, flexures, or genital area is not recommended unless under direct medical supervision.

Drug Interactions

• No known clinically significant systemic drug interactions: Because systemic absorption of calcipotriol following topical application is minimal at recommended doses, pharmacokinetic interactions with oral or injectable medications are unlikely. However, caution should be exercised when Heximar Ointment is used concomitantly with other topical products on the same area, especially other vitamin D analogues or preparations that may affect calcium metabolism.
• Calcium or vitamin D supplements: Patients taking oral calcium or vitamin D supplements in high doses should use Heximar Ointment with caution, as the additive effect could theoretically increase the risk of hypercalcaemia. Serum calcium levels should be monitored if large areas of the body are treated.
• Thiazide diuretics: Thiazide diuretics (e.g., hydrochlorothiazide) reduce urinary calcium excretion and may increase the risk of hypercalcaemia when used with topical calcipotriol on extensive areas. Monitor serum calcium if combined therapy is necessary.
• Other topical agents: Concomitant use of salicylic acid (commonly found in keratolytic preparations for psoriasis) may inactivate calcipotriol. If both agents are used, they should be applied at different times of the day, or the salicylic acid should be applied first and washed off before applying calcipotriol.

Practical Advice

• Administration: Apply the ointment exactly as directed by your doctor. Use it only on the psoriatic plaques, and keep it away from normal skin. Wash your hands before and after each application. Do not use more than the recommended amount per week (100 g). If you are using other topical medications, allow at least 30 minutes between applications or apply them at different times of the day.
• Monitoring: For most patients, no routine laboratory monitoring is required. If you are using the ointment on large areas of the body (more than 30% of body surface area), your doctor may check your serum calcium levels periodically to ensure they remain within the normal range. Report any symptoms of hypercalcaemia (nausea, vomiting, excessive thirst, muscle weakness) promptly.
• Storage: Store at room temperature (15‑30 °C), away from direct heat and light. Do not freeze. Keep the tube tightly capped after each use. Discard any unused ointment after the expiry date on the tube. Keep out of the reach and sight of children.
• Lifestyle: Heximar Ointment is most effective when used as part of a comprehensive psoriasis management plan. Avoid triggers that can worsen psoriasis, such as stress, smoking, excessive alcohol, and skin injuries. Protect your skin from excessive sun exposure, and use a non‑perfumed moisturiser to keep skin hydrated, which can help reduce scaling and itching between applications. Do not share your ointment with others.
• When to seek medical review: Contact your doctor if you develop severe skin irritation, a rash spreading beyond the treated area, signs of hypercalcaemia (nausea, vomiting, weakness, confusion), or if your psoriasis worsens or does not improve after several weeks of treatment. Seek emergency medical attention for signs of a serious allergic reaction (swelling of the face, lips, or throat, difficulty breathing).
• Disposal: Return unused or expired ointment to a pharmacy for safe disposal. Do not flush down the toilet or discard in household waste.

Alternative Medications

• Topical corticosteroids: Agents such as betamethasone valerate, clobetasol propionate, and hydrocortisone are the most commonly prescribed topical treatments for psoriasis. They are effective anti‑inflammatory agents but carry risks of skin atrophy, telangiectasias, and systemic absorption with prolonged use, particularly with high‑potency formulations. Calcipotriol is often used in rotation or in combination with corticosteroids to minimise these risks.
• Calcipotriol and betamethasone dipropionate fixed‑dose combination (Dovobet®, Enstilar®): A convenient once‑daily formulation that combines the anti‑inflammatory effects of a corticosteroid with the normalising effects of calcipotriol. It has been shown to be more effective than either component alone and is available in Canada as an ointment, gel, or foam.
• Topical retinoids (tazarotene, Tazorac®): A vitamin A derivative used for plaque psoriasis. It normalises skin cell growth and has anti‑inflammatory properties but can be more irritating than calcipotriol.
• Coal tar and anthralin: Older topical therapies that are still used in some settings for chronic plaque psoriasis. They are effective but can be messy, stain clothing, and have an odour that many patients find unpleasant.
• Phototherapy (narrowband UVB, PUVA): Ultraviolet light therapy is an effective treatment for moderate to severe psoriasis. Calcipotriol should not be applied immediately before phototherapy, as it can increase UV sensitivity. It may be used after light treatment.
• Systemic therapies (methotrexate, cyclosporine, apremilast, biologics): For moderate to severe psoriasis or when topical therapy alone is insufficient. These require specialist supervision and regular laboratory monitoring.

Clinical Efficacy

The efficacy of calcipotriol in the treatment of plaque psoriasis has been demonstrated in numerous randomised controlled trials. In a systematic review, calcipotriol ointment applied twice daily was associated with a mean improvement in the Psoriasis Area and Severity Index (PASI) of approximately 50‑60% over 6‑8 weeks, with a significant proportion of patients achieving marked improvement or clearance. Calcipotriol has been shown to be more effective than coal tar, anthralin, and low‑potency corticosteroids, and comparable to moderate‑potency corticosteroids, but with a slower onset of action. The combination of calcipotriol with a super‑potent corticosteroid (applied at separate times of the day) improves efficacy and tolerability, reducing the corticosteroid‑related risk of skin atrophy. Long‑term maintenance therapy with calcipotriol alone or in rotation with corticosteroids is safe and effective in preventing relapse. The recommended maximum weekly dose of 100 g should be respected to avoid the risk of hypercalcaemia. In Canada, calcipotriol is a standard second‑line topical agent for plaque psoriasis, and the 15 g and 30 g tubes provide flexibility for short‑term and maintenance treatment.

Important:

Heximar Ointment (calcipotriol) is a prescription topical medication that should be used only under the supervision of a qualified healthcare professional. It is for external use only. Do not apply it to the face, skin folds, or genital areas unless directed by your doctor. Avoid excessive sun exposure and do not exceed the recommended weekly dose of 100 g, as this can lead to elevated calcium levels in the blood (hypercalcaemia) which can be harmful. If you develop severe skin irritation, a widespread rash, or symptoms such as nausea, vomiting, weakness, or confusion, discontinue use and contact your doctor. Women who are pregnant, planning to become pregnant, or breastfeeding should consult their physician before using this product. This information is not a substitute for professional medical advice, diagnosis, or treatment.

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