Gentamicin + Betamethasone Valerate + Clotrimazole

What is gentamicin + betamethasone valerate + clotrimazole?

Gentamicin + betamethasone valerate + clotrimazole (Gentizol™ Ointment, MalOtic® Ointment, Otomax®, Tri-Otic®, Triple Otic Ointment) is a combination topical medication used to treat bacterial and/or yeast ear infections in dogs.

Gentamicin + betamethasone valerate + clotrimazole is also used off label to treat bacterial and/or yeast infections in cats, or for the topical treatment of superficial skin infections in both dogs and cats.

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label. 

How is gentamicin + betamethasone valerate + clotrimazole given?

• Gentamicin + betamethasone valerate + clotrimazole comes as an ointment.
• The ointment is applied topically to the affected ear(s) twice daily.
• Your veterinarian must ensure that the eardrum is intact before your pet uses this medication.
• Ensure the ears are clean and dry prior to use. Trim any excessive hair in the ears. 
• Instill the exact amount as prescribed by your veterinarian into the affected ear(s). Massage the external ear canal to ensure the medication is distributed well.
• This medication is usually given for 7 consecutive days.
• Ideally, apply this medication at the same time every day.
• Do not allow this medication to get into your pet’s eyes

This medication should take effect within 1 to 2 hours; however, improvement in clinical signs may not be apparent for a few days.

Precautions for humans exposed to gentamicin + betamethasone valerate + clotrimazole:

• Humans with known hypersensitivity to any medicines found in this product should not handle it.
• Avoid contact with the eyes
• Avoid ingestion. Contact your physician immediately if accidental ingestion occurs.
• It is recommended to wear gloves when applying medicated products.
• Wash your hands after applying the medication.

What if I miss giving my pet the medication?

If you miss a dose of gentamicin + betamethasone valerate + clotrimazole, give it as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once.

Are there any potential side effects?

Gentamicin + betamethasone valerate + clotrimazole may cause the following side effects:

• redness or discomfort at the site of application.

The following reactions are rare. If they occur, contact your veterinarian immediately:

• sudden hearing loss (deafness or partial hearing loss)
• infections that do not respond to treatment, do not appear to be healing, or are getting worse
• worsening ear pain
• loss of appetite
• vomiting, or diarrhea
• weight loss
• head tilt or walking in circles
• sores around the mouth
• increased thirst (i.e., frequent drinking of large quantities of water) and frequent urination
• thinning of the skin or increased skin tears
• progressive hair loss and skin redness
• infections at the application site

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This moderate-acting medication should stop working within a few days, although the effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

This medication should NOT BE USED in dogs who:

• are allergic to it
• have a confirmed or suspected ruptured ear drum
• are pregnant

This medication should be USED WITH CAUTION in:

• dogs with recurring ear infections
• very small/toy breeds of dogs

Long-term use of steroids such as betamethasone has been associated with the onset of Cushing’s disease in dogs, and symptoms such as increased thirst and urination, and increase in blood liver enzymes.

Are there any drug interactions I should be aware of?

Certain medications may interact with gentamicin + betamethasone valerate + clotrimazole and so it is important to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your dog is taking before starting any new treatment. 

Some medications should be used with caution when given with gentamicin + betamethasone valerate + clotrimazole, including:

• medications that contain gentamicin, as they may increase the risk of hearing loss (ototoxicity)
• corticosteroids (unless instructed by your veterinarian)

Is any monitoring needed with this medication?

• Your veterinarian should perform ear cytology (a microscopic evaluation of the ear flora) to monitor for successful treatment of the ear infection. 
• The manufacturer recommends that this medication not be used for longer than 7 days, as it may cause delayed wound healing. However, your veterinarian will determine the length of the course of treatment based on ear cytology and clinical response. 
• At home, monitor for any side effects such as those noted above. If any side effects occur, discontinue the medication and contact your veterinarian.
• Your veterinarian will let you know when they want to reassess your pet to ensure the medication is working and not causing side effects.

How do I store gentamicin + betamethasone valerate + clotrimazole?

• Store this medication in the original, tightly sealed container at room temperature, between 36°F and 77°F (2°C and 25°C).
• This medicine should only be used for 28 days after first use.
• Shake well before using.
• Keep the container out of reach of children and pets.
• Ask your veterinarian for disposal instructions. Do not flush medicines down the sink or toilet unless instructed to do so.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet's weight and symptoms.