effects side ocular induced-Drug  • PART7  

be unilateral initially, but most with time are bilateral. Grinbaum et al (1992) reported a case with rechallenge data showing this agent can cause a reversible myopia. Oculogyric crisis has been reported in one patient who also experienced limb tremors.

While not approved by the FDA, topical periocular application is said to be of value in acne rosacea. Use on the eyelid may cause ocular irritation, but to date no permanent ocular side effects.

A midline facial defect, including telecanthus, has been reported by Cantu and Garcia-Cruz (1982) following maternal use of this drug during the first trimester. Recent articles suggest little to support the concern that this drug used orally has any teratogenic effects.

References and Further Reading

Cantu JM, Garcia-Cruz D. Midline facial defect as a teratogenic effect of metronidazole. Birth Defects 18: 85, 1982.

Chen K-T, Twu S-J, Chang H-J, Lin R-S. Outbreak of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with mebendazole and metronidazole use among Filipino laborers in Taiwan. Am J Public Health 93: 489–492, 2003.

Czeizel AE, Rockenbauer M. A population based case-control teratologic study of oral metronidazole treatment during pregnancy. Br J Obstetrics Gyn 105: 322–327, 1998.

DeBleecker JL, Leroy BP, Meire VI. Reversible visual deficit and corpus callosum lesions due to metronidazole toxicity. Eur Neurol 53: 93–95, 2005.

Dunn PM, Stewart-Brown S, Peel R. Metronidazole and the fetal alcohol syndrome. Lancet 2: 144, 1979.

Grinbaum A, Ashkenazi I, Avni I, et al. Transient myopia following metronidazole treatment for trichomonas vaginallis. JAMA 267(4): 511–512, 1992.

Kirkham G, Gott J. Oculogyric crisis associated with metronidazole. BMJ 292: 174, 1986.

Metronidazole hydrochloride (Flagyl IV). Med Lett Drugs Ther 23: 13, 1981. Putnam D, Fraunfelder FT, Dreis M. Metronidazole and optic neuritis.

Am J Ophthalmol 112(6): 737, 1991.

Schentag JJ, et al. Mental confusion in a patient treated with metronidazole

– A concentration-related effect? Pharmacotherapy 2: 384, 1982. Snavely SR, Hodges GR. The neurotoxicity of antibacterial agents. Ann

Intern Med 101: 92, 1984.

Generic name: Suramin sodium.

Proprietary names: None.

Primary use

This non-metallic polyanion is effective in the treatment of trypanosomiasis and is used as adjunctive therapy in oncho­ cerciasis and acquired immune deficiency syndrome. Recently this drug has been used in anticancer therapy.

Ocular side effects

Systemic administration

Certain

1. Blurred vision

2. Intraepithelial inclusions

a.Cornea

b.Conjunctiva

c.Anterior lens epithelium 3. Cornea

a.Keratitis

b.Superficial punctate keratitis

c.Erosions

d.Vortex keratopathy

4. Foreign body sensation

5. Hypermetropia

6. Non-specific ocular irritation

a.Lacrimation

b.Photophobia

c.Conjunctivitis

7. Eyelids or conjunctiva

a.Edema

b.Urticaria

Possible

1. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

Clinical significance

When suramin sodium is used in the management of parasitic disease, it is difficult to differentiate an adverse drug ­effect from the adverse reaction of the death of the intraocular organism. However, Hemady et al (1996), in a study of 114 patients, reported that suramin sodium for metastatic cancer of the prostate had an incidence of 16.6% of ocular signs and symptoms. These include bilateral, whorl-like corneal deposits, often with foreign body sensation and lacrimation. This was also associated with blurred vision and a hyperopic shift in a range of +0.75 to +2.00 diopters. This refractive change was persistent throughout the course of treatment. No patients showed a decrease in baseline best corrected vision, and the drug was not considered dose limiting due to ocular toxicity. In AIDS patients on high-dose suramin sodium, Teich et al (1986) reported not only vortex keratopathy but fine, cream-colored, deep epithelial or subepithelial deposits. Holland et al (1988) described these as light golden-brown deposits starting on the lower portion of the cornea and progressing into a whorl keratopathy that involved the whole cornea. One patient had these deposits on the anterior lens epithelium. These deposits histologically are identified as membranous lamellar inclusion bodies, the same as with other drug-induced lipid storage diseases produced by lysosomal enzyme inhibition.

References and Further Reading

Adverse effects of antiparasitic drugs. Med Lett Drugs Ther 24: 12, 1982. Hemady RK, Sinibaldi VJ, Eisenberger MA. Ocular symptoms and signs

associated with suramin sodium treatment for metastatic cancer of the prostate. Am J Ophthalmol 121(3): 291–296, 1996.

Holland EJ, Stein CA, Palestine AG, et al. Suramin keratopathy. Am J Ophthalmol 106: 216–220, 1988.

Reynolds JEF (ed). Martindale: The Extra Pharmacopoeia, 28th edn. Pharmaceutical Press, London, pp 983–984, 1982.

Teich SA, et al. Toxic keratopathy associated with suramin therapy. N Engl J Med 314: 1455, 1986.

Thylefors B, Rolland A. The risk of optic atrophy following suramin treatment of ocular onchocerciasis. Bull WHO 57: 479, 1979.

Generic name: Tryparsamide.

Proprietary names: None.

Primary use

This organic arsenical is used in the treatment of trypanosomiasis (African sleeping sickness) as back-up to safer drugs.