effects side ocular induced-Drug • 7 t Pa r

Larizza D, et al. Ketoprofen causing pseudotumor cerebri in Bartter’s ­syndrome. N Engl J Med 300: 796, 1979.

Le Coz CJ, Bottlaender A, Scrivener JN, Santinelli F. Photocontact ­dermatitis from ketoprofen and tiaprofenic acid: cross-reactivity study in 12 consecutive patients. Contact Dermatitis 38(5): 245–252, 1998.

McDowell IFW, McConnell JB. Cholinergic crisis in myasthenia gravis precipitated by ketoprofen. BMJ 291: 1094, 1985.

Umez-Eronini EM. Conjunctivitis due to ketoprofen. Lancet 2: 737, 1978.

Generic name: Naproxen.

Proprietary names: Aleve, Anaprox, Anaprox DS, Ec-naprosyn, Naprelan, Naprosyn.

Primary use

This antipyretic analgesic is used in the treatment of rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Papilledema secondary to intracranial hypertension

3. Photophobia

4. Corneal opacities – verticillate pattern

5. Eyelids or conjunctiva

a.Allergic reactions

b.Erythema

c.Conjunctivitis – non-specific

d.Edema

e.Photosensitivity

f.Angioneurotic edema

g.Urticaria

h.Purpura

i.Loss of eyelashes or eyebrows

Probable

1. Problems with color vision

a.Color vision defect

b.Objects have green or red tinge 2. Optic or retrobulbar neuritis

3. Visual field defects

a.Scotomas – centrocecal or paracentral

b.Constriction

c.Hemianopia

d.Enlarged blind spot

Possible

1. Subconjunctival or retinal hemorrhages secondary to druginduced anemia

2. Eyelids or conjunctiva

a.Erythema multiforme

b.Stevens-Johnson syndrome

c.Exfoliative dermatitis

d.Lyell’s syndrome

Conditional/Unclassified

1. Exacerbation of glaucoma

2. Cornea – peripheral ulcerations

Clinical significance

With increased use of this non-steroidal anti-inflammatory agent, more adverse ocular effects have been reported. Although some patients complain of decreased vision, this is seldom a ­significant finding and occurs in less than 5% of patients. In rare instances, it is possible that this agent can cause optic or retro­ bulbar neuritis. This, however, is not proven, although this group of drugs can cause numerous CNS side effects. Typically, these patients are on the drug for about a year before the optic neuritis, often unilateral, presents. There are cases in the ­ational Registry of this occurring in only a few months of therapy. The drug should be discontinued until an etiology of the neuritis is established. This probable side effect seems to be more common in patients with renal disease, on multiple other drugs or with autoimmune disease. Intracranial hypertension seems to be well documented to occur with naproxen. Well-described aseptic meningitis is seen with this agent with secondary effects on the visual system. Whether or not this agent causes anterior or posterior cataracts is unknown; there are 20 such reports in the National Registry, but there is neither pattern nor proof to date of a cause-and-effect relationship. Whorl-like corneal opacities have been associated (Sznyd and Perry 1985) with the use of naproxen, and the National Registry has also received several reports of peripheral corneal ulcerations. This agent is one of the more potent photosensitizing non-steroidal anti-inflammatory agents. Ultraviolet light blocking lenses may be indicated in ­selected patients. Fincham (1989) reported a case of exacerbation of glaucoma, which may be secondary to naproxen.

References and Further Reading

Fincham JE. Exacerbation of glaucoma in an elderly female taking naproxen sodium: a case report. J Geriatr Drug Ther 3: 139–143, 1989.

Fraunfelder FT. Interim report: National Registry of Possible Drug-Induced Ocular Side Effects. Ophthalmology 86: 126, 1979.

Fraunfelder FT, Samples JR, Fraunfelder FW. Possible optic nerve side ­effects associated with nonsteroidal anti-inflammatory drugs. J Toxicol Cut Ocular Toxicol 13(4): 311–316, 1994.

Harry DJ, Hicks H. Naproxen hypersensitivity. Hosp Form 18: 648, 1983.

McEvoy GK. American Hospital Formulary Service Drug Information 87. American Society of Hospital Pharmacists, Bethesda, p 942–946, 1987.

Mordes JP, Johnson MW, Soter NA. Possible naproxen associated vasculitis. Arch Intern Med 140: 985, 1980.

Shelley WB, et al. Naproxen photosensitization demonstrated by challenge. Cutis 38: 169, 1986.

Svihovec J. Anti-inflammatory analgesics and drugs used in gout. In: Meyler’s Side Effects of Drugs, Dukes MNG (ed), Excerpta Medica, Vol. IX, Amsterdam, p 152, 1980.

Szmyd L Jr., Perry HD. Keratopathy associated with the use of naproxen. Am J Ophthalmol 99: 598, 1985.

Generic name: Piroxicam.

Proprietary name: Feldene.

Primary use

This non-steroidal anti-inflammatory drug is used in the treatment of osteoarthritis and rheumatoid arthritis.