Ординатура / Офтальмология / Английские материалы / Drugs in Ophthalmlogy_Fong, Law, Schmidt-Erfurth_2006

Foscarnet Sodium

107

nance therapy with appropriate dose adjustments. To reduce

the risk of nephrotoxicity, CrCl (milliliters per minute per kilo-

gram) should be calculated even if serum creatinine is within

the normal range, and doses should be adjusted accordingly.

Because of physical incompatibility, Foscavir and ganciclovir

Contraindications

must not be mixed.

In patients with clinically significant hypersensitivity to the

product or any of its components. During therapy, if CrCl falls

below the limits of the dosing nomograms (0.4 ml/min per

kilogram), Foscavir should be discontinued and the patient

hydrated and monitored daily until resolution of renal impair-

Warnings

ment is ensured.

Renal impairment: The major toxicity is renal impairment,

which most likely becomes clinically evident during the se-

cond week of induction therapy but may occur at any time

during treatment. Renal function should be monitored care-

fully during both induction and maintenance therapy. Mine-

ral and electrolyte abnormalities: Patients should be advised

to report symptoms of low ionized calcium such as perioral

tingling, numbness in the extremities, and paresthesias.

Physicians should be prepared to treat these abnormalities

and their sequelae, such as tetany, seizures, or cardiac distur-

bances. An infusion pump must be used for administration to

prevent rapid i.v. infusion. Slowing the infusion rate may de-

crease or prevent symptoms. Seizures: related to mineral and

electrolyte abnormalities have been associated with Foscavir

treatment. Risk factors associated with seizures included im-

paired baseline renal function, low total serum calcium, and

Adverse Reactions

underlying CNS conditions.

Renal impairment. Mineral and electrolyte abnormalities—

has been associated with changes in serum electrolytes,

including hypocalcemia, hypophosphatemia, hyperphos-

phatemia, hypomagnesemia, and hypokalemia; may also

be associated with a dose-related decrease in ionized serum

calcium, which may not be reflected in total serum calcium.

Seizures. Hemopoietic system—anemia, granulocytopenia,

Pregnancy Category

neutropenia.

C.

Drug Interactions

Concomitanttreatment with i.v. pentamidine may have

caused hypocalcemia; one patient died with severe hypo-

calcemia. Because of tendency to cause renal impairment,

should be avoided in combination with potentially nephro-

toxic drugs, such as aminoglycosides, amphotericin B, and i.v.

pentamidine unless the potential benefits outweigh the risks

to the patient. Abnormal renal function has been observed

in clinical practice during concomitant use with ritonavir or

with ritonavir and saquinavir. Since foscarnet decreases se-

rum concentrations of ionized calcium, concurrent treatment

with other drugs known to influence serum calcium concen-

trations should be used with particular caution.

Brand Name

Vitrasert (implantable); Cytovene.

Class of Drug

Antiviral.

Indications

Prevention of CMV disease in solid organ transplant recipi-

ents and in individuals with advanced HIV infection at risk for

developing CMV disease. Alternative to i.v. formulation for

maintenance treatment of CMV retinitis in immunocompro-

mised patients, including patients with AIDS, in whom retini-

tis is stable following appropriate induction therapy and for

whom the risk of more rapid progression is balanced by the

Dosage Form

benefit associated with avoiding daily i.v. infusions.

Oral, injectable, implantable.

Dose

CMV retinitis: Induction treatment—5 mg/kg (given i.v. at a

constant rate over 1 h) every 12 h for 14–21 days; cytovene

capsules should not be used for induction treatment. Main-

tenance treatment—Cytovene i.v. solution 5 mg/kg given as

a constant-rate i.v. infusion over 1 h once per day 7 days per

week or 6 mg/kg once per day 5 days per week; or Cytovene

capsules 1,000 mg three times per day with food. Alterna-

tively, the dosing regimen of 500 mg six times per day every

3 h with food during waking hours may be used. For patients

who experience progression of CMV retinitis while receiving

maintenance treatment with either formulation of ganciclo-

vir, reinduction treatment is recommended. Prevention of

CMV disease in patients with advanced HIV infection: Cytovene

capsules 1,000 mg three times per day with food. Preventi-

on of CMV disease in transplant recipients: Cytovene i.v. solu-

tion 5 mg/kg (given at a constant rate over 1 h) every 12 h

for 7–14 days, followed by 5 mg/kg once per day 7 days per

week or 6 mg/kg once per day 5 days per week; or Cytovene

capsules 1,000 mg three times per day with food. Duration

of treatment with solution and capsules in transplant recipi-

ents is dependent upon the duration and degree of immu-

nosuppression. CBC, platelet count, and serum creatinine or

CrCl values should be followed carefully to allow for dosage

Contraindications

adjustments.

In patients with hypersensitivity to the product or any of its

components or to acyclovir. Should not be administered if

absolute neutrophil count is less than 500 cells/µl or platelet

count is less than 25,000 cells/µl. Should, therefore, be used

with caution in patients with preexisting cytopenias or with

a history of cytopenic reactions to other drugs, chemicals, or

Warnings

irradiation.

Teratogenesis: Because of the mutagenic and teratogenic

potential of ganciclovir, women of childbearing potential

should be advised to use effective contraception during

treatment. Similarly, men should be advised to practice

barrier contraception during and for at least 90 days follo-

wing treatment. Do not administer i.v. solution by rapid or

Gentamicin Sulfate

111

Dosage Form

Topical ophthalmic solution 0.3%.

Dose

Bacterial conjunctivitis: days 1 and 2, 1 drop every 2 h to affec-

ted eye(s) while awake up to eight times per day; days 3–7, 1

Contraindications

drop up to four times per day while awake.

In patients with a history of hypersensitivity to the product or

Warnings

any of its components or to other quinolones.

Should not be injected subconjunctivally nor introduced

directly into the anterior chamber of the eye. In patients

receiving systemic quinolones, including gatifloxacin, se-

rious and occasionally fatal hypersensitivity (anaphylactic)

reactions, some following the first dose, have been repor-

ted. Some reactions were accompanied by cardiovascular

collapse, loss of consciousness, angioedema (including la-

ryngeal, pharyngeal, or facial edema), airway obstruction,

dyspnea, urticaria, and itching. If an allergic reaction occurs,

discontinue the drug. Serious acute hypersensitivity reac-

tions may require immediate emergency treatment. Oxy-

gen and airway management should be administered as

Adverse Reactions

clinically indicated.

Ophthalmic use: Most frequently reported in the overall study

population—conjunctival irritation, increased lacrimation,

keratitis, and papillary conjunctivitis (approximately 5–10%

of patients). Other reported reactions—chemosis, conjunc-

tival hemorrhage, dry eye, eye discharge, eye irritation, eye

pain, eyelid edema, headache, red eye, reduced visual acuity,

Pregnancy Category

and taste disturbance ( occurring in 1–4% of patients).

C.

Drug Interactions

Specific drug interaction studies have not been conducted.

However, systemic administration of some quinolones has

been shown to elevate plasma concentrations of theophyl-

line, interfere with metabolism of caffeine, enhance effects

of the oral anticoagulant warfarin and its derivatives, and has

been associated with transient elevations in serum creatinine

in patients receiving systemic cyclosporine concomitantly.

Brand Name

Genoptic; Gentak; Gentacidin.

Class of Drug

Antibacterial, aminoglycoside. Inhibits bacterial protein syn-

Indications

thesis.

Gentamicin ophthalmic solution is indicated in the topical

treatment of ocular bacterial infections, including conjuncti-

vitis, keratitis, keratoconjunctivitis, corneal ulcers, blepharitis,

blepharoconjunctivitis, acute meibomianitis, and dacryo-

cystitis caused by susceptible strains of S. aureus, S. epider-

Gentamicin Sulfate

113

114

Glycerin

Secondary infection: Has occurred after use of combinations

containing steroids and antimicrobials. Fungal and viral in-

fections of the cornea are particularly prone to develop coin-

cidentally with long-term applications of steroid. The possibi-

lity of fungal invasion should be considered in any persistent

corneal ulceration where steroid treatment has been used.

Secondary bacterial ocular infection following suppression of

Pregnancy Category

host responses also occurs.

C.

Brand Name

Refresh Endura.

Class of Drug

Lubricant eye drops.

Indications

Temporary relief of burning, irritation, and discomfort due to

dryness of the eye or exposure to wind or sun. May be used as

Dosage Form

a protectant against further irritation.

Active ingredients: glycerin 1% and polysorbate 80 1%. Avai-

Dose

lable in preservative-free, disposable, single-use containers.

1–2 drops to affected eye(s) as needed and discard contai-

Contraindications

ner.

In patients with a known hypersensitivity to the product or

Warnings

any of its components.

For external use only. Stop use and ask a doctor if you experi-

ence eye pain, changes in vision, continued redness or irritati-

on of the eye, or if the condition worsens or persists for more

Pregnancy Category

than 72 h.

C.

Brand Name

Tears Naturale Forte.

Class of Drug

Lubricant eye drops.

Indications

Temporary relief of burning and irritation due to dryness of

the eye and for use as a protectant against further irritation.

Temporary relief of discomfort due to minor irritations of the

Dosage Form

eye or to exposure to wind or sun.

Active ingredients: dextran 70 0.1%, glycerin 0.2%, and hy-

droxypropyl methylcellulose 0.3%. Available in preservative-

Dose

free reclosable vials.

1 or 2 drops to affected eye(s) as needed.

Contraindications

Known hypersensitivity to the product of any of its compon-

Warnings

ents.

See »Refresh Endura.«

Pregnancy Category

C.

Brand Name

Visine For Contacts Lubricating and Rewetting Drops.

Glycerin

115

Class of Drug

Lubricant eye drops.

Indications

May be used with dailyand extended-wear soft (hydrophi-

lic) contact lenses for the following: moistening of daily-wear

soft lenses while on the eyes during the day; moistening of

extended-wear soft lenses upon awakening and as needed

during the day; moistening of extended-wear soft lenses pri-

Dosage Form

or to retiring at night.

Sterile, isotonic solution with a borate buffer system, hypro-

mellose, and glycerin, with potassium sorbate and edetate

Dose

disodium as the preservatives.

May be used as needed throughout the day.

Contraindications

In patients with known hypersensitivity to the product or any

Warnings

of its components.

If minor irritation, discomfort, or blurring occurs while wea-

ring lenses, place 1 or 2 drops on the eye and blink two or

three times. If discomfort continues, immediately remove

Adverse Reactions

lenses and immediately see your eye care professional.

May occur while wearing contact lenses: stinging, burning ,or

itching (irritation); excessive watering (tearing); unusual sec-

retions; redness; reduced sharpness of vision (visual acuity);

Pregnancy Category

blurred vision; sensitivity to light (photophobia); dry eyes.

C.

Brand Name

Visine Tears; Visine Tears Preservative Free.

Class of Drug

Lubricant eye drops.

Indications

Temporary relief of burning and irritation due to dryness of

Dosage Form

the eye or protection against further irritation.

Active ingredients: glycerin 0.2%, hypromellose 0.2%, and

polyethylene glycol 400 1%. Available in preservative-free,

Dose

single-use container.

1 or 2 drops to affected eye(s) as needed.

Contraindications

In patients with a known hypersensitivity to the product or

Pregnancy Category

any of its components.

C.

Brand Name

Glycerin.

Class of Drug

Topical osmotic agent.

Indications

To clear an edematous cornea in order to facilitate ophthal-

moscopic and gonioscopic examination, especially in acute

glaucoma, bullous keratitis, Fuchs‘ endothelial dystrophy, etc.

In gonioscopy of an edematous cornea, additional glycerin

may be used as the lubricant. A local anesthetic should be

instilled shortly before use of glycerin.