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

Interferon alpha-2a (IFN-alpha 2a)

129

Warnings

Serious and potentially fatal infections and sepsis have occur-

red in the setting of TNF-alpha blockade, including histoplas-

mosis, listeriosis, and pneumocystosis. Has been associated

with hypersensitivity reactions that vary in their time of on-

set; most hypersensitivity reactions, which include urticaria,

dyspnea, and/or hypotension, have occurred during or within

Adverse Reactions

2 h of infusion.

Opportunistic infections after prolonged use; TB reactivations;

injection-related hypersensitivity, including urticaria, dyspnea,

and hypotension; new onset or exacerbation of preexisting

CNS demyelinating disorders; autoantibodies/Lupus-like syn-

drome. Reports of new occurrence of non-Hodgkin‘s B-cell

lymphoma, breast cancer, melanoma, squamous, rectal ade-

nocarcinoma, and basal cell carcinoma have been described;

insufficient data to determine whether infliximab contributed

to the development of these malignancies. Rule out prior TB

infection with PPD and CXR. Monitor CBC with differential, ALT,

Pregnancy Category

and AST every 2 weeks for first month, then every 4–6 weeks.

B.

Drug Interactions

Safety and effectiveness in patients with JRA and pediatric

patients with Crohn‘s disease have not been established.

Concurrent administration of etanercept and anakinra (an

IL-1 antagonist) has been associated with an increased risk

of serious infections and increased risk of neutropenia and

no additional benefit compared with these products alone.

Brand Name

Roferon A.

Class of Drug

Antiviral. Decreases activity of natural killer cells.

Indications

Various hematologic malignancies, chronic viral infections,

Kaposi sarcoma.Off-label: uveitis refractory, in the setting of

Dosage Form

Behçet disease.

Solution injectable for subcutaneous or i.m. injection: 3 milli-

on units/0.5 ml, 6 million units/0.5 ml, 9 million units/0.5 ml,

Dose

36 million units/0.5 ml.

3–9 million units three times per week.

Contraindications

In patients with a known hypersensitivity to the product or

any of its components. Injectable solutions contain benzyl al-

cohol and are contraindicated in any individual with a known

Warnings

allergy to that preservative.

Depression and suicidal behavior have been reported.CNS:

Reported in a number of patients, including decreased men-

Itraconazole

131

Brand Name

Sporanox.

Class of Drug

Antifungal.

Indications

Empiric therapy of febrile neutropenic patients with sus-

pected fungal infections. Injection is also indicated for the

treatment of the following fungal infections in immunocom-

promised and nonimmunocompromised patients: blastomy-

cosis, pulmonary and extrapulmonary; histoplasmosis, inclu-

ding chronic cavitary pulmonary disease and disseminated,

nonmeningeal histoplasmosis; aspergillosis, pulmonary and

extrapulmonary, in patients who are intolerant of or who are

Dosage Form

refractory to amphotericin B therapy.

Injection, capsule, solution.

Dose

Empiric therapy in febrile, neutropenic patients with suspected

fungal infections (ETFN): IV 200 mg two times per day for four

doses, followed by 200 mg once per day for up to 14 days.

Each i.v. dose should be infused over 1 h. Treatment should

be continued with oral solution 200 mg (20 ml) two times per

day until resolution of clinically significant neutropenia. Blas-

tomycosis, histoplasmosis, and aspergillosis: IV or p.o. 200 mg

two times per day for four doses, followed by 200 mg q.d.

Each i.v. dose should be infused over 1 h. Total itraconazole

therapy (injection followed by oral) should be continued for

a minimum of 3 months and until clinical parameters and

laboratory tests indicate that the active fungal infection has

subsided. An inadequate period of treatment may lead to re-

currence of active infection. Injection should not be used in

Contraindications

patients with CrCl <30 ml/min.

In patients who have shown hypersensitivity to the product

or any of its components . Caution should be used when

prescribing to patients with hypersensitivity to other azoles.

Life-threatening cardiac dysrhythmias and/or sudden death

have occurred in patients using cisapride, pimozide, leva-

cetylmethadol (levomethadyl), or quinidine concomitantly

with Sporanox and/or other CYP3A4 inhibitors. Concomitant

administration of these drugs with Sporanox is contraindica-

Warnings

ted.

Hepatic effects: rare cases of serious hepatotoxicity, including

liver failure and death, have been reported. Cardiac dysrhyth-

mias: life-threatening cardiac dysrhythmias and/or sudden

death have occurred in patients using cisapride, pimozide,

levacetylmethadol (levomethadyl), or quinidine concomi-

tantly with Sporanox and/or other CYP3A4 inhibitors. Car-

diac disease: injection should not be used in patients with

evidence of ventricular dysfunction unless the benefit clearly

outweighs the risk. Injection contains the excipient hydroxy-

Brand Name

Nizoral.

Class of Drug

Antifungal.

Indications

Systemic fungal infections: candidiasis, chronic mucocuta-

neous candidiasis, oral thrush, candiduria, blastomycosis,

coccidioidomycosis, histoplasmosis, chromomycosis, and

paracoccidioidomycosis; fungal endophthalmitis. Tablets

should not be used for fungal meningitis because it penet-

rates poorly into the cerebral spinal fluid. Severe recalcitrant

cutaneous dermatophyte infections: tablets are also indicated

for patients who have not responded to topical therapy or

Dosage Form

oral griseofulvin or who are unable to take griseofulvin.

Oral tablet.

Dose

Adults: Starting dose is a single daily administration of 200 mg

(1 tablet). In very serious infections or if clinical responsive-

ness is insufficient within the expected time, dose may be in-

creased to 400 mg (1 tablets) once per day. Children: In small

numbers of children older than 2 years of age, a single daily

dose of 3.3–6.6 mg/kg has been used. Tablets have not been

studied in children younger than 2 years of age.

Minimum treatment for candidiasis is 1 or 2 weeks. Patients

with chronic mucocutaneous candidiasis usually require

maintenance therapy. Minimum treatment for the other in-

dicated systemic mycoses is 6 months. Minimum treatment

for recalcitrant dermatophyte infections is 4 weeks in cases

involving glabrous skin. Palmar and plantar infections may

respond more slowly. Apparent cures may subsequently re-

Contraindications

cur after discontinuation of therapy in some cases.

Coadministration with terfenadine, cisapride, astemizole, or

oral triazolam. Coadministration with terfenadine has led to

elevated plasma concentrations of terfenadine, which may

prolong QT intervals, sometimes resulting in life-threatening

cardiac dysrhythmias. Cases oftorsades de pointes and other

serious ventricular dysrhythmias, in rare cases leading to fata-

lity, have been reported among patients taking terfenadine

concurrently with ketoconazole tablets. Concomitant admi-

nistration with cisapride because it has resulted in marked-

ly elevated cisapride plasma concentrations and prolonged

QT interval and has rarely been associated with ventricular

arrhythmias and torsades de pointes. In patients who have

shown hypersensitivity to the product or any of its compon-

Warnings

ents.

Hepatotoxicity, primarily of the hepatocellular type, inclu-

ding rare fatalities. Several cases of hepatitis have been re-

ported in children. LFTs (such as SGGT, alkaline phosphatase,

SGPT, SGOT, and bilirubin) should be measured before star-

ting treatment and at frequent intervals during treatment.

Patients should be instructed to report any signs and symp-

toms that may suggest liver dysfunction so that appropriate

Ketorolac Tromethamine

135

Dosage Form

Topical ophthalmic solution 0.5%.

Dose

1 drop four times per day for relief of ocular itching due to

seasonal allergic conjunctivitis. For postoperative inflamma-

tion in patients who have undergone cataract extraction,

1 drop to the affected eye(s) four times per day beginning

24 h after cataract surgery and continuing through the first 2

Contraindications

weeks of the postoperative period.

In patients with previously demonstrated hypersensitivity to

Warnings

the product or any of its components.

Potential for cross-sensitivity to acetylsalicylic acid, phenyla-

cetic acid derivatives, and other nonsteroidal anti-inflamma-

tory agents; therefore, caution should be used when treating

individuals who have previously exhibited sensitivities to

these drugs. With some NSAIDs, there exists the potential for

increased bleeding time due to interference with thrombo-

cyte aggregation. There have been reports that ocularly ap-

plied NSAIDs may cause increased bleeding of ocular tissues

(including hyphemas) in conjunction with ocular surgery. All

topical NSAIDs may slow or delay healing. Topical corticoste-

roids are also known to slow or delay healing. Concomitant

use of topical NSAIDs and topical steroids may increase the

Adverse Reactions

potential for healing problems.

Topical NSAIDs may result in keratitis. In some susceptible

patients, continued use may result in epithelial breakdown,

corneal thinning, corneal erosion, corneal ulceration, or cor-

neal perforation; these events may be sight threatening. Pa-

tients with evidence of corneal epithelial breakdown should

immediately discontinue use and should be closely monito-

red for corneal health. Postmarketing experience suggests

that patients with complicated ocular surgeries, corneal

denervation, corneal epithelial defects, diabetes mellitus,

ocular surface diseases (e.g., dry eye syndrome), rheumato-

id arthritis, or repeat ocular surgeries within a short period

of time may be at increased risk for corneal adverse events,

which may become sight threatening; should be used with

caution in these patients. Use more than 24 h prior to surge-

ry or beyond 14 days postsurgery may increase risk for oc-

currence and severity of corneal adverse events. It is recom-

mended that Acular be used with caution in patients with

known bleeding tendencies or who are receiving medicati-

ons that may prolong bleeding time. Transient stinging and

burning on instillation, allergic reactions, corneal edema,

iritis, ocular inflammation, superficial keratitis, superficial

ocular infections, corneal infiltrates, eye dryness, headaches,

visual disturbance (blurry vision), and epithelial breakdown

Pregnancy Category

have been reported.

C.

Brand Name

Acular LS.

Class of Drug

Topical NSAID.

Ketotifen Fumarate

137

underlying ocular disease being studied. The following

ocular and nonocular adverse reactions were reported at

an incidence of less than 5%:Ocular—allergic reactions,

burning or stinging, conjunctivitis, discharge, dry eyes, eye

pain, eyelid disorder, itching, keratitis, lacrimation disorder,

mydriasis, photophobia, rash. Nonocular—flu syndrome,

Pregnancy Category

pharyngitis.

C.