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

Boric Acid

23

Contraindications

In patients with a known hypersensitivity to the product or

Warnings

any of its components exist.

Reported to cause changes to pigmented tissues (increased

pigmentation), growth of eyelashes, increased pigmentation

of iris and periorbital tissues; changes may be permanent.

Patients should be informed of the possibility of iris color

change. Should be used with caution in patients with active

ocular inflammation. Macular edema, including cystoid ma-

cular edema, has been reported during treatment. Should

be used with caution in patients with a torn posterior lens

capsule, aphakic or pseudophakic patients, and patients with

macular edema risk factors. May be associated with recur-

Adverse Reactions

rence of Herpes simplex keratitis.

Conjunctival hyperemia, growth of eyelashes, and ocular

pruritus (15–45% of patients); ocular dryness, visual distur-

bance, foreign-body sensation, eye pain, skin pigmentation

or periocular skin, blepharitis, cataract, superficial punctate

keratopathy, eyelid erythema (3–10% of patients); eye di-

scharge, tearing, photophobia, allergic conjunctivitis, asthe-

nopia, increase of pigmentation, conjunctival edema (1–3%

of patients); iritis was reported in more than 1% of patients.

Systemic: infections, mostly colds; upper respiratory tract

infections (URTIs) (~10% of patients); headaches, abnormal

Pregnancy Category

LFTs, asthenia, hirsutism (1–5% of patients).

C.

Drug Interactions

There are no adequate and well-controlled studies in preg-

nant women. It should be used only when benefit justifies

potential risk to the fetus. Caution should be exercised in nur-

sing mothers. Safety and effectiveness in the pediatric popu-

lation is not established.

Brand Name

Collyrium Fresh Eyes.

Class of Drug

Eye wash.

Indications

Cleanse the eye and remove loose foreign material, air pol-

Dosage Form

lutants, etc.

Solution.

Dose

Flush affected eye as needed.

Warnings

Discontinue if change in vision or eye pain occur, if redness or

Pregnancy Category

irritation persist, or if condition worsens or persists.

C.

Brand Name

Eye Wash Solution.

Class of Drug

Eye wash.

Brinzolamide

25

Pregnancy Category

B.

Drug Interactions

No carcinogenic, mutagenic, or impairment of fertility no-

ted in animal studies. No specific drug interaction studies

have been conducted. May cause additive effects with CNS

depressants. Use caution with beta-blockers, antihypertensi-

ves, cardiac glycosides, TCAs. In animal studies, brimonidine

tartrate was excreted in human milk. Not recommended in

children younger than 2 years of age.

Brand Name

Alphagan-P.

Class of Drug

See »Alphagan.«

Indications

See »Alphagan.«

Dosage Form

Topical ophthalmic solution 0.15% (purite preservative).

Dose

See »Alphagan.«

Contraindications

See »Alphagan.«

Warnings

See »Alphagan.«

Adverse Reactions

Allergic conjunctivitis, conjunctival hyperemia, ocular pru-

ritus (10–20% of patients); burning sensation, conjunctival

folliculosis, hypertension, oral dryness, visual disturbance

(~5–9% of patients); allergic reaction, asthenia, blepharitis,

bronchitis, conjunctival edema, conjunctival hemorrhage,

conjunctivitis, cough, dizziness, dyspepsia, dyspnea, epi-

phora, eye discharge, eye dryness, eye irritation, eye pain,

eyelid edema, eyelid erythema, flu-like symptoms, follicular

conjunctivitis, foreign-body sensation, headache, pharyngi-

tis, photophobia, rash, rhinitis, sinus infection, sinusitis, stin-

ging, superficial punctate keratitis (SPK), visual-field defect,

vitreous floaters, decreased visual acuity (~1–4% of patients).

Pregnancy Category

Postmarketing experience: see »Alphagan.«

B.

Drug Interactions

See »Alphagan.«

Brand Name

Azopt.

Class of Drug

Glaucoma. CAI.

Indications

OAG; ocular hypertension.

Dosage Form

Topical ophthalmic suspension 1%.

Dose

1 drop to affected eye(s) three times per day

Contraindications

In patients who are hypersensitive to the product or any of its

Warnings

components.

Same types of adverse reactions attributable to sulfonami-

des may occur with topical administration (see »Warnings«

under acetazolamide). If signs of serious reactions or hyper-

sensitivity occur, discontinue use. The effect of continued ad-

Bupivacaine

27

agent in management of noninfectious ocular inflammation

disease; effective in the treatment of thyroid ophthalmopa-

Dosage Form

thy.

Oral:capsules 5 mg; tablets 2.5 mg.

Dose

1.25 mg with food at bedtime gradually increased to 2.5 mg

Contraindications

three or four times per day

In patients with uncontrolled systemic hypertension, toxemia

of pregnancy, or a history of hypersensitivity to ergot alkalo-

Warnings

ids.

Crosses the placenta and may suppress fetal prolactin levels;

should be avoided during pregnancy unless indicated. Mo-

thers who choose to breast-feed their infants should avoid

bromocriptine since it suppresses lactation. Caution must be

exercised in administering concurrently with any antihyper-

Adverse Reactions

tensive medication.

Nausea, vomiting, postural hypotension, headache, dyspep-

sia, constipation, nasal congestion, dryness of the mouth,

nocturnal leg cramps, depression, impaired concentration,

nightmares, peripheral digital vasospasm on exposure to

Drug Interactions

cold, pleural thickening, dry eye.

Hepatic clearance may be reduced by concomitant adminis-

tration of erythromycin. Efficacy may be diminished in pati-

ents who are also receiving agents that exhibit clopamine

Pregnancy Category

antagonism (i.e., phenothiazines).

B.

Brand Name

Marcaine; Sensorcaine.

Class of Drug

Local anesthetic.

Indications

Local anesthesia for surgery; major nerve block for surgery.

Dosage Form

Parenteral for injection 0.25, 0.5, 0.75%; maximum dose

Dose

150 mg.

Maximum dose 2 mg/kg body weight. Slow onset (10–

Contraindications

20 min), lasts for 4–8 h.

Most significant: infection at site. Significant: disease of cardi-

ovascular system, myasthenia gravis, plasma cholinesterase

Adverse Reactions

deficiency. Possibly significant: diseases of liver, renal disease.

Allergic reactions, anaphylaxis, cardiac arrhythmias, CNS to-

xicity, erythema, methemoglobinemia, myocardial dysfunc-

tion, nausea, pruritus, skin rash, sneezing, urticaria, vasodila-

Drug Interactions

tion of blood vessels, vomiting.

Possibly safe in pregnancy. It is not known whether this drug

or its metabolites are excreted in human milk. Safety and ef-

fectiveness in pediatric patients have not been established.

Brand Name

Carbastat; Miostat.

Class of Drug

Surgery, ophthalmic, adjunct, parasympathomimetic, miotic,

dual action; direct cholinergic as well as partial inhibitor of

Indications

cholinesterase.

Intraoperative miosis as well as reducing intensity of IOP

Dosage Form

spike in the first 24 h.

Sterile, balanced, salt solution of carbachol for intraocular in-

Dose

jection 0.01%.

Solution for injection 0.01% .

Contraindications

Carbachol intraocular injection: in patients showing hyper-

Warnings

sensitivity to the product or any of its components.

For single-dose intraocular use only. Discard unused portion.

Intraocular carbachol 0.01% should be used with caution in

patients with acute cardiac failure, bronchial asthma, peptic

ulcer, hyperthyroidism, GI spasm, urinary tract obstruction,

Adverse Reactions

and Parkinson‘s disease.

Systemic side effects, such as flushing, sweating, epigastric dist-

ress, abdominal cramps, tightness in urinary bladder, and head-

Pregnancy Category

ache have been reported with topical or systemic application.

C.

Brand Name

Isopto Carbachol; Carboptic.

Class of Drug

Parasympathomimetic, miotic, dual action. Direct cholinergic

Indications

as well as partial inhibitor of cholinesterase.

Glaucoma.

Dosage Form

Topical ophthalmic solution 0.75%, 1.5%, 2.25%, 3.0%.

Dose

1–2 drops up to three times per day

Contraindications

Miotics are contraindicated where constriction is undesirab-

le, such as acute iritis or in patients showing hypersensitivity

Warnings

to the product or any of its components.

Should be used with caution in the presence of corneal ab-

rasion to avoid excessive penetration, which can produce

systemic toxicity, and in patients with acute cardiac failure,

bronchial asthma, active peptic ulcer, hyperthyroidism, gas-

trointestinal spasm, urinary tract obstruction, Parkinson‘s

disease, recent myocardial infarct, systemic hypertension or

hypotension. As with all miotics, retinal detachment has been

reported when used in certain susceptible individuals. Remo-

Adverse Reactions

ve contact lenses before using.

Transient symptoms of stinging and burning may occur. Ca-

pable of producing systemic symptoms of cholinesterase in-

hibitor, even when epithelium is intact. Transient ciliary and

conjunctival injection, headache, and ciliary spasm with re-

sultant temporary decrease of visual acuity may occur. Saliva-

tion, syncope, cardiac arrhythmia, gastrointestinal cramping,

vomiting, asthma, hypotension, diarrhea, frequent urge to

Pregnancy Category

urinate, increased sweating, and eye irritation may occur.

C.

Carteolol Hydrochloride

31

Dosage Form

Topical ophthalmic solution 1%.

Dose

1 drop to affected eye(s) two times per day

Contraindications

In patients with bronchial asthma or with a history of bronchi-

al asthma or severe chronic obstructive pulmonary disease

(see »Warnings«), sinus bradycardia, secondand third-de-

gree AV block, overt cardiac failure (see »Warnings«), cardi-

ogenic shock, or hypersensitivity to the product or any of its

Warnings

components.

The same adverse reactions found with systemic administ-

ration of beta-adrenergic-blocking agents may occur with

topical administration. Severe respiratory reactions and

cardiac reactions, including death due to bronchospasm, in

patients with asthma and, rarely, death in association with

cardiac failure have been reported with topical application

of beta-adrenergic-blocking agents.Cardiac failure: In pati-

ents without a history of cardiac failure, continued depres-

sion of the myocardium with beta-blocking agents over a

period of time can, in some cases, lead to cardiac failure.

At the first sign or symptom of cardiac failure, carteolol hy-

drochloride should be discontinued. Nonallergic bronchos-

pasm: in patients with nonallergic bronchospasm or with a

history of nonallergic bronchospasm carteolol, should be

administered with caution since it may block bronchodi-

lation produced by endogenous and exogenous catecho-

lamine stimulation of beta 2 receptors. Major surgery: The

necessity of withdrawal of beta-adrenergic-blocking agents

prior to major surgery is controversial. Beta-adrenergic re-

ceptor blockade may impair the ability of the heart to re-

spond to beta-adrenergically mediated reflex stimuli, aug-

ment the risk of general anesthesia, or result in protracted

severe hypotension during anesthesia. For these reasons, in

patients undergoing elective surgery, gradual withdrawal

of beta-adrenergic-blocking agents may be appropriate. If

necessary, during surgery, the effects of beta-adrenergic-

blocking agents may be reversed by sufficient doses of such

agonists as isoproterenol, dopamine, dobutamine, or levar-

terenol. Diabetes mellitus: Beta-adrenergic-blocking agents

should be administered with caution in patients subject

to spontaneous hypoglycemia or diabetic patients (espe-

cially those with labile diabetes). May also mask the signs

and symptoms of acute hypoglycemia. Thyrotoxicosis: Beta-

adrenergic-blocking agents may mask certain clinical signs

(e.g., tachycardia) of hyperthyroidism. Patients suspected

of developing thyrotoxicosis should be managed carefully

to avoid abrupt withdrawal of beta-adrenergic-blocking

agents, which might precipitate a thyroid storm. Muscle

weakness: beta-adrenergic blockade has been reported to

potentiate muscle weakness consistent with certain my-

asthenic symptoms (e.g., diplopia, ptosis, and generalized

weakness).