126
APPENDIX 5: GLAUCOMA MEDICATION PRESERVATIVES
There is a growing body of literature indicating that higher concentrations of BAK are associated with inflammatory changes in the conjunctiva and even trabecular meshwork.1-2
Preservative |
|
Drug |
Trade |
None |
|
timolol maleate |
Timoptic (ocu-dose) |
|
|
pilocarpine 2% & 4% |
generic (steri-unit) |
Benzalkonium chloride |
0.01% |
apraclonidine |
Iopidine |
|
0.01% |
betaxolol |
Betoptic |
|
0.005% |
bimatoprost |
Lumigan |
|
0.005% |
brimonidine |
Alphagan |
|
0.01% |
brinzolamide |
Azopt |
|
|
carbachol |
Isopto Carbachol |
|
0.005% |
carteolol |
Carteolol HCl |
|
|
demecarium bromide |
Humorsol |
|
|
dipivefrin |
Propine |
|
0.0075% |
dorzolamide |
Trusopt |
|
|
epinephrine |
Epifrin |
|
0.02% |
latanoprost |
Xalatan |
|
0.004% |
levobunolol |
Betagan |
|
0.004% |
metipranolol |
Optipranolol |
|
|
pilocarpine hydrochloride |
Isopto Carpine, Pilocar, Pilostat, Pilopine HS gel |
|
0.01% |
timolol maleate |
Timoptic |
|
0.0075% |
timolol maleate/dorzolamide |
Cosopt |
|
0.01% |
timolol hemihydrate |
Betimol |
|
0.015% |
travoprost |
Travatan |
Benzodeodecinium bromide |
0.012% |
timolol maleate |
Timoptic XE |
Chlorobutanol |
|
echothiophate iodide |
Phospholine Iodide |
|
|
pilocarpine nitrate |
Pilagan |
Purite (stabilized oxychloro complex) |
0.005% |
brimonidine 0.1%, 0.15% |
Alphagan-P |
|
|
|
|
1.Anwaruddin R, et al Invest Ophthalmol Vis Sci (Suppl) 2002;43:164
2.Baudouin C, et al Ophthalmology 1999;106:556–563
Appendices 127
128
APPENDIX 6: TITRATING TOPICAL DROPS FOR CHILDREN
This table is given to help the clinician estimate how to adjust the adult eye drop dose for pediatric aged patients. Due to the infants smaller blood volume, systemic levels of topically applied drops can be very high compared to the adult. One study showed that infants using timolol maleate 0.25% had up to 25 times the adult plasma level (Ophthalmology 1984;91:1361–1363). Other considerations when attempting to limit systemic adsorption in children are:
1)Start with lower concentrations when therapeutically warrented and the alternative exists. (example timolol maleate 0.25% instead of 0.5%)
2)Use passive lid closure and digital pressure over the canalicular drainage system when possible to limit access to the nasal mucosa.
It is important to note that this table is not applicable to all children. Body weight, metabolic function, and concomitant medications should also be taken into account.
Age |
Fraction of adult dose |
birth–2 years old |
50% |
2–3 years old |
67% |
3–7 years old |
90% |
7–12 years old |
95% |
> 12 years old |
full dose |
|
|
Adapted from Abelson MB, Paradis A, Grant KK. How to prescribe for the smallest sufferers. Review of Ophthalmology 1999;2:101–103
APPENDIX 7: DOSING PROTOCOL FOR VERTEPORFIN (VISUDYNE)
Indication: Photodynamic therapy (PDT) for subfoveal choroidal neovascularization (CNV)
Supplied as: Comes as single use vial, 15 mg verteporfin, lyophilized. Reconstitute with 7 mL sterile water to provide 7.5 mL of 2 mg/mL. Dose: 6 mg/m2 diluted to 30 mL in 5% dextrose. Infusion is given over 10 minutes at a rate of 3 mL/minute using syringe pump and
in-line filter.
Light administration: 689 nm wavelength of laser light exactly 15 minutes after the start of the 10 minute infusion (i.e. 5 minutes after the infusion ends). The exposure time is 83 seconds. [Recommended light dose is 50 J/cm2 at an intensity of 600 mW/cm2.]
Treatment: PDT is currently approved in the United States for the treatment of subfoveal predominantly classic CNV (> 50% classic) and subfoveal occult CNV with evidence of recent progression. Nasal edge of treatment spot must be at least 200 microns from the temporal edge of the optic disc, even if this will result in lack of treatment within 200 microns of the optic nerve. Spot size should be 1000 microns larger then greatest linear dimension of the CNV lesion. Maximum spot size used in clinical trials was 6400 microns.
Contraindicated in patients with porphyria
Treatment should be carefully considered in patients with moderate to severe hepatic impairment (eliminated via liver)
After dye administration, patients must avoid direct sunlight, indoor halogen lighting, tanning beds, or other bright lighting for 5 days. Side effects: headache, injection site reaction, visual disturbance (including blurred vision, decreased vision, and visual field defects), and
photosensitivity in 10–20% of patients Other side effects occurring in < 10% of patients:
ocular: subretinal or vitreous hemorrhage
systemic: back pain (during infusion of dye), flu syndrome, elevated liver function tests, others
Appendices 129