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Elephant Formulary © 2003-06 Susan K. Mikota DVM and Donald C. Plumb, Pharm.D. Ophthalmic Products (Topical) |
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Ophthalmic Products Index
The following section lists the majority of veterinary-labeled ophthalmic topical products and some of the more commonly used human-labeled products in veterinary medicine. It was written in cooperation with Dennis K. Olivero, DVM, DACVO to whom I would like to express my gratitude. Drugs are listed by therapeutic class. All doses (in italics) are from Dr. Olivero, unless otherwise noted.
For additional information, an excellent review on veterinary ophthalmic pharmacology and therapeutics can be found in the chapter by A. Regnier and P.L. Toutain in: Veterinary Ophthalmology, 2nd Edition; Kirk N. Gelatt, Editor; Lea & Febiger, Philadelphia, 1991. 765 pp
Ophthalmic Products, Topical..................................................................................... Glaucoma, Topical Agents.................................................................................. Timolol Maleate Ophthalmic)............................ Metipranolol(Ophthalmic)............ Levobunolol HCL(Ophthalmic)......... Pilocarpine HCl (Ophthalmic).................................. Demecarium (Ophthalmic).................................. Epinephrine, Topical (Ophthalmic)................. Dorzolamide HCl (Ophthalmic).................... Latanoprost (Ophthalmic)................................. Vasoconstrictors/Mydriatics.......................................................... Phenylephrine HCl (Ophthalmic)................. Cycloplegic Mydriatics......................................................................................... Atropine Sulfate (Ophthalmic).............. Tropicamide (Ophthalmic)............................. Topical Anesthetics............................ Proparacaine Hcl (Ophthalmic)........................... Non-Steroidal Antiinflammatory Agents.......................... Flurbiprofen Sodium (Ophthalmic)1....................... Ketorolac Tromethamine (Ophthalmic)................... Diclofenac Sodium (Ophthalmic)..................... Antiinflammatory Mast Cell Stabilizers........................... Lodoxamine Tromethamine (Ophthalmic)1...... Cromolyn Sodium (Ophthalmic)................ Corticosteroids, Topical (Ophthalmic)..................... Antibiotics, Single and Combination Agents.............. Norfloxacin (Ophthalmic)...... Ofloxacin (Ophthalmic)..................... Gentamicin (Ophthalmic)................... Tobramycin (Ophthalmic).................... Tetracycline (Ophthalmic)................. Antibiotic Combinations Antibiotic & Corticosteroid Combinations Antifungals (Ophthalmic)................................. Natamycin (Ophthalmic).... Miconazole (Ophthalmic)............. Silver Sulfadiazine (Ophthalmic)............. Antivirals (Ophthalmic).......... Trifluridine (Trifluorothymidine)................. Cyclosporine (Ophthalmic)........... Artificial Tear Products.............. Ophthalmic Irrigants................. Diagnostics..................................................................................... Fluorescein Sodium (Ophthalmic)1.............. Rose Bengal (Ophthalmic)
Glaucoma, Topical Agents
Note: Generally, once acute congestive primary glaucoma is noted in one eye it is treated as an emergency using mannitol/glycerin systemically, a systemic carbonic anhydrase inhibitor, a miotic and then surgery is considered for lasting control of intraocular pressure. The following topical drugs are used "in general" as a preventative measure to prevent the occurrence of primary glaucoma in the unaffected eye. Topical ocular antihypertensive medications are sometimes employed for pressure control with secondary glaucomas also.
Timolol Maleate (Ophthalmic)
Indications/Pharmacology - Timolol maleate is used primarily to prevent the development of primary glaucoma in the contralateral eye of a dog which has developed primary glaucoma in one eye. It only reduces intraocular pressure 3-10 mmHg and, therefore is of minimal usefulness in patients requiring treatment of primary acute congestive glaucoma. Timolol's mechanism of action: decreases cyclic-AMP synthesis in non-pigmented ciliary epithelium resulting in decreased aqueous humor production. It may also cause slight miosis in dogs and cats.
Suggested Dosage/Precautions/Adverse Effects - One drop twice daily of the 0.5% solution. The 0.25% concentration has minimal efficacy in animals and is not worth using. While problems have rarely been noted in veterinary medicine, ophthalmic beta blockers should be used with caution in patients with bronchoconstrictive disease or congestive heart failure.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Timolol Maleate 0.25% (see dosage above) or 0.5% solution in 2.5, 5, 10, and 15 ml Ocumeter® bottles; Timoptic® (MSD); (Rx)
Metipranolol (Ophthalmic)
Indications/Pharmacology - Metipranolol HCl can be used as a substitute for timolol maleate (see above). Metipranolol is a nonselective beta blocking agent and reduces intraocular pressure minimally in animals by decreasing cyclic-AMP synthesis in the ciliary body. Pilot studies have suggested that metipranolol is as effective as timolol maleate, but is significantly less expensive. Metipranolol has been useful in the author's (DKO) clinic for the management of primary open angle glaucoma in cats.
Suggested Dosage/Precautions/Adverse Effects - One drop twice daily of the 0.3% solution. While problems have rarely been noted in veterinary medicine, ophthalmic beta blockers should be used with caution in patients with bronchoconstrictive disease or congestive heart failure.
Dosage Forms/Preparations/FDA Approval Status - Veterinary Labeled Products: None Human-Approved Products: 0.3% Metipranolol Solution in 2, 5, & 10 ml OptiPranolol ® (Bausch & Lomb); (Rx)
Levobunolol HCL (Ophthalmic)
Indications/Pharmacology - Levobunolol HCl is a beta1 and beta2 blocking agent similar to timolol and metipranolol above but without the potential for myocardial depression or airway constriction noted rarely in veterinary medicine and occasionally in human patients. Levobunolol is used in humans with glaucoma responsive to beta adrenergic blocking agents but who suffer cardiac and respiratory side effects associated with timolol.
Suggested Dosage/Precautions/Adverse Effects - One drop twice daily of the 0.5% concentration. Miosis may develop in veterinary patients after application of topical beta blocking antiglaucoma medications.
Dosage Forms/Preparations/FDA Approval Status- Veterinary Labeled Products: None Human-Approved Products: Levobunolol HCl 0.25% or 0.5% solution in 5, 10, & 15ml. Betagan ® (Allergan); (Rx)
Pilocarpine HCl (Ophthalmic)
Indications/Pharmacology - Pilocarpine is a miotic agent that is used in the treatment of primary glaucoma only. Pilocarpine causes the ciliary body muscle to constrict placing posteriorly directed tension on the base of the iris to mechanically pull open the iridocorneal angle structures. By causing miosis, it may prevent closure of the iridocorneal angle by preventing excess iris tissue from peripherally compromising the outflow of aqueous humor. The lacrimal glands of dogs and cats are predominately under parasympathetic stimulation. Pilocarpine was used in the 1970's and early 1980's as a stimulant of tear production, delivered either topically or by applying it (the eyedrop preparation) on the food of dogs with keratoconjunctivitis sicca. Toxicity problems with excessive salivation, vomiting and diarrhea complicated its use. It does not directly address the issue of autoimmunity thought to be the etiopathogenesis behind most cases of keratoconjunctivitis sicca in the dog. The popularity of treatment of KCS with ophthalmic cyclosporine ointment has been associated with a decline in the use of pilocarpine for this disease.
Suggested Dosage/Precautions/Adverse Effects - One drop in affected eye(s) 3 times daily. Usually 1% or 2% is most commonly used in veterinary medicine. Pilocarpine can cause local irritation initially. In humans, this irritation reportedly diminishes after 3 days of therapy. It may also cause inflammation of the uveal tract, especially with repeated applications and can cause hyphema. Pilocarpine should not be used in secondary glaucoma cases. With repeated use, pilocarpine may cause systemic effects (vomiting, diarrhea, and increased salivation).
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Pilocarpine HCl Ophthalmic Solution 0.25%, 0.5%, 1%, 2%, 3%, 4%, and 6% (in addition there are 8% and 10% solutions and a 4% gel is available from Alcon) in 15 ml and 30 ml containers. There are many products and trade names associated with pilocarpine, including Isopto Carpine® (Alcon), Ocu-Carpine® (Iomed), Piloptic® (Optopics), Pilostat® (Bausch and Lomb) and many generically labeled products. All are Rx. See also the epinephrine monograph for information on epinephrine/pilocarpine fixed dose combination products.
Demecarium (Ophthalmic)
Indications/Pharmacology - Demecarium is a potent carbamate inhibitor that may reduce intraocular pressures for up to 48 hours in canines. Demecarium reversibly inhibits anticholinesterase thereby causing miosis. Demecarium is generally used in preventive management of the contralateral eye in patients after the diagnosis of an acute congestive crisis of primary glaucoma in the other eye. It is not used in secondary glaucoma. Demecarium has the advantage of once or twice daily dosing.
Suggested Dosage/Precautions/Adverse Effects - One drop once or twice daily. Demecarium is contraindicated during pregnancy. Because of additive effects, demecarium should be used with caution with other cholinesterase inhibitors (e.g., carbamate/organophosphate antiparasiticides), or succinylcholine. Demecarium may cause local inflammation and systemic adverse effects (vomiting, diarrhea, increased salivation, cardiac effects) are possible, particularly with high dosages or in very small dogs.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Demecarium 0.125% or 0.25% in 5 ml dropper bottles, Humorsol ® (Merck); (Rx). Do not freeze and protect from heat.
Epinephrine, Topical (Ophthalmic)
Indications/Pharmacology - Epinephrine (usually in combination with pilocarpine due to epinephrine's mydriatic effects) is usually used as a preventative measure to prevent glaucoma in the unaffected eye. Epinephrine acts on both alpha and beta adrenergic receptors, thereby causing conjunctival decongestion, transient mydriasis (less so in cats) and decreased IOP (intraocular pressure). Decreased IOP is probably due primarily to increased aqueous humor outflow, but decreased aqueous humor production may occur secondary to vasoconstriction.
Suggested Dosage/Precautions/Adverse Effects - One drop 2-3 times daily in the unaffected eye. Epinephrine may cause ocular discomfort upon instillation.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Epinephrine (HCl) 0.25%, 0.5%, 1% & 2% in 10 or 15 ml btls.; Epifrin® (Allergan), Glaucon® (Alcon); (Rx) Epinephrine (Borate) 0.5%, 1% & 2% in 7.5 ml btls; Eppy/N® (Pilkington/Barnes-Hind), Epinal® (Alcon); (Rx) Epinephrine Bitartrate 1% in combination with Pilocarpine HCl (either 1%, 2%, 3%, 4% or 6%) E-Pilo-1® (2, 3, etc.) (Iolab); P1(2, 3, etc.)E1 (Alcon); (Rx)
Dorzolamide HCl (Ophthalmic)
Indications/Pharmacology - Dorzolamide is often used in the contralateral eye of a dog with primary glaucoma to prevent development of bilateral disease. It is also an excellent agent to consider for most secondary glaucomas in dogs and cats because it has no effect on pupil size. Like the related oral carbonic anhydrase inhibitors (dichlorphenamide or Daranide®, methazolamide or Neptazane®), dorzolamide decreases aqueous humor production by the ciliary body epithelium by altering pH and affecting the H+/Na+ active transport exchange mechanism. Oral carbonic anhydrase inhibitors cause numerous systemic side effects such as metabolic acidosis and panting, diarrhea, vomiting, anorexia and others, all of which can be avoided with topical carbonic anhydrase inhibitors.
Suggested Dosage/Precautions/Adverse Effects - One drop three times daily is the standard treatment frequency, adjusted based on clinical response. Dorzolamide may cause stinging upon topical application.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Dorzolamide HCl 2% 5, 10, 15ml; Trusopt® (Merck); (Rx)
Latanoprost (Ophthalmic)
Indications/Pharmacology - Latanoprost is a prostaglandin F2alpha analogue which reduces intraocular pressure by increasing aqueous humor outflow via the uveoscleral outflow mechanism. The major outflow mechanism in animals and people is through the iridocorneal angle termed the conventional outflow mechanism. A species variable alternative pathway directly across the surface of the iris into the iridal venous supply accounts for some outflow in people and animals. The horse apparently has the highest uveoscleral outflow of the domestic species studied. Latanoprost dramatically increases uveoscleral outflow and is an exciting agent for glaucoma patients because this medication directly increases alternative drainage of aqueous humor, which logically would seem superior to reducing production or attempting to increase outflow through a failing conventional outflow system. Latanoprost is marketed for once daily usage in people and clinical studies show reduced effectiveness when once daily treatment is exceeded. In the author’s clinic (DKO) with limited cases, the intraocular pressure reduction associated with the use of this agent has been impressive and can exceed even that possible with oral or topical carbonic anhydrase inhibitors. Latanoprost has been used in veterinary ophthalmology to treat primary and secondary glaucomas although clinicians should assess the possibility of profound miosis associated with the use of this medication in their secondary glaucoma cases.
Suggested Dosage/Precautions/Adverse Effects - One drop is applied in the PM. Latanoprost may cause topical irritation. Conjunctival hyperemia is commonly noted in patients using this medication. A direct stimulation of iris melanocytes results in excess melanin production in the iris of people using this medication, causing a dark brown color change to the iris. Profound miosis is noted with the use of latanoprost in dogs and cats.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Latanoprost 0.005% 2.5 ml; Xalantan ® (Pharmacia & Upjohn) (Rx). Store under refrigeration until use; at room temp for 6 weeks after opened.
Vasoconstrictors/Mydriatics
Phenylephrine HCl (Ophthalmic)
Indications/Pharmacology - Phenylephrine is used to differentiate conjunctival vascular injection (blanches with phenylephrine application) versus deep episcleral injection (blanches incompletely) associated with uveitis, glaucoma, or scleritis. It is also used prior to conjunctival surgery to reduce hemorrhage and in combination with atropine prior to cataract or other intraocular surgeries which require maximal pupillary dilation. Phenylephrine can be used to confirm the diagnosis of Horner's syndrome. Dilution of 2.5% phenylephrine solution with saline (1:10) produces a 0.25% solution. Normal eyes will not demonstrate mydriasis in response to this low concentration of phenylephrine. Third order Horner's syndrome of greater than two weeks duration is associated with receptor up regulation and therefore a response to 0.25% phenylephrine is noted. In this way, the diagnosis of Horner's is confirmed and a suggestion as to whether or not the condition is 2nd or 3rd order in nature. In dogs, maximum mydriasis persists for about 2 hours and effects may last for up to 18 hours. Phenylephrine has significant alpha adrenergic effects (vasoconstriction and pupillary dilation) and minimal effects on beta receptors. When used alone, phenylephrine is reportedly not efficacious in the cat unless used with other mydriatics.
Suggested Dosage/Precautions/Adverse Effects - For diagnosis and characterization of Horner's syndrome: Apply 0.25% solution (see above) in both eyes. If there is a response in the miotic eye; 3rd order. If no response, apply 2.5% solution; if there is a response in both eyes it confirms Horner's and probably is 2nd order. For treatment of Horner's Syndrome: Treatment is indicated only if patient experiences visual difficulty because third eyelid is elevated over pupil; then given on an as needed basis with an average duration of effect of 3-6 hours. Prior to cataract or intraocular surgery: 2.5% or 10% given every 15 minutes for two hours. Monitor for hypertension and/or cardiac arrhythmia in small patients especially when using the 10% solution. Local discomfort may occur after instillation and chronic use may lead to inflammation. In some species (cat, rabbit, humans) transient stromal clouding may occur if used when corneal epithelium is damaged.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Phenylephrine HCl 0.12% in 15 ml or 20 ml bottles (OTC) Phenylephrine HCl 2.5% in 2, 5 or 15 ml bottles (Rx) Phenylephrine HCl 10% available in 1, 2, 5 or 15 ml bottles (Rx). Available generically and under several proprietary names. A well known trade name is Neo-Synephrine® (Sanofi Winthrop). A viscous form of the 10% is also available.
Cycloplegic Mydriatics
Atropine Sulfate (Ophthalmic)
Indications/Pharmacology - Atropine, when used topically on the eye, acts by blocking the cholinergic responses of the sphincter muscle of the iris and the ciliary body to cause mydriasis (pupillary dilation) and accommodation paralysis (cycloplegia). Atropine may be useful in the control of pain secondary to corneal and uveal disease; to maximally dilate the pupil prior to intraocular surgery; to dilate the pupil and prevent pupillary block in glaucoma and uveitis. In the dog, atropine causes maximal mydriasis in about 1 hour and it may persist for up to 120 hours. Cats also show a delayed onset of action and mydriasis may persist for up to 144 hours (dose dependent). Atropine is particularly long acting in horses. Atropine may be used in combination with 10% phenylephrine to achieve mydriasis and cycloplegia in cases of anterior uveitis.
Suggested Dosages/Precautions/Adverse Effects - Ointments or drops are routinely used in dogs. One percent is commonly used, but 2% solutions may be required in severe cases of uveitis. Ointments are generally used in cats to prevent hypersalivation associated with the bitter taste of this medication. Dosage frequencies are variable depending on the condition and its severity. Commonly, atropine is given as one drop 2-3 times a day until pupillary dilation is achieved and once daily thereafter to maintain this response. Atropine may precipitate acute, congestive primary glaucoma in dogs predisposed to primary glaucoma; do not use in primary glaucoma. Repeated topical application prior to surgery can result in systemic atropine toxicosis (mania, hyperthermia, etc.). Salivation may result in dogs as well as cats (see above) secondary to the bitter taste. Reportedly, very frequent treatment with atropine may induce colic in horses secondary to systemic absorption and atropine's vagal parasympathetic effects. However, clinically this effect is only rarely noted.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: Atropine Sulfate Ophthalmic Ointment 10 mg/gm (1%) in 3.5 gm tubes; Atrophate® (Schering-Plough); (Rx) Human-Approved Products: Atropine Sulfate Ophthalmic Ointment 5 mg/gm (0.5%), 10 mg/gm (1%) in 3.5 gm tubes; Generic and various trade names; (Rx) Atropine Sulfate Ophthalmic Solution 0.5%, 1%, and 2% in unit dose droppers; 2, 5, & 15 ml bottles; Generic and various trade names; (Rx)
Tropicamide (Ophthalmic)
Indications/Pharmacology - Tropicamide, like atropine, causes mydriasis and cycloplegia, but has more mydriatic than cycloplegic activity. Tropicamide has a more rapid onset (maximum mydriasis in 15-30 minutes) of action and a shorter duration of action (pupil returns to normal in 6-12 hours in most animals) than does atropine, thereby making it more useful for funduscopic examinations. In dogs, intraocular pressure is apparently not affected by tropicamide.
Suggested Dosages/Precautions/Adverse Effects - Once or twice application to eye, prior to exam. Following cataract surgery: apply 2-3 times daily to keep pupil constantly changing in size and reduce formation of synechiae associated with prolonged pupillary dilation (atropine). Note: a current trend away from the use of mydriatics after intraocular surgery has developed in recognition of immediate postoperative pressure elevations in some animals following surgery. Tropicamide is less effective in pain control (cycloplegia) than atropine. Tropicamide may cause salivation, particularly in cats and may also sting when applied. Tropicamide may precipitate acute congestive glaucoma in predisposed patients.
Dosage Forms/Preparations/FDA Approval Status - Veterinary Approved Products: None Human-Approved Products: Tropicamide Solution 0.5% and 1% in 2 ml & 15 ml bottles; Mydriacyl® (Alcon), Opticyl® (Optopics), Tropicacyl® (Akorn), Generic; (Rx)
Topical Anesthetics
Proparacaine Hcl (Ophthalmic)
Indications/Pharmacology - Proparacaine is a rapid acting topical anesthetic useful for a variety of ophthalmic procedures including tonometry (intraocular pressure measurement), relief of corneal pain to facilitate examination, biopsy/sample collection, and to distinguish between corneal and uveal pain. Proparacaine primarily anesthetizes the cornea; with limited penetration into conjunctiva. Anesthesia is of short duration (5-10 minutes).
Suggested Dosages/Precautions/Adverse Effects- Usual dose is 1 - 2 drops prior to examination or procedure. For prolonged procedures only requiring local anesthesia; may repeat 1 drop doses every 5-10 minutes for 5-7 doses. Topical anesthetics should not be used to treat painful eye disease. Prolonged use may retard wound healing and cause corneal epithelial ulcers. Because the blink reflex may be suppressed, the eye should be protected from external injury during use. Repeated use may lead to rapid development of tolerance. Local allergic-type reactions have been rarely reported in humans.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: Proparacaine HCl Solution 0.5% in 15 ml bottles; Ophthaine® (Solvay); (Rx) Protect from light. Refrigerate. Human-Approved Products: Proparacaine HCl Solution 0.5% in 2 & 15 ml bottles; Ophthetic® (Allergan), Alcaine® (Alcon), Ophthaine® (Squibb), AK-Taine® (Akorn), Generic; (Rx) Protect from light. Some products should be refrigerated; check label.
Non-Steroidal Antiinflammatory Agents
Flurbiprofen Sodium (Ophthalmic)
Indications/Pharmacology - Flurbiprofen is a non-steroidal anti-inflammatory agent that probably acts by inhibiting the cyclo-oxygenase enzyme system, thereby reducing the biosynthesis of prostaglandins. Prostaglandins may mediate certain kinds of ocular inflammation. They may disrupt the blood-aqueous humor barrier, cause vasodilation, increase intraocular pressure and leukocytosis, and increase vascular permeability. Prostaglandins may also cause iris sphincter constriction (miosis) independent of cholinergic mechanisms. Flurbiprofen can inhibit this intraocular miosis and may also be useful in the management of uveal inflammation (usually in addition to topical steroids).
Suggested Dosages/Precautions/Adverse Effects - Prior to surgery: One drop 4 times at 20 minute intervals. Because flurbiprofen may be as immunosuppressive as topical corticosteroids, it should not be used in patients with infected corneal ulcers. By blocking prostaglandin synthesis, arachidonic acid metabolites may be shunted into leukotriene pathways and this effect may result in a transient increase in intraocular pressure commonly noted after intraocular surgery. Postoperative pressure spikes following cataract surgery have been the subject of much study in recent years and a general trend away from the use of flurbiprofen prior to cataract surgery has resulted from these studies.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Flurbiprofen Sodium 0.03% Solution in 2.5, 5 & 10 ml btls; Ocufen® (Allergan); (Rx)
Ketorolac Tromethamine (Ophthalmic)
Indications/Pharmacology - Ketorolac tromethamine is a pyrrolol-pyrrole nonsteroidal anti-inflammatory agent that inhibits prostaglandin formation. Prostaglandins mediate inflammation within the eye by disrupting the blood-aqueous barrier, inducing vasodilation and increasing intraocular pressure. Prostaglandins may also cause iris sphincter constriction (miosis) independent of cholinergic mechanisms. Ketorolac tromethamine is marketed for use before cataract extraction in human patients (to prevent miosis during surgery) and for control of post surgical inflammation, especially following cataract surgery. It is also approved for management of conjunctivitis associated with seasonal allergy in people. In veterinary medicine, ketorolac tromethamine is primarily used to control surgical or nonsurgical uveitis particularly in cases with concurrent corneal infection when topical corticosteroids are contraindicated or in diabetic patients, especially smaller patients, adversely affected by systemic uptake of topically applied corticosteroids. Nonsteroidal agents like ketorolac tromethamine can be combined with topical steroids in patients with severe uveal inflammation.
Suggested Dosages/Precautions/Adverse Effects - Prior to surgery: One drop 4 times at 20 minute intervals. One drop four times daily following cataract surgery or for treatment of uveitis or for management of allergic conjunctivitis. The manufacturer indicates that ketorolac tromethamine does not enhance the spread of preexisting corneal fungal, viral or bacterial infections in animals models. Ketorolac tromethamine does not in and of itself induce postoperative pressure elevation other then that which frequently follows cataract extraction in people and animals.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None Human-Approved Products: Ketorolac Tromethamine Solution 0.5% 3, 5, 10 ml; Acular® (Allergan); (Rx)
Diclofenac Sodium (Ophthalmic)
Indications/Pharmacology - Diclofenac sodium is a phenylacetic acid that inhibits cyclooxygenase, inhibiting prostaglandin synthesis. Diclofenac sodium topical solution reduces inflammation following cataract extraction in people and counteracts photophobia in humans having refractive corneal surgery. In veterinary medicine, diclofenac sodium is used for treatment of uveitis following surgery on the eye or other causes of uveitis especially when corneal infection is suspected or in diabetic patients whose insulin regulation could be altered by the systemic uptake of topical corticosteroids. Diclofenac can be combined with topical corticosteroids for better control of uveitis in animals when the condition is severe.
Suggested Dosages/Precautions/Adverse Effects - Prior to surgery: One drop 4 times at 20 minute intervals. One drop four times daily following cataract surgery or for the treatment of uveitis. Caution should be used when applying any anti-inflammatory agent on the cornea in the face of corneal stromal infection because of the positive role inflammation plays in the immune response to microbial invasion of tissue. A stinging sensation is noted in 15% of people using this medication.
Dosage Forms/Preparations/FDA Approval Status - Veterinary-Approved Products: None |
