Loteprednol

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[edit] BRAND NAMES

[edit] STRUCTURE

Loteprednol.jpg

[edit] MECHANISM OF ACTION

Loteprednol is a topical anti-inflammatory corticosteroid. corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor arachidonic acid.

After exerting its therapeutic effects on the site of action, loteprednol is rapidly converted to inactive metabolites, and has low propensity to cause elevated intraocular pressure when used in the short term.

[edit] INDICATIONS

  • Loteprednol (0,5%): Treatment of post-operative inflammation and pain following ocular surgery
  • Loteprednol (0,2%):Treatment of seasonal allergic conjunctivitis

[edit] DOSAGE

  • Loteprednol (0,5%): Apply one to two drops of into the conjunctival sac of the affected eye four times daily beginning the day after surgery and continuing throughout the first 2 weeks of the post-operative period.
  • Loteprednol (0,2%): One drop instilled into the affected eye(s) four times daily.

[edit] CONTRAINDICATIONS

As with other ophthalmic corticosteroids, Loteprednol is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures

[edit] PRECAUTIONS

  • Intraocular pressure (IOP) increase: Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. If Loteprednol is used for 10 days or longer, intraocular pressure should be monitored.
  • Cataracts: Use of corticosteroids may result in posterior subcapsular cataract formation.
  • Delayed healing: The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation. In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of topical steroids. The initial prescription and renewal of the medication order should be made by a physician only after examination of the patient with the aid of magnification such as slit lamp biomicroscopy and, where appropriate, fluorescein staining.
  • Bacterial infections: Prolonged use of corticosteroids may suppress the host response and thus increase the hazard of secondary ocular infection. In acute purulent conditions, steroids may mask infection or enhance existing infection.
  • Viral infections: Employment of a corticosteroid medication in the treatment of patients with a history of herpes simplex requires great caution. Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex).
  • Fungal infections: Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use.

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US). Loteprednol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Nursing Mothers: It is not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human milk. Caution should be exercised when Loteprednol is administered to a nursing woman.

[edit] SIDE EFFECTS

The most common adverse drug reactions were anterior chamber inflammation (5%), eye pain (2%), and foreign body sensation (2%)

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