Usage
- Medical Conditions: Bromfenac ophthalmic solution is primarily prescribed for the treatment of postoperative ocular inflammation and reduction of ocular pain in patients who have undergone cataract surgery. It can also be used to treat inflammation and pain after other eye surgeries.
- Pharmacological Classification: Non-Steroidal Anti-Inflammatory Drug (NSAID)
- Mechanism of Action: Bromfenac works by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, which are responsible for the production of prostaglandins. Prostaglandins contribute to inflammation and pain. By inhibiting COX enzymes, bromfenac reduces the production of these inflammatory mediators, thereby decreasing pain and inflammation in the eye.
Alternate Names
- Bromfenac sodium
- Brand Names: BromSite, Bromday, Prolensa, Xibrom, Yellox
How It Works
- Pharmacodynamics: Bromfenac reduces ocular pain and inflammation by inhibiting prostaglandin synthesis. The topical application minimizes systemic effects.
- Pharmacokinetics:
- Absorption: When applied as eye drops, bromfenac is absorbed into the ocular tissues, achieving therapeutic concentrations in the aqueous humor. Systemic absorption is minimal, leading to low plasma concentrations.
- Metabolism: While the specific metabolic pathways of topical bromfenac are not fully elucidated, systemic bromfenac is primarily metabolized in the liver.
- Elimination: Systemic bromfenac is primarily excreted via the kidneys. The elimination pathway of topical bromfenac is not definitively characterized.
- Mode of Action: Bromfenac binds to and inhibits both COX-1 and COX-2 enzymes, decreasing prostaglandin production.
- Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Inhibits COX-1 and COX-2 enzymes.
- Elimination Pathways: Primarily renal excretion for systemically administered bromfenac; the elimination pathway of topical bromfenac is not well-defined.
Dosage
Standard Dosage
Adults:
- One drop in the affected eye(s) once daily (Prolensa, Bromday) or twice daily (BromSite, some generics), starting 1 day before cataract surgery, continued on the day of surgery, and for up to 14 days postoperatively. Another regimen uses twice daily dosing starting the day after surgery for 14 days.
- Yellox is dosed twice daily after cataract extraction for up to 14 days.
Children:
- Safety and efficacy have not been established in pediatric patients. Use is generally avoided.
Special Cases:
- Elderly Patients: No dosage adjustments are typically necessary.
- Patients with Renal Impairment: Not specifically studied; caution advised.
- Patients with Hepatic Dysfunction: Not specifically studied; caution advised.
- Patients with Comorbid Conditions: Caution should be exercised in patients with diabetes, rheumatoid arthritis, dry eye syndrome, bleeding disorders, asthma or sulfite allergy, or history of corneal issues or multiple eye surgeries.
Clinical Use Cases
- Intubation: Not applicable.
- Surgical Procedures: Used primarily for cataract surgery; can be used after other ocular surgeries.
- Mechanical Ventilation: Not applicable.
- Intensive Care Unit (ICU) Use: Not applicable.
- Emergency Situations: Not applicable.
Dosage Adjustments
- Dosage adjustments may be required based on patient-specific factors such as renal or hepatic dysfunction or other comorbidities, though limited data is available on these adjustments.
Side Effects
Common Side Effects
- Increased sensitivity to light
- Mild eye irritation
- Foreign body sensation
- Headache
- Blurred vision
Rare but Serious Side Effects
- Corneal complications (keratitis, thinning, erosion, ulceration, perforation)
- Increased intraocular bleeding
- Delayed healing
- Severe allergic reactions (hives, breathing difficulties, swelling)
Long-Term Effects
- Corneal complications with prolonged use may lead to vision loss.
Adverse Drug Reactions (ADR)
- Corneal melting or perforation
- Anterior uveitis
- Severe allergic reactions
Contraindications
- Hypersensitivity to bromfenac, other NSAIDs, or any component of the formulation
- Patients with aspirin-sensitive asthma, rhinitis, or urticaria
Drug Interactions
- Other NSAIDs (aspirin, ibuprofen): Increased risk of bleeding
- Anticoagulants/Antiplatelets (warfarin, clopidogrel): Increased risk of bleeding
- Corticosteroids: May increase the risk of corneal adverse effects and slow down healing.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: C (0.07% and 0.09% solutions); Not assigned (0.075% solution). Not recommended during the third trimester. Use in the first and second trimesters only if the potential benefit outweighs the risk.
- Fetal risks: Potential for premature closure of ductus arteriosus.
- Breastfeeding: Drug excretion in human milk unknown. Caution advised.
Drug Profile Summary
- Mechanism of Action: Inhibits COX-1 and COX-2, reducing prostaglandin synthesis and subsequent inflammation.
- Side Effects: Common: Increased light sensitivity, eye irritation. Serious: Corneal complications, bleeding.
- Contraindications: Hypersensitivity to bromfenac or other NSAIDs, aspirin-sensitive asthma/rhinitis/urticaria.
- Drug Interactions: Other NSAIDs, anticoagulants, corticosteroids.
- Pregnancy & Breastfeeding: Not recommended in third trimester; caution advised if breastfeeding.
- Dosage: One drop once or twice daily, starting 1 day before or the day after surgery for up to 14 days post-cataract surgery.
- Monitoring Parameters: Monitor for signs of corneal complications, bleeding, or allergic reactions.
Popular Combinations
- Often used alone. Concomitant use with other eye drops is possible but requires careful administration with adequate spacing between instillations (at least 5 minutes).
Precautions
- General Precautions: Avoid contact of the dropper tip with any surface. Assess allergy history. Patients should not wear contact lenses during treatment.
- Specific Populations: Use with caution in pregnant or breastfeeding women. Safety and efficacy in children not established. Use caution in the elderly and those with certain medical conditions.
- Lifestyle Considerations: May cause transient blurred vision. Advise patients against driving or operating machinery until vision clears.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromfenac?
A: For adults, one drop once or twice daily in the affected eye, starting one day before or the day after cataract surgery, for up to 14 days post-surgery.
Q2: What are the most common side effects of Bromfenac eye drops?
A: The most common side effects include increased sensitivity to light, mild eye irritation, foreign body sensation, headache, and blurred vision.
Q3: Can Bromfenac eye drops be used in children?
A: Safety and efficacy have not been established in pediatric patients, and its use is generally avoided.
Q4: Are there any serious side effects associated with Bromfenac?
A: Yes. While rare, serious side effects can include corneal complications (keratitis, thinning, erosion, perforation), bleeding within the eye, delayed healing, and severe allergic reactions.
Q5: What should patients be advised about while using Bromfenac eye drops?
A: Advise patients to avoid contact of the dropper tip with any surface to prevent contamination, to report any signs of eye infection or unusual symptoms, and to avoid wearing contact lenses during treatment. They should also be advised about potential blurred vision and cautioned against driving or operating machinery until vision clears.
Q6: What medications interact with Bromfenac?
A: Bromfenac can interact with other NSAIDs, anticoagulants/antiplatelet medications, and corticosteroids. Concurrent use should be approached with caution.
Q7: Can Bromfenac be used during pregnancy or breastfeeding?
A: Bromfenac is not recommended during the third trimester of pregnancy. Use in the first and second trimesters only if the potential benefit outweighs the risk. Caution is advised during breastfeeding as the drug’s excretion in human milk is unknown.
Q8: What is the mechanism of action of Bromfenac?
A: Bromfenac is an NSAID that inhibits COX-1 and COX-2 enzymes, thereby reducing prostaglandin production, inflammation, and pain.
Q9: What conditions is Bromfenac contraindicated in?
A: Bromfenac is contraindicated in patients with hypersensitivity to bromfenac, other NSAIDs, or any component of the formulation. It is also contraindicated in patients with aspirin-exacerbated respiratory disease (AERD), which can manifest as asthma, rhinitis, or urticaria.
