Borax + Boric Acid + Camphor + Hydroxypropylmethylcellulose + Menthol + Naphazoline

Usage

This combination of drugs is primarily used as an ophthalmic solution for symptomatic relief of minor eye irritation, redness, and discomfort caused by allergies, dryness, or other environmental factors. It is not intended to treat infections.

• Pharmacological Classification: This combination includes several drug classes:

  • Naphazoline: Decongestant, Vasoconstrictor, Alpha-adrenergic agonist
  • Boric Acid & Borax: Antiseptic, buffering agent
  • Camphor & Menthol: Counterirritants, providing a cooling sensation
  • Hydroxypropylmethylcellulose: Lubricant, viscosity enhancer

• Mechanism of Action: Naphazoline acts as a vasoconstrictor, reducing redness and swelling in the eye. Boric acid and borax provide mild antiseptic action and act as a buffer, helping maintain the solution’s pH. Menthol and camphor produce a cooling sensation, relieving itching and discomfort. Hydroxypropylmethylcellulose acts as a lubricant and helps the solution spread evenly across the eye’s surface.

Alternate Names

There is no single international nonproprietary name (INN) for this combination product. It is often referred to by the names of its individual components.

• Brand Names: Ocurest Plus, Napzol Plus, I Boric Eye Drops (and possibly others depending on the region and manufacturer).

How It Works

• Pharmacodynamics: Naphazoline stimulates alpha-adrenergic receptors in the blood vessels of the conjunctiva, causing vasoconstriction. This reduces blood flow, alleviating redness and swelling. Boric acid and borax have weak antiseptic properties and help maintain the solution’s pH. Menthol and camphor activate cold receptors, creating a cooling sensation that counteracts itching and irritation. Hydroxypropylmethylcellulose increases the viscosity of the solution and lubricates the ocular surface.

• Pharmacokinetics: Naphazoline is absorbed locally in the eye. Systemic absorption is minimal with topical application. The other components are also minimally absorbed. Elimination pathways for naphazoline are not well-defined following topical ophthalmic use.

• Mode of Action: Naphazoline acts as an alpha-adrenergic agonist, specifically targeting alpha-1 and alpha-2 adrenergic receptors in the ocular blood vessels.

• Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: Naphazoline directly binds to and activates alpha-adrenergic receptors, mimicking the effects of norepinephrine and epinephrine. This leads to vasoconstriction.

Dosage

Standard Dosage

Adults: Instill 1-2 drops in the affected eye(s) every 3-4 hours as needed. Do not exceed recommended dosage.

Children: Consult a pediatrician before use in children. Safety and efficacy in children have not been fully established.

Special Cases:

• Elderly Patients: Use with caution. Monitor for potential systemic effects like increased blood pressure.

• Patients with Renal Impairment: Use with caution.

• Patients with Hepatic Dysfunction: Use with caution.

• Patients with Comorbid Conditions: Use with caution in patients with cardiovascular disease, hypertension, hyperthyroidism, diabetes, or narrow-angle glaucoma.

Clinical Use Cases

This medication is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. Its use is primarily for symptomatic relief of minor eye irritation.

Dosage Adjustments

Dosage adjustments may be necessary in elderly patients or those with certain medical conditions. Always follow the physician’s recommendations.

Side Effects

Common Side Effects:

• Temporary burning or stinging upon instillation
• Pupil dilation (mydriasis)
• Rebound redness with prolonged use

Rare but Serious Side Effects:

• Blurred vision
• Eye pain
• Headache
• Systemic effects (e.g., increased blood pressure, rapid heart rate)

Long-Term Effects:

• Rebound congestion with overuse

Adverse Drug Reactions (ADR):

• Severe allergic reactions (rare)

Contraindications

• Hypersensitivity to any of the components
• Narrow-angle glaucoma

Drug Interactions

• Monoamine oxidase inhibitors (MAOIs) can potentiate the pressor effects of naphazoline.
• Beta-blockers may interact with naphazoline.

Pregnancy and Breastfeeding

• Pregnancy: Consult a doctor before use. Safety during pregnancy has not been established.
• Breastfeeding: Consult a doctor before use. It is unknown if naphazoline is excreted in breast milk.

Drug Profile Summary

• Mechanism of Action: Naphazoline: Alpha-adrenergic agonist causing vasoconstriction. Other ingredients provide antiseptic, cooling, and lubricating effects.
• Side Effects: Burning, stinging, pupil dilation, rebound redness, blurred vision (rare), systemic effects (rare).
• Contraindications: Hypersensitivity, narrow-angle glaucoma.
• Drug Interactions: MAOIs, beta-blockers.
• Pregnancy & Breastfeeding: Consult a doctor before use.
• Dosage: 1-2 drops every 3-4 hours as needed.
• Monitoring Parameters: Eye pressure, heart rate, blood pressure (especially in patients with pre-existing conditions).

Popular Combinations

This combination is typically used as a standalone product.

Precautions

• General Precautions: Avoid touching the dropper tip to any surface to prevent contamination.
• Specific Populations: Use with caution in pregnant or breastfeeding women, children, and elderly individuals.
• Lifestyle Considerations: None specifically related to this combination.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Borax + Boric Acid + Camphor + Hydroxypropylmethylcellulose + Menthol + Naphazoline?

A: The usual dose is 1-2 drops in the affected eye every 3-4 hours as needed. Do not exceed the recommended dose.

Q2: Can this combination be used to treat eye infections?

A: No. It is for symptomatic relief of minor eye irritation and is not effective against bacterial or viral infections.

Q3: What are the common side effects?

A: Burning or stinging upon instillation and mild pupil dilation are common. Rebound redness can occur with overuse.

Q4: Who should not use this combination?

A: Individuals with narrow-angle glaucoma or hypersensitivity to any component should avoid this product.

Q5: Can pregnant or breastfeeding women use it?

A: Consult a physician before use during pregnancy or breastfeeding.

Q6: What should I do if I experience blurred vision after using the drops?

A: Discontinue use and consult a doctor immediately.

Q7: Can I use this product with contact lenses?

A: Remove contact lenses before using the drops and wait at least 15 minutes before reinserting them.

Q8: How should I store the eye drops?

A: Store below 30°C and discard one month after opening.

Q9: What should I do if my symptoms don’t improve?

A: Consult an ophthalmologist. Persistent eye irritation may indicate a more serious condition.