Boric Acid + Chlorbutol + Chlorpheniramine Maleate + Sodium Chloride + Sulphacetamide

Usage

This combination medication is primarily prescribed for the treatment of bacterial eye infections. It addresses the infection while also alleviating associated symptoms like pain, swelling, redness, itching, and excessive tearing.

Pharmacological Classification: This is a combination product with multiple classifications:

• Sulphacetamide: Sulfonamide antibiotic
• Chlorpheniramine Maleate: Antihistamine
• Boric Acid: Antiseptic
• Chlorbutol: Antiseptic and Preservative
• Sodium Chloride: Isotonic agent

Mechanism of Action: Sulphacetamide, a sulfonamide antibiotic, inhibits bacterial growth by interfering with folic acid synthesis, essential for bacterial DNA replication. Chlorpheniramine maleate, an antihistamine, reduces allergic reactions that contribute to eye irritation. Boric acid and chlorbutol act as antiseptics, further combating bacterial growth. Sodium chloride helps maintain proper osmotic balance in the eye and reduce corneal swelling.

Alternate Names

No commonly recognized alternate names exist for this specific combination. However, it’s important to note that the concentration of each component may vary in different formulations. Brand names may exist regionally.

How It Works

Pharmacodynamics: Sulphacetamide exerts its antibacterial effect by competitively inhibiting dihydropteroate synthase, a bacterial enzyme crucial for folic acid synthesis. Chlorpheniramine maleate antagonizes histamine H1 receptors, reducing the effects of histamine release that cause allergic symptoms. Boric acid and chlorbutol disrupt bacterial cell membranes. Sodium chloride helps maintain osmotic balance.

Pharmacokinetics: Sulphacetamide is absorbed systemically to some extent after topical ocular administration. Chlorpheniramine maleate, boric acid, and chlorbutol are also absorbed, although their systemic effects are usually minimal. Sodium chloride remains primarily localized to the ocular surface. The exact metabolic pathways and elimination routes for all components in this specific combination, after topical ophthalmic application, aren’t comprehensively documented.

Mode of Action: Sulphacetamide competitively inhibits dihydropteroate synthase, blocking the folic acid pathway crucial for bacterial growth. Chlorpheniramine maleate blocks histamine H1 receptors, reducing allergic responses. Boric acid and chlorbutol disrupt bacterial cell membranes.

Dosage

Standard Dosage

Adults: Instill 1-2 drops into the affected eye(s) every 2-4 hours, or as directed by a physician. The frequency may be reduced as the infection improves.

Children: Dosage should be determined by a pediatrician based on the child’s age and weight.

Special Cases:

• Elderly Patients: Dosage adjustments are generally not required unless there is significant renal or hepatic impairment.

• Patients with Renal Impairment: Caution is advised, and dosage adjustments may be needed depending on the degree of impairment.

• Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustments may be needed.

• Patients with Comorbid Conditions: Dosage adjustments may be required based on the specific condition.

Clinical Use Cases

The provided sources focus on the treatment of bacterial eye infections and do not specify dosing recommendations for surgical settings, intubation, mechanical ventilation, ICU, or emergency situations.

Dosage Adjustments

Dosage adjustment is based on individual patient response and the severity of the infection.

Side Effects

Common Side Effects:

• Transient burning or stinging upon instillation
• Eye irritation
• Blurred vision
• Photophobia (sensitivity to light)

Rare but Serious Side Effects:

• Severe allergic reactions (e.g., rash, itching, swelling, difficulty breathing)

Long-Term Effects:

Prolonged use of topical sulphonamides can lead to the development of resistant organisms.

Adverse Drug Reactions (ADR):

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare but potentially life-threatening ADRs associated with sulfonamides.

Contraindications

• Known hypersensitivity to any of the components, particularly sulfonamides
• Patients with certain enzymatic deficiencies related to glucose-6-phosphate dehydrogenase (G6PD)

Drug Interactions

Sulphacetamide may interact with other topical ophthalmic medications, specifically silver preparations.

Pregnancy and Breastfeeding

Sulphacetamide is considered relatively safe during pregnancy when used topically. However, its safety during breastfeeding has not been fully established. The manufacturer’s recommendations should be consulted before use during pregnancy or breastfeeding.

Drug Profile Summary

• Mechanism of Action: Sulphacetamide: antibacterial; Chlorpheniramine: antihistamine; Boric Acid/Chlorbutol: antiseptic; Sodium Chloride: isotonic.
• Side Effects: Burning, stinging, irritation, blurred vision, photophobia.
• Contraindications: Hypersensitivity to components.
• Drug Interactions: Silver preparations.
• Pregnancy & Breastfeeding: Relatively safe during pregnancy (topical); consult manufacturer for breastfeeding.
• Dosage: 1-2 drops in the affected eye(s) every 2-4 hours.
• Monitoring Parameters: Resolution of infection symptoms, signs of adverse reactions.

Popular Combinations

The formulation itself is a popular combination.

Precautions

• Avoid contact of the dropper tip with any surface to prevent contamination.
• Discontinue use if symptoms worsen or do not improve within a few days.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Boric Acid + Chlorbutol + Chlorpheniramine Maleate + Sodium Chloride + Sulphacetamide eye drops?

A: Typically, 1-2 drops are instilled into the affected eye(s) every 2-4 hours, or as directed by the physician.

Q2: How long does it take for this combination to work?

A: Improvement is typically seen within a few days, but the full course of treatment should be completed as directed by the physician.

Q3: Can these eye drops be used with contact lenses?

A: Contact lenses should generally be removed before instilling the drops and reinserted after 15-20 minutes.

Q4: What are the signs of an allergic reaction to these eye drops?

A: Signs of an allergic reaction may include itching, swelling, redness, and difficulty breathing. Seek immediate medical attention if these occur.

Q5: Can I use this medication if I am pregnant or breastfeeding?

A: Consult your physician before using these eye drops if you are pregnant or breastfeeding.

Q6: What should I do if I miss a dose?

A: Instill the missed dose as soon as you remember, then continue with your regular dosing schedule. Do not double the dose.

Q7: Can this medication be used in children?

A: Yes, but the dosage should be determined and monitored by a pediatrician.

Q8: What are the potential long-term effects of using these eye drops?

A: Prolonged use can lead to resistance development to the antibiotic component. Always follow your physician’s recommendations on duration of use.

Q9: Are there any specific precautions for elderly patients using this medication?

A: Elderly patients should use this medication with caution, especially if they have pre-existing renal or hepatic impairment. Dosage adjustments may be necessary.