Usage
This ophthalmic solution is prescribed for the temporary relief of redness, itching, swelling, and watering of the eyes associated with allergic conjunctivitis and minor eye irritations. It also provides relief from burning and irritation due to dryness.
Pharmacological Classification:
This combination product includes:
- Naphazoline: Decongestant, Vasoconstrictor
- Chlorpheniramine Maleate: Antihistamine
- Boric Acid: Antiseptic
- Sodium Chloride: Isotonic agent
- Hydroxypropylmethylcellulose: Lubricant
Mechanism of Action: The combined effects of the components in this solution alleviate the symptoms of allergic eye disease by targeting different aspects of the inflammatory response. Naphazoline constricts conjunctival blood vessels, reducing redness and swelling. Chlorpheniramine blocks the action of histamine, a chemical mediator responsible for itching, watering, and other allergic symptoms. Boric acid acts as a mild antiseptic. Sodium chloride maintains the solution’s isotonicity, ensuring compatibility with ocular tissues. Hydroxypropylmethylcellulose is a lubricant that increases the solution’s viscosity, providing a soothing effect, prolonging contact time with the eye, and enhancing drug delivery.
Alternate Names
There are no widely recognized alternate names for this specific drug combination. However, it’s marketed under various brand names such as Zoneph Eye Drop, Redif Ophthalmic Solution, Borizol Eye Drop, Kaytears Plus, and Trikool Eye Drop. Regional variations in the name may exist.
How It Works
Pharmacodynamics:
- Naphazoline: Stimulates alpha-adrenergic receptors in the conjunctiva, causing vasoconstriction, which reduces redness and swelling.
- Chlorpheniramine: Antagonizes histamine H1 receptors, relieving itching, watering, and other allergic symptoms.
- Boric Acid: Mild antiseptic action.
- Sodium Chloride: Maintains isotonicity.
- Hydroxypropylmethylcellulose: Lubricates and soothes the eye, prolonging the medication’s contact time.
Pharmacokinetics: Topical ophthalmic administration results in minimal systemic absorption of naphazoline and chlorpheniramine. The drugs are primarily eliminated through metabolism and renal excretion.
Dosage
Standard Dosage
Adults: Instill 1-2 drops in the affected eye(s) every 4-6 hours, or as directed by the physician.
Children: Use with caution in children under 6 years of age. Consult a physician for appropriate dosing and safety considerations in pediatric patients. Safety and efficacy in children haven’t been fully established.
Special Cases:
- Elderly Patients: Use with caution. Monitor for systemic side effects, especially cardiovascular effects.
- Patients with Renal Impairment: Dose adjustment may be necessary. Monitor renal function.
- Patients with Hepatic Dysfunction: Dose adjustment may be necessary. Monitor liver function.
- Patients with Comorbid Conditions: Exercise caution in patients with cardiovascular disease, hypertension, hyperthyroidism, diabetes, and narrow-angle glaucoma.
Clinical Use Cases
This medication is primarily intended for the relief of allergic eye symptoms and not typically indicated for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Adjustments may be necessary based on individual patient response, renal or hepatic function, and other patient-specific factors.
Side Effects
Common Side Effects:
- Burning or stinging sensation upon instillation
- Blurred vision
- Eye irritation
- Redness of the eye
- Dilated pupils
Rare but Serious Side Effects:
- Systemic effects like increased blood pressure, rapid heart rate, headache, nervousness, and tremor (especially with overuse)
- Allergic reactions
Long-Term Effects:
Prolonged use can cause rebound congestion, potentially worsening symptoms.
Adverse Drug Reactions (ADR):
- Severe eye irritation
- Allergic reactions (rare)
Contraindications
- Hypersensitivity to any component of the formulation.
- Narrow-angle glaucoma.
- Severe cardiovascular disease.
- Uncontrolled hypertension.
Drug Interactions
- Monoamine oxidase inhibitors (MAOIs): May potentiate naphazoline’s pressor effects.
- Beta-blockers: May interact with naphazoline.
- Tricyclic antidepressants: May interact with naphazoline.
- Other ophthalmic medications: Administer at least 5 minutes apart.
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding. The safety of this combination product during these periods hasn’t been definitively established. Consult a physician if the benefits outweigh the potential risks. Consider safer alternatives if available.
Drug Profile Summary
- Mechanism of Action: See “How It Works.”
- Side Effects: Burning, stinging, blurred vision, eye irritation, redness, dilated pupils.
- Contraindications: Hypersensitivity, narrow-angle glaucoma, severe cardiovascular disease, uncontrolled hypertension.
- Drug Interactions: MAOIs, beta-blockers, tricyclic antidepressants.
- Pregnancy & Breastfeeding: Use with caution; consult a physician.
- Dosage: 1–2 drops in the affected eye(s) every 4–6 hours, or as directed.
- Monitoring Parameters: Blood pressure, heart rate (especially in patients with pre-existing cardiovascular conditions); ocular irritation, pupil size, intraocular pressure.
Popular Combinations
This combination is already a commonly used formulation. There may be variations available that include additional or alternative active compounds.
Precautions
- General Precautions: Avoid contact of the dropper tip with any surface. Discontinue use if symptoms persist or worsen after 72 hours. Remove contact lenses before application; wait at least 15 minutes before reinserting. Avoid prolonged and excessive use. Patients should be advised about potential transient blurred vision.
- Specific Populations: See “Dosage - Special Cases” and “Pregnancy and Breastfeeding.”
- Lifestyle Considerations: Limit alcoholic beverages. Caution should be exercised while driving or operating machinery immediately after application due to the potential for transient blurred vision.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Boric Acid + Chlorpheniramine Maleate + Hydroxypropylmethylcellulose + Naphazoline + Sodium Chloride?
A: The typical adult dosage is 1-2 drops in the affected eye(s) every 4-6 hours. Pediatric, geriatric, and other special population dosing may vary. Always consult with a physician for accurate dosing recommendations.
Q2: How long can I use this eye drop?
A: Do not use this medication for more than 72 hours without consulting a physician. Prolonged use may lead to rebound congestion.
A: Remove contact lenses before instilling the drops and wait at least 15 minutes before reinserting them.
Q4: Can I use this eye drop if I am pregnant or breastfeeding?
A: Consult your physician before using this eye drop if you are pregnant or breastfeeding. Safety in these populations has not been definitively established.
Q5: What are the common side effects of this combination?
A: Common side effects include burning or stinging upon instillation, blurred vision, eye irritation, redness, and dilated pupils.
Q6: Are there any serious side effects I should be aware of?
A: Rare but serious side effects include systemic effects such as increased blood pressure, rapid heart rate, headache, nervousness, and tremor, particularly with overuse. Allergic reactions can also occur.
Q7: What should I do if I accidentally get the drops in my mouth or nose?
A: Rinse the area thoroughly with water.
Q8: What should I do if I experience severe or persistent side effects?
A: Discontinue use and consult a physician immediately.
Q9: Can I use this medication with other eye drops?
A: If you are using other ophthalmic medications, wait at least five minutes between applications.
Q10: How should I store this medication?
A: Store in a cool, dry place away from direct sunlight and heat. Do not freeze. Keep out of reach of children. Discard the bottle one month after opening, even if there is solution remaining.
