Usage
This ophthalmic solution is prescribed for the temporary relief of symptoms associated with allergic conjunctivitis, such as redness, itching, burning, tearing, and swelling. It is also used to alleviate minor eye irritation caused by environmental factors like dust, smoke, wind, and chlorinated water.
Pharmacological Classification: This is a combination product containing drugs from different pharmacological classes:
- Decongestant: Phenylephrine and Naphazoline (Note: Naphazoline is included in some formulations of this medication as mentioned in some sources, though not explicitly in the query)
- Antihistamine: Chlorpheniramine Maleate
- Lubricant: Hydroxypropylmethylcellulose
- Antiseptic: Boric Acid
Mechanism of Action:
The combined action of these ingredients addresses multiple aspects of allergic conjunctivitis and eye irritation. Phenylephrine, a sympathomimetic amine, acts as a vasoconstrictor, constricting the conjunctival blood vessels, thereby reducing redness and swelling. Chlorpheniramine maleate, an H1 receptor antagonist, blocks the effects of histamine, reducing itching, tearing, and other allergic manifestations. Hydroxypropylmethylcellulose, a lubricant, provides a soothing coating on the eye surface, alleviating dryness and discomfort. Boric acid acts as a mild antiseptic and buffering agent.
Alternate Names
This combination does not have a universally recognized non-proprietary name. It is often referred to by the names of its individual components.
Brand Names: Several brand names exist for products containing this or a very similar combination, some examples include (but are not limited to): Analar, Decomic, Ocurest AH, Allercool, and Vizokul.
How It Works
Pharmacodynamics: Phenylephrine activates alpha-adrenergic receptors in the conjunctival blood vessels, causing vasoconstriction. Chlorpheniramine maleate antagonizes H1 histamine receptors, inhibiting histamine’s effects on the eye. Hydroxypropylmethylcellulose lubricates the ocular surface, providing a protective and moisturizing film. Boric acid exerts mild antiseptic action and helps maintain the solution’s pH.
Pharmacokinetics: When applied topically to the eye, systemic absorption of these ingredients is minimal. Some amount of phenylephrine and chlorpheniramine may be absorbed through the conjunctiva and nasal mucosa, leading to potential systemic side effects, especially with prolonged use. Hydroxypropylmethylcellulose and boric acid are largely confined to the ocular surface. The absorbed fraction is metabolized primarily in the liver and excreted renally. Specific information about cytochrome P450 (CYP) enzyme interactions for ophthalmic administration is limited.
Dosage
Standard Dosage
Adults: Instill 1-2 drops in the affected eye(s) every 4-6 hours as needed. Do not exceed the recommended dosage.
Children: Use in children should be under strict medical supervision. Dosage will be determined by the physician based on the child’s age, weight, and the severity of symptoms. Pediatric safety considerations include increased risk of systemic absorption and central nervous system effects.
Special Cases:
- Elderly Patients: Start with a lower dose and monitor for systemic side effects, particularly cardiovascular effects of phenylephrine.
- Patients with Renal Impairment: Exercise caution and monitor for potential accumulation of systemically absorbed drugs.
- Patients with Hepatic Dysfunction: Use with caution due to the liver’s role in metabolizing absorbed components.
- Patients with Comorbid Conditions: Particular care should be exercised in patients with cardiovascular diseases (hypertension, arrhythmias), hyperthyroidism, diabetes, and closed-angle glaucoma.
Clinical Use Cases:
This specific combination is not typically used in the clinical settings mentioned (intubation, surgical procedures, mechanical ventilation, ICU, and emergency situations). Different medications are preferred in these scenarios.
Dosage Adjustments: Dosage adjustments should be individualized based on patient response and the presence of any renal or hepatic impairment.
Side Effects
Common Side Effects:
Burning or stinging upon instillation, temporary blurred vision, mydriasis (pupil dilation), ocular discomfort, rebound congestion with prolonged use.
Rare but Serious Side Effects:
Allergic reactions (e.g., rash, itching, swelling), systemic effects of phenylephrine such as headache, tachycardia, palpitations, and hypertension.
Long-Term Effects:
Rebound congestion, angle-closure glaucoma (in predisposed individuals), and damage to the corneal epithelium with prolonged use.
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis), acute angle-closure glaucoma, and significant cardiovascular events (e.g., hypertensive crisis).
Contraindications
Narrow-angle glaucoma or predisposition to it, hypersensitivity to any of the components, concurrent use of monoamine oxidase inhibitors (MAOIs), severe cardiovascular disease, uncontrolled hyperthyroidism.
Drug Interactions
MAOIs, tricyclic antidepressants, beta-blockers, other sympathomimetics, and certain antihypertensive medications may interact with this combination, potentially exacerbating systemic side effects.
Pregnancy and Breastfeeding
This combination is generally avoided during pregnancy and breastfeeding due to the potential for fetal and neonatal exposure. Consult with a physician to assess the benefit-risk ratio if use is considered necessary.
Drug Profile Summary
- Mechanism of Action: Decongestant, antihistamine, lubricant, and mild antiseptic actions.
- Side Effects: Burning/stinging, blurred vision, mydriasis, rebound congestion, headache, tachycardia.
- Contraindications: Narrow-angle glaucoma, hypersensitivity, MAOI use, severe cardiovascular disease.
- Drug Interactions: MAOIs, tricyclic antidepressants, beta-blockers, other sympathomimetics.
- Pregnancy & Breastfeeding: Consult a doctor before use.
- Dosage: 1-2 drops in affected eye(s) every 4-6 hours.
- Monitoring Parameters: Eye redness, itching, swelling, pupil size, blood pressure, heart rate.
Popular Combinations
This product itself is a combination product. Additional ophthalmic medications are usually not recommended without a doctor’s advice.
Precautions
- General Precautions: Discontinue use if symptoms worsen or persist after 72 hours. Avoid touching the dropper tip to any surface.
- Specific Populations: Pregnant women and breastfeeding mothers should use only when clearly needed and under strict medical supervision. Pediatric use should also be under medical guidance.
- Lifestyle Considerations: Be cautious when driving or operating machinery due to the potential for blurred vision.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Boric Acid + Chlorpheniramine Maleate + Hydroxypropylmethylcellulose + Phenylephrine?
A: The usual adult dose is 1-2 drops in the affected eye(s) every 4-6 hours as needed. Pediatric and special population dosing should be determined by a physician.
Q2: What conditions does this eye drop treat?
A: It’s used for temporary relief of allergic conjunctivitis symptoms and minor eye irritations.
A: Remove contact lenses before instilling the drops and wait at least 15 minutes before reinserting them.
Q4: What are the common side effects?
A: Burning/stinging, blurred vision, pupil dilation, and discomfort.
Q5: Are there any serious side effects I should be aware of?
A: While rare, allergic reactions, systemic effects like headache, tachycardia, and hypertension can occur. Seek medical help if you experience these.
Q6: Can pregnant or breastfeeding women use this eye drop?
A: It’s best avoided unless specifically directed by a physician due to potential risks to the fetus or infant.
Q7: Can I use this with other eye medications?
A: Generally, avoid combining with other eye drops without consulting a doctor. Drug interactions can occur.
Q8: What should I do if my symptoms worsen or don’t improve?
A: Discontinue use and consult your physician if symptoms don’t improve after 72 hours or if they worsen.
Q9: Can this eye drop cause rebound congestion?
A: Yes, prolonged and overuse can lead to rebound congestion, where the redness returns and even worsens upon discontinuation. Follow the recommended dosage and duration.
