Usage
This ophthalmic solution is prescribed for the temporary relief of symptoms associated with allergic conjunctivitis, such as redness, itching, watering, swelling, burning or stinging sensation, and discomfort caused by dryness. It can also provide relief from minor eye irritation caused by environmental factors like wind, sun, dust, smoke, air pollutants, and close work.
Pharmacological Classification: This is a combination product containing:
- Decongestant (Naphazoline): Narrows blood vessels in the eye to decrease redness and swelling.
- Antihistamine (Chlorpheniramine Maleate): Blocks the action of histamine, reducing itching, watering, and other allergic symptoms.
- Lubricant (Methylcellulose): Moisturizes the eyes, relieving dryness and discomfort.
- Antiseptic (Boric Acid and Zinc Sulfate): Prevents the growth of microorganisms, providing relief from irritation and redness. Zinc sulfate also acts as an astringent, further reducing redness.
Alternate Names
Some alternate names and brand names include: Allerdrop, Andre, I-Top DPS, Imaze Eye Drop, Mezol Eye Drops, MICROSOL, Naifa, NAPPO-ZER, NCZ, Nefacool Eye Drops, Persil Eye Drops, Zetex-O, Zincula, Zoneph, Zoline Eye, Zoline Plus.
How It Works
Pharmacodynamics:
- Naphazoline: Acts as an alpha-adrenergic agonist, constricting conjunctival blood vessels, leading to decreased redness and swelling.
- Chlorpheniramine: An H1-receptor antagonist, blocking histamine’s effects, reducing itching, watering, and other allergic manifestations.
- Methylcellulose: Increases tear film viscosity, providing lubrication and soothing irritated eyes.
- Boric Acid and Zinc Sulfate: Act as antiseptics and astringents, reducing microbial growth and redness.
Pharmacokinetics:
- Absorption: Primarily absorbed through the conjunctiva, with limited systemic absorption.
- Metabolism and Elimination: The metabolic pathways and elimination routes for this combination product when used ophthalmically are not clearly defined in current research. Given minimal systemic absorption, the metabolic burden and elimination through renal or hepatic routes are expected to be low.
Dosage
Standard Dosage
Adults:
Instill 1-2 drops in the affected eye(s) up to four times daily.
Children:
Use only if prescribed by a doctor. Dosage will depend on age and weight. Pediatric safety considerations include careful monitoring for potential side effects, especially drowsiness and central nervous system effects. Children under 6 should generally not use this medication without direct physician supervision.
Special Cases:
- Elderly Patients: Use with caution. Monitor for systemic side effects, especially cardiovascular effects.
- Patients with Renal Impairment: Use with caution. Monitor for potential adverse effects.
- Patients with Hepatic Dysfunction: Use with caution. Monitor for potential adverse effects.
- Patients with Comorbid Conditions: Use cautiously in patients with hypertension, cardiovascular disease, diabetes mellitus, hyperthyroidism. Close monitoring is recommended.
Clinical Use Cases This medication is not typically used in clinical settings such as intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. Its use is primarily limited to outpatient management of allergic conjunctivitis and minor eye irritation.
Dosage Adjustments
Dosage adjustments may be necessary based on patient response and the severity of symptoms. Always follow the prescribing physician’s recommendations.
Side Effects
Common Side Effects
- Burning or stinging sensation in the eyes
- Blurred vision
- Dilated pupils
- Eye irritation
- Watery eyes
Rare but Serious Side Effects
- Eye pain
- Worsening redness/itching/swelling in or around the eyes
- Dizziness, nausea, sweating, drowsiness, weakness
- Nervousness, headache
- Decrease in body temperature
Long-Term Effects
Prolonged use can lead to rebound congestion, where the blood vessels become more dilated than before, potentially worsening redness and swelling. Overuse may damage blood vessels in the eye.
Adverse Drug Reactions (ADR)
Severe allergic reactions (anaphylaxis) are rare but require immediate medical intervention.
Contraindications
- Hypersensitivity to any component of the medication.
- Angle-closure glaucoma.
- Concurrent use with monoamine oxidase inhibitors (MAOIs).
Drug Interactions
- MAOIs can potentiate the effects of naphazoline, leading to a hypertensive crisis.
- Other ophthalmic medications should be used with caution, maintaining a sufficient time interval between applications (at least 5-10 minutes).
- Systemic antihistamines or decongestants may have additive effects.
Pregnancy and Breastfeeding
Consult a physician before using during pregnancy or breastfeeding. The safety profile in these situations is not definitively established.
Drug Profile Summary
- Mechanism of Action: See “How It Works” section.
- Side Effects: See “Side Effects” section.
- Contraindications: See “Contraindications” section.
- Drug Interactions: See “Drug Interactions” section.
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: See “Dosage” section.
- Monitoring Parameters: Eye redness, swelling, itching, tearing, pupil size, blood pressure (in patients with hypertension).
Popular Combinations
This medication is itself a combination product. It is generally not combined with other ophthalmic solutions unless specifically directed by a physician.
Precautions
See “Special Cases” under Dosage and “Drug Interactions” sections.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Boric Acid + Chlorpheniramine Maleate + Methylcellulose + Naphazoline + Zinc Sulfate?
A: See “Dosage” section for details regarding adults, children, and special populations.
A: No, remove contact lenses before use and wait at least 10-15 minutes before reinserting. The preservative in the solution can be absorbed by soft contact lenses and cause discoloration or irritation.
Q3: What should I do if I miss a dose?
A: Instill the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not instill a double dose to make up for a missed one.
Q4: How long can I use this medication?
A: Do not use for more than 72 hours unless advised by your doctor. Prolonged use can lead to rebound congestion.
Q5: Can I use this medication if I have glaucoma?
A: Use cautiously if you have open-angle glaucoma. This medication is contraindicated in angle-closure glaucoma.
Q6: Can this medication cause drowsiness?
A: Chlorpheniramine, the antihistamine component, can cause drowsiness. Avoid driving or operating heavy machinery until you know how this medication affects you.
Q7: What are the signs of an allergic reaction to this medication?
A: Severe allergic reactions are rare. Signs include difficulty breathing, swelling of the face or throat, and hives. Seek immediate medical attention if these occur.
Q8: Can I use this medication if I am pregnant or breastfeeding?
A: Consult your physician before use during pregnancy or while breastfeeding, as the safety profile is not definitively established.
Q9: Can I buy this medication over the counter?
A: In India, this medication may be available over the counter, depending on the specific brand and formulation. However, it’s always recommended to consult a physician before using any new medication.
