Usage
This ophthalmic solution is prescribed for the symptomatic relief of allergic eye diseases. It alleviates redness, itching, burning, swelling, and watering of the eyes caused by allergens like pollen, pet dander, dust mites, and other environmental irritants. It also offers relief from minor eye irritations and dryness.
Pharmacological Classification: This is a combination product containing:
- Chlorpheniramine maleate: Antihistamine (H1 receptor antagonist)
- Naphazoline: Decongestant (alpha-adrenergic agonist)
- Zinc sulfate monohydrate: Astringent
- Boric acid: Antiseptic
Mechanism of Action: The combined action of its components provides relief: Chlorpheniramine blocks histamine action, naphazoline constricts blood vessels to reduce redness and swelling, zinc sulfate acts as an astringent reducing swelling, and boric acid acts as a mild antiseptic.
Alternate Names
This combination is marketed under various brand names, including Allercool, Borosol, Eyecon, Imaze, Mil, Optihist, and Zecool Eye Drops. Andre Ophthalmic Solution is another recognized name. Other names for the combination include Boric Acid + Chlorpheniramine + Naphazoline + Zinc Sulphate Monohydrate Eye Drop, and Naphazoline+methylcellulose+boric Acid+zinc Sulfate+chlorpheniramine Maleate.
How It Works
Pharmacodynamics: The four ingredients work synergistically. Chlorpheniramine maleate antagonizes H1 receptors, mitigating histamine’s effects. Naphazoline hydrochloride activates alpha-adrenergic receptors, leading to vasoconstriction and reduced redness. Zinc sulfate monohydrate exerts astringent effects, while boric acid provides antiseptic action.
Pharmacokinetics: Primarily administered as eye drops, limiting systemic absorption. While some naphazoline may be absorbed systemically, the amount is generally low.
Mode of Action: Chlorpheniramine competitively inhibits histamine binding to H1 receptors. Naphazoline stimulates alpha-adrenergic receptors in the vascular smooth muscle of the conjunctiva, causing vasoconstriction. Zinc sulfate and boric acid cause a local astringent and antiseptic effect.
Elimination Pathways: Primarily eliminated through renal excretion.
Dosage
Standard Dosage
Adults: 1-2 drops in the affected eye(s) every 4-6 hours, not exceeding 8 drops per eye per day.
Children: Use only as directed by a physician. Dosage is adjusted based on age and weight.
Special Cases:
- Elderly Patients: Use with caution, starting with a lower dose and monitoring for adverse effects.
- Patients with Renal Impairment: Use with caution. Dose adjustments may be required.
- Patients with Hepatic Dysfunction: Use with caution. Dose adjustments may be necessary.
- Patients with Comorbid Conditions: Use cautiously in patients with narrow-angle glaucoma, hypertension, heart disease, hyperthyroidism, diabetes, or difficulty urinating. Dosage adjustments may be required.
Clinical Use Cases
The use of this combination in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is generally not indicated. Its primary use is for temporary relief of allergic conjunctivitis symptoms.
Dosage Adjustments
Adjustments may be necessary based on individual patient response and tolerability. Consider renal or hepatic function and other comorbid conditions when determining the appropriate dose.
Side Effects
Common Side Effects
Burning or stinging sensation in the eyes, blurred vision, dryness of the eyes, dilated pupils.
Rare but Serious Side Effects
Eye pain, vision changes, worsening redness/itching/swelling, dizziness, nausea, sweating, drowsiness, weakness, nervousness, headache, decrease in body temperature, irregular heartbeat. Severe allergic reactions (rash, itching/swelling, severe dizziness, trouble breathing) are rare but require immediate medical attention.
Long-Term Effects
Prolonged naphazoline use can cause rebound congestion (worsening redness and swelling). Long-term use is generally not recommended.
Adverse Drug Reactions (ADR)
Severe allergic reactions requiring immediate medical attention.
Contraindications
Hypersensitivity to any component, narrow-angle glaucoma, severe cardiovascular disease, and concomitant use of MAO inhibitors.
Drug Interactions
Other ophthalmic medications (maintain a 5-minute interval between applications), MAO inhibitors (avoid concomitant use), beta-blockers (may enhance naphazoline’s systemic effects).
Pregnancy and Breastfeeding
Consult a physician before use during pregnancy or breastfeeding as the safety profile is not fully established.
Drug Profile Summary
- Mechanism of Action: Multifactorial: antihistamine, decongestant, astringent, and antiseptic effects.
- Side Effects: Burning, stinging, blurred vision, eye irritation, rebound congestion (prolonged naphazoline use).
- Contraindications: Hypersensitivity, narrow-angle glaucoma.
- Drug Interactions: Other ophthalmic medications, MAOIs, beta-blockers.
- Pregnancy & Breastfeeding: Consult a physician before use.
- Dosage: 1-2 drops in the affected eye(s) every 4-6 hours as needed.
- Monitoring Parameters: Eye pressure, pupil size, symptoms of rebound congestion.
Popular Combinations
This is already a combination product. Individual components may be available separately.
Precautions
Avoid contact of the dropper tip with the eye or other surfaces. Remove contact lenses before use. Use with caution in patients with cardiovascular disease, diabetes, or hyperthyroidism. Avoid driving or operating machinery if blurred vision occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Boric Acid + Chlorpheniramine Maleate + Naphazoline + Zinc Sulphate Monohydrate?
A: 1-2 drops in the affected eye(s) every 4-6 hours, not exceeding 8 drops/eye/day.
Q2: How long can I use this eye drop?
A: Consult your doctor. Generally, avoid using for more than 3-7 days to prevent rebound congestion.
A: Remove contact lenses before use and wait at least 15 minutes before reinserting.
Q4: What are the signs of an allergic reaction?
A: Rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. Seek immediate medical attention if these occur.
Q5: Can I drive after using these drops?
A: The drops may cause temporary blurred vision. Avoid driving or operating machinery until your vision clears.
Q6: Can pregnant or breastfeeding women use this medication?
A: Consult a physician before use during pregnancy or breastfeeding. Safety in these groups hasn’t been fully established.
Q7: What should I do if I accidentally overdose?
A: Seek immediate medical attention.
Q8: Are there any dietary restrictions while using this medication?
A: No specific dietary restrictions are associated with this medication, but consult your doctor for personalized advice.
Q9: What if I miss a dose?
A: Instill the missed dose as soon as you remember, unless it is almost time for the next dose. Do not double the dose.
