Boric Acid + Chlorpheniramine Maleate + Sodium Chloride + Tetrahydrozoline

Usage

This ophthalmic solution is primarily prescribed for the temporary relief of redness, itching, burning, and discomfort caused by allergic conjunctivitis and minor eye irritations.

• Pharmacological Classification: This combination drug falls under multiple classifications due to its components:

  • Decongestant (Tetrahydrozoline)
  • Antihistamine (Chlorpheniramine Maleate)
  • Antiseptic (Boric Acid)

• Mechanism of Action: Tetrahydrozoline constricts conjunctival blood vessels, reducing redness. Chlorpheniramine maleate, an antihistamine, blocks the effects of histamine, relieving itching and watering. Boric acid acts as a mild antiseptic and buffering agent. Sodium chloride provides isotonicity.

Alternate Names

While the generic name is a combination of its components, it’s frequently marketed under brand names like Optihist Plus Eye Drops. No internationally recognized non-proprietary name exists for this specific combination. Regional variations may also exist.

How It Works

• Pharmacodynamics: Tetrahydrozoline is an alpha-adrenergic agonist, causing vasoconstriction. Chlorpheniramine maleate antagonizes histamine H1 receptors, inhibiting histamine’s effects. Boric acid exerts mild antiseptic activity and maintains a stable pH.

• Pharmacokinetics: The ophthalmic route limits systemic absorption. Small amounts of tetrahydrozoline and chlorpheniramine may be absorbed, leading to systemic effects with prolonged or excessive use. Boric acid and sodium chloride, when used topically in the eye, have minimal systemic absorption.

• Mode of Action: Tetrahydrozoline stimulates alpha-adrenergic receptors on vascular smooth muscle, causing vasoconstriction. Chlorpheniramine competitively binds to H1 receptors, preventing histamine from binding and exerting its inflammatory effects.

• Elimination Pathways: Absorbed components are primarily eliminated through renal excretion, though chlorpheniramine undergoes hepatic metabolism.

Dosage

Standard Dosage

Adults: 1-2 drops instilled into the affected eye(s) every 4-6 hours as needed. Do not exceed recommended dosage.

Children: Consult a doctor. Generally, for children above 6 years of age, the dosage is similar to adults. For children below 6 years, use only under strict medical supervision.

Special Cases:

• Elderly Patients: Use with caution. Monitor for potential systemic effects like cardiovascular issues.

• Patients with Renal Impairment: Use with caution, dose adjustment might be needed. Consult a doctor for specific guidance.

• Patients with Hepatic Dysfunction: Use with caution as chlorpheniramine undergoes hepatic metabolism. Monitor for potential adverse effects.

• Patients with Comorbid Conditions: Exercise caution in patients with narrow-angle glaucoma, hypertension, diabetes, hyperthyroidism, or cardiovascular disease. Consult a doctor before use.

Clinical Use Cases

This combination medication is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. Its use is primarily limited to outpatient management of allergic conjunctivitis and minor eye irritations.

Dosage Adjustments

Dosage adjustments are typically made based on the severity of symptoms, patient age, and the presence of comorbidities. Always follow the physician’s recommendations for dosage adjustments.

Side Effects

Common Side Effects:

• Burning or stinging sensation upon instillation
• Temporary blurred vision
• Pupillary dilation (mydriasis)
• Dry eyes

Rare but Serious Side Effects:

• Allergic reactions (rash, itching, swelling)
• Systemic effects (tachycardia, hypertension) with excessive or prolonged use
• Worsening of glaucoma

Long-Term Effects:

• Rebound congestion with prolonged or excessive use of tetrahydrozoline
• Increased risk of glaucoma with chronic use

Adverse Drug Reactions (ADR):

• Angle-closure glaucoma
• Systemic hypertension
• Cardiac arrhythmias

Contraindications

• Hypersensitivity to any of the components
• Narrow-angle glaucoma
• Severe cardiovascular disease

Drug Interactions

• Monoamine oxidase inhibitors (MAOIs): May potentiate the pressor effects of tetrahydrozoline.
• Beta-blockers: May enhance the hypertensive effects of tetrahydrozoline.

Pregnancy and Breastfeeding

Consult a physician before using during pregnancy or breastfeeding as safety has not been established.

Drug Profile Summary

• Mechanism of Action: Decongestant, antihistamine, antiseptic.
• Side Effects: Burning/stinging, blurred vision, dry eyes, rebound congestion.
• Contraindications: Hypersensitivity, narrow-angle glaucoma.
• Drug Interactions: MAOIs, beta-blockers.
• Pregnancy & Breastfeeding: Consult a physician.
• Dosage: 1-2 drops every 4-6 hours as needed.
• Monitoring Parameters: Intraocular pressure, blood pressure.

Popular Combinations

This combination itself is commonly used. Combining with other ophthalmic medications should be done only under medical supervision.

Precautions

• Avoid touching the dropper tip to any surface.
• Do not use if solution changes color or becomes cloudy.
• Remove contact lenses before use.
• Exercise caution in patients with cardiovascular disease, hypertension, or diabetes.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Boric Acid + Chlorpheniramine Maleate + Sodium Chloride + Tetrahydrozoline?

A: The typical adult dose is 1-2 drops in the affected eye(s) every 4-6 hours as needed.

Q2: Can I use this eye drop while wearing contact lenses?

A: No, remove contact lenses before using and wait at least 15 minutes before reinserting.

Q3: How long can I use this eye drop?

A: Use for only a short period (typically no more than 3-4 days) unless otherwise directed by your physician.

Q4: What should I do if I accidentally swallow this eye drop?

A: Rinse your mouth and seek immediate medical advice.

Q5: Can I use this medication if I have glaucoma?

A: This medication should not be used by individuals with narrow-angle glaucoma. Consult an ophthalmologist.

Q6: Can pregnant or breastfeeding women use this eye drop?

A: Consult a physician before use during pregnancy or breastfeeding.

Q7: What are the potential side effects of overuse?

A: Rebound congestion, worsening of redness, increased risk of glaucoma.

Q8: Can this eye drop treat bacterial eye infections?

A: While boric acid has mild antiseptic properties, this combination is not primarily intended for treating bacterial infections. Consult a doctor for appropriate treatment.

Q9: Can children use this medication?

A: Use in children below 6 years should only be under strict medical supervision. For older children, the dosage is generally similar to adults, but consult a doctor before use.