Usage
Bromfenac + Moxifloxacin ophthalmic solution is prescribed for the treatment of bacterial eye infections and for reducing postoperative ocular inflammation and pain, particularly after cataract surgery. It is indicated for adult use only.
Pharmacological Classification:
- Bromfenac: Nonsteroidal anti-inflammatory drug (NSAID)
- Moxifloxacin: Fluoroquinolone antibiotic
Mechanism of Action:
Bromfenac inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin production, thereby mitigating pain and inflammation. Moxifloxacin inhibits bacterial DNA gyrase and topoisomerase IV, essential enzymes for bacterial DNA replication and repair, leading to bacterial cell death.
Alternate Names
This combination medication may sometimes be referred to as Bromfenac/Moxifloxacin. Brand names vary depending on the manufacturer. Some examples include: Bromday MOX, Moxibrom, Moxif-BF, and others.
How It Works
Pharmacodynamics:
Bromfenac exerts its anti-inflammatory and analgesic effects by inhibiting COX-1 and COX-2 enzymes, which are responsible for prostaglandin synthesis. Moxifloxacin, a fourth-generation fluoroquinolone antibiotic, exerts its bactericidal effect by inhibiting bacterial DNA gyrase and topoisomerase IV. These enzymes are crucial for bacterial DNA replication, transcription, repair, and recombination. Inhibition of these enzymes disrupts bacterial DNA function, leading to cell death.
Pharmacokinetics:
When administered as ophthalmic drops, both Bromfenac and Moxifloxacin achieve therapeutic concentrations in ocular tissues. Systemic absorption is minimal. Bromfenac is metabolized primarily in the liver, while Moxifloxacin is metabolized in both the liver and kidneys. Both drugs are eliminated through renal and hepatic pathways.
Mode of Action:
- Bromfenac: Inhibits COX enzymes, leading to decreased prostaglandin synthesis.
- Moxifloxacin: Inhibits bacterial DNA gyrase and topoisomerase IV.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation:
- Bromfenac: Inhibits COX-1 and COX-2 enzymes.
- Moxifloxacin: Inhibits bacterial DNA gyrase and topoisomerase IV.
Elimination Pathways: Both Bromfenac and Moxifloxacin are eliminated via hepatic and renal pathways.
Dosage
Standard Dosage
Adults:
One drop in the affected eye(s) twice daily, beginning one day after cataract surgery and continuing for up to 14 days.
Children:
Not recommended for use in children.
Special Cases:
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Elderly Patients: No dosage adjustments necessary based on age alone. However, monitor for potential systemic effects with prolonged use.
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Patients with Renal Impairment: Dosage adjustments are generally not required.
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Patients with Hepatic Dysfunction: Dosage adjustments are generally not required.
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Patients with Comorbid Conditions: Exercise caution in patients with conditions affecting wound healing, such as diabetes or rheumatoid arthritis. Monitor closely.
Clinical Use Cases
This combination is intended primarily for postoperative management of ocular inflammation and prevention of infection after cataract surgery. Its use in other clinical settings like intubation, surgical procedures unrelated to the eye, mechanical ventilation, ICU use, or emergency situations is not relevant.
Dosage Adjustments
No specific dosage adjustments are recommended based on clinical use cases other than the standard postoperative use following cataract surgery.
Side Effects
Common Side Effects
- Ocular: Mild eye irritation, burning, stinging, foreign body sensation, itching, increased lacrimation, blurred vision, photophobia.
- Systemic: Headache, abnormal taste (dysgeusia)
Rare but Serious Side Effects
- Ocular: Corneal ulceration or perforation, anterior chamber hemorrhage, endophthalmitis, severe allergic reactions (e.g., angioedema, anaphylaxis).
Long-Term Effects
Prolonged use can potentially increase the risk of corneal complications and elevate intraocular pressure.
Adverse Drug Reactions (ADR)
Severe allergic reactions (e.g., anaphylaxis) require immediate medical intervention. Corneal complications, although rare, warrant prompt ophthalmologic evaluation.
Contraindications
- Hypersensitivity to Bromfenac, Moxifloxacin, or other quinolone antibiotics.
- Most viral diseases of the cornea and conjunctiva.
- Active fungal infections of the eye.
Drug Interactions
- Topical corticosteroids: Concomitant use may increase the risk of corneal complications.
- Anticoagulants (e.g., warfarin): Monitor for potential increased bleeding risk. (While systemic absorption of Bromfenac is minimal, caution is still advised).
- Antacids, sucralfate, and multivitamins containing metal cations: May reduce absorption of Moxifloxacin if taken concomitantly.
Pregnancy and Breastfeeding
Pregnancy Category C: Use only if the potential benefit justifies the potential risk to the fetus. Avoid use during the third trimester due to the risk of fetal harm.
It is unknown if Bromfenac is excreted in human breast milk. Exercise caution when administering to breastfeeding women.
Drug Profile Summary
- Mechanism of Action: Bromfenac: COX inhibitor, Moxifloxacin: Bacterial DNA gyrase and topoisomerase IV inhibitor.
- Side Effects: Eye irritation, burning, stinging, blurred vision, headache, dysgeusia. Rarely: corneal ulceration, perforation.
- Contraindications: Hypersensitivity to components, viral/fungal keratitis.
- Drug Interactions: Topical steroids, anticoagulants, antacids.
- Pregnancy & Breastfeeding: Category C; avoid in third trimester. Caution in breastfeeding.
- Dosage: 1 drop twice daily in affected eye(s) for up to 14 days post-cataract surgery.
- Monitoring Parameters: Visual acuity, intraocular pressure, signs of corneal complications.
Popular Combinations
This particular fixed combination is commonly used as a single formulation. It is not typically combined with other medications in the same ophthalmic solution.
Precautions
- General Precautions: Evaluate for corneal integrity prior to initiating therapy. Discontinue use if signs of corneal complications develop.
- Specific Populations: Not recommended for children. Caution in patients with a history of corneal disease.
- Lifestyle Considerations: Blurred vision may occur. Advise patients to avoid driving or operating machinery until vision clears.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromfenac + Moxifloxacin?
A: One drop in the affected eye(s) twice daily, for up to 14 days, starting one day after cataract surgery.
Q2: Can Bromfenac + Moxifloxacin be used in children?
A: No, it is not recommended for use in children.
Q3: What are the common side effects of Bromfenac + Moxifloxacin?
A: Common side effects include mild eye irritation, burning, stinging, foreign body sensation, itching, increased lacrimation, blurred vision, and headache.
Q4: Are there any serious side effects associated with Bromfenac + Moxifloxacin?
A: Although rare, serious side effects can include corneal ulceration, perforation, anterior chamber hemorrhage, and severe allergic reactions.
Q5: Can Bromfenac + Moxifloxacin be used during pregnancy?
A: It is a Pregnancy Category C drug. Use only if the potential benefit justifies the risk to the fetus. Avoid using during the third trimester.
Q6: Is it safe to use Bromfenac + Moxifloxacin while breastfeeding?
A: The safety during breastfeeding is not fully established. Exercise caution and discuss the risks and benefits with the patient.
A: Remove contact lenses before instilling the drops and wait at least 15 minutes before reinserting.
Q8: How should Bromfenac + Moxifloxacin be stored?
A: Store at room temperature and protect from light.
Q9: What should I do if a dose is missed?
A: Instill the missed dose as soon as remembered. If it is almost time for the next dose, skip the missed dose and continue with the regular schedule. Do not double the dose.
Q10: What should patients be advised regarding driving and operating machinery?
A: Advise patients that blurred vision may occur and to avoid driving or operating machinery until their vision clears.
