Usage
This combination medication is primarily used to treat allergic conjunctivitis (eye allergy) and relieve symptoms associated with minor eye irritations. These symptoms include redness, itching, burning, watering, dryness, and discomfort caused by allergens (e.g., pollen, dust, pet dander), environmental factors (e.g., wind, sun, smoke), or contact lens wear.
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Pharmacological Classification: Decongestant, ocular lubricant, topical analgesic.
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Mechanism of Action: Naphazoline and phenylephrine are decongestants that constrict blood vessels in the conjunctiva, reducing redness, swelling, and itching. Carboxymethylcellulose is a lubricant that mimics natural tears, providing relief from dryness. Camphor and menthol produce a cooling sensation, further soothing irritated eyes.
Alternate Names
Napaglare, Briscool Eye Drops, Lacricool Eye Drop, RECOOL PLUS Eye Drops, Ocurest Plus Eye Drops, Mahakool Eye Drops, Naphacare Eye Drop.
How It Works
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Pharmacodynamics: Naphazoline and phenylephrine act as α-adrenergic agonists, causing vasoconstriction in the eye’s blood vessels. This reduces redness, itching, and swelling. Carboxymethylcellulose increases tear film viscosity, providing lubrication. Camphor and menthol stimulate cold receptors, creating a cooling sensation.
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Pharmacokinetics: The drugs are absorbed locally in the eye. Systemic absorption is minimal. Metabolism and elimination pathways for this ophthalmic combination are not well-defined. It’s assumed that minimal amounts absorbed systemically would undergo hepatic metabolism and renal excretion.
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Mode of Action: Naphazoline and phenylephrine bind to α-adrenergic receptors on the vascular smooth muscle of the conjunctiva, leading to vasoconstriction. Carboxymethylcellulose physically lubricates the ocular surface. Camphor and menthol activate TRPM8 receptors, which are cold-sensing ion channels, leading to a cooling sensation.
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Elimination Pathways: Primarily local elimination through tear drainage; minimal systemic absorption undergoes likely hepatic metabolism with renal excretion.
Dosage
Standard Dosage
Adults:
Instill 1-2 drops into the affected eye(s) every 3-4 hours as needed. Do not exceed the recommended dosage.
Children:
Use in children should be under the guidance of a physician. Safety and efficacy in children below 6 years of age have not been established. Some sources suggest using with caution in children younger than 12.
Special Cases:
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Elderly Patients: Use with caution. Monitor for cardiovascular side effects like increased blood pressure and heart rate.
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Patients with Renal Impairment: Use with caution. Monitor renal function.
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Patients with Hepatic Dysfunction: Use with caution. Monitor liver function.
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Patients with Comorbid Conditions: Use with caution in patients with hypertension, heart disease, hyperthyroidism, diabetes, and benign prostatic hyperplasia (BPH). Close monitoring is recommended.
Clinical Use Cases
The combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. Its use is primarily for outpatient management of allergic conjunctivitis and minor eye irritations.
Dosage Adjustments
Dosage adjustments should be made based on individual patient response and tolerability. Patients with pre-existing conditions should be monitored closely for potential side effects.
Side Effects
Common Side Effects
Burning or stinging sensation in eyes, blurred vision, headache, eye irritation, eye pain, dilated pupils, photophobia.
Rare but Serious Side Effects
Systemic effects like increased blood pressure, rapid heart rate, and difficulty urinating (especially in patients with BPH) are rare but possible.
Long-Term Effects
Rebound congestion (worsening of symptoms upon discontinuation) can occur with prolonged use.
Adverse Drug Reactions (ADR)
Severe allergic reactions (rare) including rash, itching, swelling, severe dizziness, and trouble breathing.
Contraindications
Narrow-angle glaucoma, hypersensitivity to any component. Use with caution in patients with heart disease, high blood pressure, diabetes, thyroid disorders, BPH.
Drug Interactions
Other decongestant eye drops (oxymetazoline), antihistamine eye drops (ketotifen), anti-inflammatory eye drops (dexamethasone), MAO inhibitors, tricyclic antidepressants, beta-blockers, antihypertensives, cardiac glycosides. Concurrent use with other ophthalmic drugs should be cautious and physician-guided.
Pregnancy and Breastfeeding
Safety during pregnancy and breastfeeding has not been fully established. Consult a doctor before use.
Drug Profile Summary
- Mechanism of Action: α-adrenergic agonists (naphazoline and phenylephrine) cause vasoconstriction; carboxymethylcellulose lubricates; camphor and menthol produce cooling sensation.
- Side Effects: Burning/stinging, blurred vision, headache, rebound congestion (with prolonged use).
- Contraindications: Narrow-angle glaucoma, hypersensitivity.
- Drug Interactions: Other eye drops, MAO inhibitors, tricyclic antidepressants, beta-blockers, antihypertensives, cardiac glycosides.
- Pregnancy & Breastfeeding: Consult a doctor before use.
- Dosage: 1-2 drops in affected eye(s) every 3-4 hours, as needed.
- Monitoring Parameters: Blood pressure, heart rate (in at-risk patients).
Popular Combinations
This is itself a combination product. Combining with other ophthalmic medications should be done cautiously under medical supervision.
Precautions
Avoid touching dropper tip. Remove contact lenses before use and wait 15 minutes before reinserting. Avoid concurrent use of other eye medications unless prescribed. Consult a doctor if irritation persists or worsens, if you experience changes in vision, or if any eye condition lasts over 72 hours. Pre-screening for relevant comorbidities (heart disease, hypertension, diabetes, thyroid disorders, BPH) is advisable. Use with caution in pregnant/breastfeeding women, children, and elderly. Alcohol and tobacco may increase systemic side effects like drowsiness or dizziness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Camphor + Carboxymethylcellulose + Menthol + Naphazoline + Phenylephrine?
A: Instill 1-2 drops into the affected eye(s) every 3-4 hours as needed. Dosage adjustments may be required for children, elderly patients, or patients with certain pre-existing conditions.
Q2: How long does it take for this medication to take effect?
A: The onset of action is typically rapid, providing relief within minutes.
A: No, remove contact lenses before instilling the drops and wait at least 15 minutes before reinserting them.
Q4: Can I use other eye medications with this combination?
A: Concurrent use with other ophthalmic medications needs a doctor’s approval. If approved, maintain a gap of at least 5-15 minutes between instillations.
Q5: What are the common side effects?
A: Common side effects include temporary burning or stinging, blurred vision, eye irritation, eye pain, and photophobia.
Q6: Can I stop using this medication on my own?
A: No, continue using as prescribed by your doctor. Consult with the doctor if irritation persists or worsens.
Q7: What should I do if I accidentally overdose?
A: Immediately rinse the eye with clean water and seek medical advice.
Q8: What should I do if I miss a dose?
A: Instill the missed dose as soon as you remember, unless it’s almost time for the next dose. Do not double the dose to catch up.
Q9: Is this medication safe during pregnancy or breastfeeding?
A: The safety during pregnancy and breastfeeding has not been fully established. Consult with your doctor before using this medication.
Q10: Can this combination interact with other medications I’m taking?
A: Yes, it can interact with other medications, including some oral medications. Inform your doctor about all the medications you are currently taking, including prescription drugs, over-the-counter medications, and herbal supplements.
