Usage
This ophthalmic solution is primarily used for symptomatic relief of allergic conjunctivitis and its associated symptoms like redness, itching, tearing, and burning sensation in the eyes. It can also provide relief from minor eye irritation caused by environmental factors such as dust, smoke, or pollen. It also provides relief from eye redness, itching, burning sensation, and discomfort due to dryness and exposure to wind, sun, or dust. In addition, it is used to treat computer vision syndrome (digital eye strain) associated with watery eyes, itching, and redness of the eye.
Pharmacological Classification: This combination drug contains components belonging to the following classes:
- Decongestant: Naphazoline, Phenylephrine
- Antihistamine: Chlorpheniramine maleate
- Counterirritant/Topical Analgesic: Camphor, Menthol
Mechanism of Action:
- Naphazoline and Phenylephrine: These are α-adrenergic agonists that constrict conjunctival blood vessels, reducing redness and swelling.
- Chlorpheniramine Maleate: An H1-receptor antagonist that blocks histamine’s effects, reducing itching, tearing, and other allergic manifestations.
- Camphor and Menthol: Provide a cooling and soothing sensation, relieving irritation and discomfort.
Alternate Names
This combination medication is available under various brand names, including (but not limited to) Ocurest AH Eye Drops, Suthin Eye Drop, Clearine, Fenx, N-Cool, Allerol, Celos N, Freydex Drop, Parinose, Decon Eye, and Decazole.
How It Works
Pharmacodynamics:
- Phenylephrine and naphazoline are decongestants that constrict blood vessels in the eye, reducing redness and swelling.
- Chlorpheniramine maleate is an antihistamine that blocks the effects of histamine, relieving itching, tearing, and other allergic symptoms.
- Menthol and camphor provide a cooling sensation, further soothing the eye.
Pharmacokinetics: The pharmacokinetic profile of this combination product has not been specifically studied. However, information regarding individual components is as follows:
- Naphazoline and phenylephrine primarily exert their effects locally in the eye, with minimal systemic absorption.
- Chlorpheniramine is absorbed systemically after ophthalmic administration, though plasma concentrations remain low. It is metabolized in the liver and excreted in the urine.
- Menthol and camphor are readily absorbed through the skin and mucous membranes. Menthol is metabolized in the liver and excreted primarily in the urine, while camphor is metabolized and excreted through the kidneys and lungs.
Mode of Action:
- Naphazoline and phenylephrine stimulate α-adrenergic receptors in the conjunctival blood vessels, leading to vasoconstriction.
- Chlorpheniramine competitively binds to H1 receptors, preventing histamine from binding and exerting its effects.
- Menthol and camphor activate TRPM8 receptors, producing a cooling sensation.
Elimination Pathways: The individual components are eliminated through a combination of hepatic metabolism and renal excretion.
Dosage
Standard Dosage
Adults: Instill 1-2 drops in the affected eye(s) every 4-6 hours.
Children: Use in children below 12 years of age is generally not recommended unless specifically prescribed by a doctor. Pediatric dosing guidelines vary depending on the specific product and the child’s age and weight. Always consult with a doctor or refer to the product’s packaging for appropriate pediatric dosing instructions.
Special Cases:
- Elderly Patients: Use with caution. Monitor for potential systemic effects like increased blood pressure and cardiovascular events.
- Patients with Renal Impairment: Use with caution in patients with severe renal impairment. Dose adjustments may be necessary.
- Patients with Hepatic Dysfunction: Use with caution. Dose adjustments may be required.
- Patients with Comorbid Conditions: Use with caution in patients with cardiovascular disease, hypertension, diabetes, hyperthyroidism, and prostatic hypertrophy.
Clinical Use Cases
This combination is typically not used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. It’s primarily indicated for the topical management of allergic conjunctivitis.
Dosage Adjustments
Dose adjustments are based on patient response, age, and the presence of any underlying medical conditions.
Side Effects
Common Side Effects:
- Burning or stinging sensation in the eyes
- Eye irritation
- Blurred vision
- Headache
- Increased redness of the eye (rebound congestion with prolonged use)
Rare but Serious Side Effects:
- Tachycardia
- Hypertension
- Pupillary dilation
- Increased intraocular pressure
- Drowsiness
Long-Term Effects:
- Rebound congestion with prolonged use of decongestants
Adverse Drug Reactions (ADR):
- Allergic reactions (rare): symptoms like rash, itching, swelling, severe dizziness, trouble breathing
Contraindications
- Narrow-angle glaucoma
- Hypersensitivity to any of the ingredients
- Concurrent use of Monoamine Oxidase Inhibitors (MAOIs)
Drug Interactions
- MAOIs (e.g., selegiline, phenelzine)
- Beta-blockers (e.g., atenolol, propranolol)
- Anti-hypertensives
- Tricyclic antidepressants
- Other sympathomimetic agents
Pregnancy and Breastfeeding
The safety of this combination during pregnancy and breastfeeding has not been fully established. Use only if clearly needed and under the guidance of a physician.
Drug Profile Summary
- Mechanism of Action: Decongestant, antihistamine, and counterirritant actions.
- Side Effects: Burning/stinging, blurred vision, headache, rebound congestion.
- Contraindications: Narrow-angle glaucoma, MAOI use, hypersensitivity.
- Drug Interactions: MAOIs, beta-blockers, antihypertensives, antidepressants.
- Pregnancy & Breastfeeding: Consult a physician before use.
- Dosage: 1-2 drops in the affected eye(s) every 4-6 hours.
- Monitoring Parameters: Intraocular pressure, blood pressure, resolution of symptoms.
Popular Combinations
This combination is commonly available as a fixed-dose ophthalmic solution.
Precautions
- Avoid touching the dropper tip to any surface.
- If symptoms persist or worsen after 3 days, consult a doctor.
- Use with caution in patients with cardiovascular disease, diabetes, hyperthyroidism, and prostatic hypertrophy.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Camphor + Chlorpheniramine Maleate + Menthol + Naphazoline + Phenylephrine?
A: The typical dosage is 1-2 drops in the affected eye(s) every 4-6 hours. However, it is important to consult a doctor for proper dosage recommendations as it depends on the specific case of the patient.
Q2: What are the common side effects?
A: Common side effects include burning or stinging, blurred vision, headache, and rebound congestion with prolonged use.
Q3: Can I use this while pregnant or breastfeeding?
A: Consult a physician before using this medication during pregnancy or breastfeeding, as safety has not been fully established.
Q4: Are there any drug interactions I should be aware of?
A: Yes, this combination can interact with MAOIs, beta-blockers, certain antidepressants, and other sympathomimetic drugs. Inform your doctor about all medications you are taking.
Q5: How long can I use this medication?
A: Do not use this medication for more than 3 days without consulting a physician. Prolonged use can lead to rebound congestion.
Q6: What should I do if my symptoms worsen or don’t improve?
A: Consult a physician immediately if your symptoms worsen or do not improve after 3 days of use.
A: It is advisable to remove contact lenses before instilling the drops and wait for at least 15 minutes before re-inserting them.
Q8: Is it safe to drive or operate machinery after using this medication?
A: This medication may cause temporary blurred vision. It is advisable to avoid driving or operating machinery until vision clears.
Q9: What are the contraindications for this medicine?
A: Contraindications include narrow-angle glaucoma, hypersensitivity to any of the ingredients, and concurrent use of MAOIs.
Q10: Can children use this medicine?
A: This medication is not recommended for children under 12 years of age unless specifically prescribed by a doctor.
