Usage
Carboxymethylcellulose + Glycerin is prescribed for the temporary relief of burning, irritation, and discomfort due to dryness of the eye. This can be caused by environmental factors like wind and sun, as well as medical conditions like dry eye disease (DED), also known as keratoconjunctivitis sicca. This condition arises from insufficient tear production or tears of poor quality, leading to inflammation and damage to the ocular surface. This combination can also be used as a protectant against further irritation.
Its pharmacological classification is as an ophthalmic demulcent and lubricant.
The mechanism of action involves Carboxymethylcellulose increasing tear viscosity, and Glycerin acting as a humectant, drawing water to the eye’s surface to lubricate and protect the mucous membranes.
Alternate Names
This combination medication doesn’t have a universally recognized international nonproprietary name (INN). It’s often referred to simply as Carboxymethylcellulose/Glycerin ophthalmic solution. Some manufacturers also use the term “artificial tears.”
Brand names include Refresh Optive, Refresh Celluvisc, and other generic formulations. Many brand names for artificial tears exist, but these may not always contain both carboxymethylcellulose and glycerin.
How It Works
Pharmacodynamics: Glycerin, a humectant, attracts and retains moisture on the ocular surface, thereby hydrating the cornea and conjunctiva. Carboxymethylcellulose, a lubricant, increases the viscosity of the tear film, prolonging its residence time and providing a protective coating. This combined action alleviates dryness, burning, and irritation.
Pharmacokinetics: Both Carboxymethylcellulose and Glycerin primarily exert their effects topically on the ocular surface. Systemic absorption is minimal, so pharmacokinetic parameters like absorption, distribution, metabolism, and elimination are not clinically significant in typical usage.
Mode of Action: Carboxymethylcellulose, through its mucoadhesive properties, binds to the corneal epithelium, enhancing the stability of the tear film. Glycerin osmotically draws water to the ocular surface, improving hydration. There is no known specific receptor binding, enzyme inhibition, or neurotransmitter modulation involved.
Elimination Pathways: Due to minimal systemic absorption, elimination is primarily through tear drainage and evaporation. Any small amount absorbed systemically is likely metabolized and excreted through normal physiological processes.
Dosage
Standard Dosage
Adults: Instill 1 or 2 drops in the affected eye(s) as needed.
Children: Use in children should be as directed by a physician. Safety and effectiveness have not been definitively established in young children.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically required.
- Patients with Renal Impairment: No dosage adjustments are needed.
- Patients with Hepatic Dysfunction: No dosage adjustments are needed.
- Patients with Comorbid Conditions: While generally safe, patients with pre-existing eye conditions (e.g., glaucoma, infection, injury) should consult a physician before use.
Clinical Use Cases
Dosage for these clinical use cases is the same as the standard dosage: instill 1 or 2 drops in the affected eye(s) as needed or as directed by the physician.
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
- Emergency Situations
Dosage Adjustments
No specific dosage adjustments are typically necessary based on renal/hepatic function, metabolic disorders, or genetic polymorphisms.
Side Effects
Common Side Effects
- Blurred vision (temporary)
- Burning or stinging sensation
- Watery eyes
- Sticky eyelids
- Mild redness
Rare but Serious Side Effects
- Eye pain
- Changes in vision
- Prolonged redness or irritation
Long-Term Effects
No long-term adverse effects are typically associated with Carboxymethylcellulose + Glycerin use.
Adverse Drug Reactions (ADR)
Severe or persistent eye pain, vision changes, or prolonged irritation should be reported to a healthcare professional immediately.
Contraindications
- Known hypersensitivity to carboxymethylcellulose sodium, glycerin, or any other component of the formulation.
- Use of discolored or cloudy solutions.
Drug Interactions
No significant drug interactions are typically anticipated. However, to ensure safety, inform your physician of all medications being used, including other ophthalmic products. Allow 5-15 minutes between administrations of different eye drops.
Pregnancy and Breastfeeding
Carboxymethylcellulose + Glycerin is generally considered safe during pregnancy and breastfeeding, as systemic absorption is minimal. However, as a precaution, it is advisable to consult a physician before use during these periods.
Drug Profile Summary
- Mechanism of Action: Glycerin hydrates, and carboxymethylcellulose lubricates and prolongs tear film residence time.
- Side Effects: Blurred vision (temporary), burning/stinging, watery eyes, sticky eyelids, mild redness. Rarely: eye pain, vision changes, prolonged irritation.
- Contraindications: Hypersensitivity, discolored/cloudy solution.
- Drug Interactions: No significant interactions expected.
- Pregnancy & Breastfeeding: Generally safe, consult a physician before use.
- Dosage: 1-2 drops in affected eye(s) as needed.
- Monitoring Parameters: Eye irritation, pain, vision changes.
Popular Combinations
Carboxymethylcellulose and glycerin are often combined for their synergistic effects in treating dry eye.
Precautions
- General Precautions: Wash hands before and after use. Avoid touching the tip of the container to the eye. Discard single-use containers after use. For multi-dose containers, discard after 90 days.
- Specific Populations: Consult with a physician before using during pregnancy/breastfeeding or in young children.
- Lifestyle Considerations: Avoid driving or operating machinery until vision clears.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Carboxymethylcellulose + Glycerin?
A: The usual dosage is 1-2 drops in the affected eye(s) as needed.
A: While some formulations are compatible with contact lenses, others recommend removing contacts before instillation. Consult the specific product instructions. Some sources recommend waiting 10-15 minutes after instillation before reinserting lenses.
Q3: How long does the effect of the drops last?
A: The duration of effect varies, but typically provides temporary relief for several hours.
Q4: Can I use this every day?
A: Yes, this medication can be used daily as needed or as directed by your physician.
Q5: What are the signs of an allergic reaction to the eye drops?
A: Signs of an allergic reaction may include severe itching, swelling, redness, or discharge from the eye. Seek medical attention immediately if these occur.
Q6: Can I use this if I have other eye conditions like glaucoma?
A: Consult your ophthalmologist before using if you have other eye conditions.
Q7: What should I do if my symptoms don’t improve or worsen?
A: Consult an ophthalmologist if your symptoms persist or worsen after 72 hours.
Q8: Are there any dietary restrictions while using this medication?
A: No specific dietary restrictions are associated with Carboxymethylcellulose + Glycerin eye drops.
Q9. Is Carboxymethylcellulose + Glycerin safe for pediatric patients?
A: While generally safe, consultation with a pediatrician or pediatric ophthalmologist is recommended for pediatric use to determine the appropriate dosage and ensure safety.
Q10. How should Carboxymethylcellulose + Glycerin be stored?
A: Store below 30°C. Protect from light and freezing. Do not use if the solution changes color or becomes cloudy. Discard any unused portion after one month from opening for multi-dose containers.
