Usage
- This combination is primarily prescribed for the temporary relief of burning, irritation, and discomfort due to dry eye syndrome. It can also provide relief from dryness caused by wind or sun exposure. Additionally, some studies suggest potential benefits in slowing the progression of cataracts.
- Pharmacological Classification: Ophthalmic demulcents and lubricants.
- Mechanism of Action: Carboxymethylcellulose acts as a lubricant, increasing tear film viscosity and reducing evaporation. Glycerin is a humectant, drawing water to the ocular surface to enhance moisture retention. N-acetylcarnosine functions as an antioxidant, potentially protecting the lens from oxidative damage.
Alternate Names
- Carboxymethylcellulose sodium + Glycerin + N-acetylcarnosine
- Artificial tears
- CMC + Glycerin + NAC
- Brand Names: Can-C™, C-Nac, Trotear Plus, Lubrinac, Boxycarb-Plus, Tear Bless Next
How It Works
- Pharmacodynamics: Carboxymethylcellulose and glycerin lubricate and moisten the ocular surface, mimicking natural tears. N-acetylcarnosine provides antioxidant protection against oxidative stress implicated in cataract formation.
- Pharmacokinetics: Primarily topical application with minimal systemic absorption. Information on metabolism and excretion is limited. Absorption of n-acetylcarnosine into the aqueous humor has been demonstrated.
- Mode of Action: Carboxymethylcellulose increases tear film viscosity. Glycerin attracts water to the eye surface. N-acetylcarnosine scavenges free radicals. These combined actions alleviate dryness, irritation, and discomfort associated with dry eye.
- Elimination Pathways: Limited systemic absorption implies minimal involvement of renal/hepatic pathways.
Dosage
Standard Dosage
Adults:
- Instill 1 or 2 drops in the affected eye(s) four times daily, or as needed.
- For contact lens rewetting, instill 1 or 2 drops as needed, or place 1 or 2 drops on the lens before insertion.
Children:
- 2-12 years: 1 drop in the affected eye(s) four times daily.
- Pediatric safety and efficacy have not been fully established. Use under the guidance of a physician.
Special Cases:
- Elderly Patients: No specific adjustments are typically needed.
- Patients with Renal Impairment: No specific adjustments are typically needed.
- Patients with Hepatic Dysfunction: No specific adjustments are typically needed.
- Patients with Comorbid Conditions: Caution is advised in patients with severe eye conditions or recent ocular surgeries. Consult a physician if using with glaucoma, hypertension, diabetes, eye infection/injury, hyperthyroidism, or heart/kidney/liver problems.
Clinical Use Cases
Dosage typically follows the standard adult guidelines in these settings:
- Intubation: Standard dosage.
- Surgical Procedures: Standard dosage.
- Mechanical Ventilation: Standard dosage.
- Intensive Care Unit (ICU) Use: Standard dosage.
- Emergency Situations: Standard dosage.
Dosage Adjustments
- Dosage adjustments may be necessary based on individual patient response and the severity of dry eye symptoms.
Side Effects
Common Side Effects
- Temporary blurred vision
- Burning or stinging sensation
- Eye redness or irritation
- Watery eyes
- Itching
Rare but Serious Side Effects
- Severe allergic reactions (rash, itching, swelling)
- Eye pain
- Changes in vision
- Persistent eye redness/irritation
Long-Term Effects
No specific long-term adverse effects have been reported with proper use.
Adverse Drug Reactions (ADR)
Clinically significant ADRs are rare but may include severe allergic reactions requiring immediate medical attention.
Contraindications
- Known hypersensitivity to any of the ingredients.
- Active eye infections.
- Recent eye surgeries or injuries.
Drug Interactions
- Potential interactions with ophthalmic antihistamines, beta-blockers, corticosteroids, antibiotics, NSAIDs, and glaucoma medications. Consult a physician about concomitant use of other eye drops.
Pregnancy and Breastfeeding
- Use with caution during pregnancy and breastfeeding. Consult a physician before use. Safety and efficacy in these populations haven’t been definitively established.
Drug Profile Summary
- Mechanism of Action: Lubrication, moisturizing, and antioxidant protection.
- Side Effects: Blurred vision, burning, stinging, irritation, redness.
- Contraindications: Hypersensitivity, active eye infections, recent eye surgeries/injuries.
- Drug Interactions: Other ophthalmic medications.
- Pregnancy & Breastfeeding: Use with caution; consult a physician.
- Dosage: 1-2 drops, four times daily, or as directed.
- Monitoring Parameters: Observe for allergic reactions or worsening of symptoms.
Popular Combinations
- Often used as a stand-alone treatment. Other ophthalmic medications may be added based on individual patient needs and in consultation with a physician.
Precautions
- General Precautions: Wash hands before and after use. Avoid touching the tip of the container to the eye or any surface. Discard used single-dose containers. Do not reuse multi-dose containers after 90 days of opening.
- Specific Populations: Consult a physician before use during pregnancy/breastfeeding or in children.
- Lifestyle Considerations: Avoid driving or operating machinery until vision clears.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Carboxymethylcellulose + Glycerin + n-acetylcarnosine eye drops?
A: Adults and children over 12 years: 1-2 drops in the affected eye(s) four times a day, or as needed. Children 2-12 years: 1 drop four times a day, or as needed. Adjust as directed by the physician.
A: Remove contact lenses before using the drops and wait at least 15 minutes before reinserting. Some brands may be compatible with contact lenses, so check the product instructions or consult your doctor.
Q3: How long can I use these eye drops?
A: Use as directed by your physician. For dry eye syndrome, these drops can be used long-term as needed.
Q4: Are there any serious side effects I should be aware of?
A: While rare, severe allergic reactions and eye pain can occur. Seek immediate medical attention if you experience these.
Q5: Can I use this combination with other eye drops?
A: Inform your doctor about all other medications you are using, including other eye drops, as potential interactions may occur.
Q6: Is it safe to use during pregnancy or breastfeeding?
A: Consult your physician before use during pregnancy or breastfeeding. Safety in these populations has not been definitively established.
Q7: How should I store these eye drops?
A: Store at room temperature (15-25°C or 59-77°F), away from direct sunlight and excessive heat. Discard the bottle 90 days after opening.
Q8: What should I do if I miss a dose?
A: Instill the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not instill a double dose to catch up.
Q9: Can these drops be used to treat cataracts?
A: While n-acetylcarnosine has antioxidant properties that may have some benefit in slowing cataract progression, these drops are not a primary treatment for cataracts. Consult an ophthalmologist for appropriate cataract management.
Q10: What should I do if my symptoms don’t improve?
A: Consult your doctor if your dry eye symptoms do not improve or worsen despite using this medication.
