Usage
This combination medication is prescribed for bacterial infections of the eye and ear, especially where inflammation is present. Conditions treated include:
- Bacterial eye infections: Conjunctivitis, corneal ulcers.
- Bacterial ear infections: Otitis externa, acute and chronic otitis media, post-operative infections.
Pharmacological Classifications:
- Ofloxacin: Fluoroquinolone antibiotic (bactericidal).
- Dexamethasone: Corticosteroid (anti-inflammatory, immunosuppressant).
- Hydroxypropylmethylcellulose (HPMC): Lubricant, artificial tears.
Mechanism of Action:
Ofloxacin inhibits bacterial DNA gyrase, essential for bacterial DNA replication and repair. Dexamethasone reduces inflammation by suppressing the immune response and inhibiting prostaglandin synthesis. HPMC lubricates and moisturizes the affected area.
Alternate Names
Ofloxacin + Dexamethasone + Hydroxypropyl Methylcellulose; O-Dex; Oflacin-DM; Oflokem-D; Ofrivid-DX; Festive-Dee Optic; Festive Dee Optic; Ogram D; BIOFF D; Oflozee D. A variety of brand names exist depending on the manufacturer and region. Examples include: Ceflox-Dee Optic, Festive-Dee Optic, Ofshot D, Sire, Ogram D.
How It Works
Pharmacodynamics:
- Ofloxacin: Bactericidal action by inhibiting bacterial DNA gyrase.
- Dexamethasone: Suppresses inflammation, reduces edema, relieves itching and redness.
- HPMC: Lubricates and soothes irritated tissues.
Pharmacokinetics:
- Ofloxacin: Well-absorbed when administered orally. Metabolized in the liver, primarily excreted renally.
- Dexamethasone: Absorbed through various routes (topical, oral, injection). Metabolized in the liver, excreted in urine.
- HPMC: Not systemically absorbed when used topically.
Mode of Action:
- Ofloxacin: Inhibits bacterial topoisomerase II (DNA gyrase) and topoisomerase IV, disrupting DNA replication and transcription.
- Dexamethasone: Binds to glucocorticoid receptors, modulating gene expression and inhibiting inflammatory mediators.
- HPMC: Increases tear film viscosity, providing lubrication.
Elimination Pathways:
- Ofloxacin: Primarily renal excretion.
- Dexamethasone: Hepatic metabolism and renal excretion.
Dosage
Standard Dosage
Adults:
Instill 1–2 drops into the affected eye(s) every 4–6 hours. Initially (first 24–48 hours), dosing may be increased to 1–2 drops every 2 hours, then tapered as the condition improves. For ear infections, instill 2–4 drops 3–4 times daily.
Children:
Use with caution under strict medical supervision. Dosage adjusted by the physician based on age and weight. Not recommended for infants under one year.
Special Cases:
- Elderly Patients: Close monitoring is necessary due to their higher susceptibility to adverse effects.
- Patients with Renal Impairment: Caution advised. Dose reduction may be needed.
- Patients with Hepatic Dysfunction: Caution is advised due to potential changes in drug clearance.
- Patients with Comorbid Conditions: Careful evaluation and monitoring for those with diabetes, glaucoma, or myasthenia gravis.
Clinical Use Cases
The dosage for specific clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, or emergencies is determined based on the patient’s specific needs and condition and is decided by the physician on a case-by-case basis.
Dosage Adjustments
Dose adjustments may be needed based on patient-specific factors like renal or hepatic impairment, other medical conditions, concomitant medications, and response to therapy.
Side Effects
Common Side Effects:
Eye/ear discomfort, irritation, burning sensation, stinging, redness, transient blurred vision, watering of the eyes, unpleasant taste (if swallowed).
Rare but Serious Side Effects:
Allergic reactions (rash, itching, swelling), vision changes, eye pain, signs of a new eye/ear infection, headache, dizziness, tendon rupture (rare but can occur).
Long-Term Effects:
Glaucoma, posterior subcapsular cataracts (with prolonged or high-dose topical use).
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome (rare), tendon inflammation or rupture.
Contraindications
Hypersensitivity to any component, epithelial herpes simplex keratitis, viral or fungal infections of the eye, mycobacterial eye infections, myasthenia gravis.
Drug Interactions
- Drug-Drug: Phenytoin, phenobarbital, ephedrine, rifampicin, ritonavir, cobicistat, warfarin, theophylline, other corticosteroids, antiarrhythmics, CNS medications, antacids containing aluminum hydroxide or magnesium hydroxide, multivitamins containing iron, zinc or calcium.
- Drug-Food: Limit alcohol consumption.
- Drug-Disease: Ulceration of the eye, heart problems (prolonged QT interval), liver or kidney disease, glaucoma, cataracts, recent eye surgery, viral diseases of the conjunctiva and cornea, severe nearsightedness, diabetes, fungal infections of the eye.
Pregnancy and Breastfeeding
Consult a physician. Use only if clearly needed and the potential benefits outweigh the risks.
Drug Profile Summary
- Mechanism of Action: See “How It Works.”
- Side Effects: See “Side Effects.”
- Contraindications: See “Contraindications.”
- Drug Interactions: See “Drug Interactions.”
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: See “Dosage.”
- Monitoring Parameters: Monitor for adverse reactions, intraocular pressure (with long-term use), and resolution of infection.
Popular Combinations
This product is itself a frequently used combination.
Precautions
- General: Careful eye exam before initiating treatment. Appropriate administration technique to avoid contamination. Monitor for superinfections.
- Specific Populations: See “Dosage - Special Cases.”
- Lifestyle Considerations: Avoid driving or operating machinery if blurred vision occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Dexamethasone + HPMC + Ofloxacin?
A: See “Dosage” section for detailed information based on age, condition, and administration route.
Q2: Can this combination be used in children?
A: Yes, but with caution and under strict medical supervision. Dosage adjustments are required. Not recommended for infants under one year.
Q3: What are the common side effects?
A: Common side effects include eye/ear discomfort, irritation, burning, stinging, redness, and transient blurred vision.
Q4: Are there any serious side effects?
A: Yes, although rare, serious side effects can include allergic reactions, vision changes, new eye/ear infection, headache, dizziness, and tendon rupture.
Q5: What are the contraindications to using this combination?
A: Contraindications include hypersensitivity, herpes simplex keratitis, viral or fungal eye infections, mycobacterial eye infections, and myasthenia gravis.
Q6: Can this medication be used during pregnancy or breastfeeding?
A: Consult a physician. Use only if clearly needed and if the potential benefits outweigh the risks.
Q7: How should I store this medication?
A: Store at room temperature, protected from light and moisture. Keep out of reach of children. Discard any unused portion after the expiration date or one month after opening.
Q8: What should I do if my symptoms don’t improve?
A: Consult your doctor if your symptoms don’t improve within a few days or worsen.
A: Generally, contact lens wear is discouraged during treatment for eye infections. Consult your doctor.
Q10: How does dexamethasone interact with ofloxacin?
A: While the combination is commonly used, combining dexamethasone with ofloxacin can increase the risk of tendon rupture, particularly in certain populations. Close monitoring is essential.
