Usage
Fluorometholone + Tobramycin is prescribed for steroid-responsive inflammatory ocular conditions with superficial bacterial ocular infection or a risk of bacterial ocular infection. It is also used for the treatment of anterior segment inflammation after cataract surgery.
It’s pharmacological classifications are:
- Fluorometholone: Corticosteroid, anti-inflammatory agent
- Tobramycin: Aminoglycoside antibiotic
Mechanism of Action:
- Fluorometholone: Suppresses the inflammatory response by inhibiting multiple inflammatory cytokines. This reduces swelling, redness, and discomfort.
- Tobramycin: Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit, leading to bacterial cell death.
Alternate Names
There are no widely recognized alternate names for this combination. Brand names may vary regionally. Some examples include:
How It Works
Pharmacodynamics:
- Fluorometholone: Exerts its anti-inflammatory effect by inhibiting the migration of neutrophils and reducing capillary permeability, thus diminishing edema and scarring.
- Tobramycin: Bactericidal against susceptible gram-negative bacteria. It may also have some activity against some gram-positive bacteria.
Pharmacokinetics:
- Fluorometholone: After topical ophthalmic administration, there is minimal systemic absorption.
- Tobramycin: Achieves therapeutic concentrations in the aqueous humor following topical application. Systemic absorption is low after topical ophthalmic administration.
Mode of Action:
- Fluorometholone: Binds to glucocorticoid receptors in the cytoplasm, translocates to the nucleus, and modulates gene expression, reducing inflammatory mediators.
- Tobramycin: Interferes with the initiation complex of bacterial protein synthesis by binding to the 30S ribosomal subunit.
Elimination:
- Fluorometholone: Primarily metabolized in the liver and excreted in the urine.
- Tobramycin: Primarily excreted unchanged in the urine.
Dosage
Standard Dosage
Adults:
Instill 1 or 2 drops into the conjunctival sac of the affected eye(s) every 4 to 6 hours. During the initial 24 to 48 hours, the dosage may be increased to 1 or 2 drops every 2 hours, as directed by a physician.
Children:
In children 2 years of age and older, instill 1 or 2 drops into the conjunctival sac of the affected eye(s) every 4 to 6 hours. The dosage may be safely increased to 1 or 2 drops every 2 hours for the first 24-48 hours of treatment under the direction of a doctor.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically required. However, monitoring for adverse effects, especially increased intraocular pressure, is essential.
- Patients with Renal Impairment: No specific dosage adjustments needed for topical application as systemic absorption is low.
- Patients with Hepatic Dysfunction: No specific dosage adjustments needed for topical application as systemic absorption is low.
- Patients with Comorbid Conditions: Use with caution in patients with glaucoma, diabetes, or other systemic diseases as corticosteroids can exacerbate these conditions.
Clinical Use Cases
The provided sources focus on the usage of fluorometholone + tobramycin for ophthalmic inflammatory conditions and post-cataract surgery inflammation, they don’t provide dosage recommendations for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Adjustments are primarily based on the severity of inflammation and the patient’s response to therapy. The initial higher frequency of administration can be tapered down as the condition improves.
Side Effects
Common Side Effects
- Eye discomfort
- Transient blurred vision
- Increased intraocular pressure
- Eye itching or burning
Rare but Serious Side Effects
- Cataract formation
- Glaucoma
- Secondary ocular infections
- Corneal thinning or perforation
Long-Term Effects
Prolonged use of topical corticosteroids can lead to glaucoma, cataracts, and increased susceptibility to ocular infections.
Adverse Drug Reactions (ADR)
Severe allergic reactions are rare but require immediate medical attention.
Contraindications
- Hypersensitivity to any component of the formulation
- Acute herpes simplex keratitis (dendritic keratitis)
- Vaccinia, varicella, and most other viral diseases of the cornea and conjunctiva
- Mycobacterial infection of the eye
- Fungal diseases of the eye
Drug Interactions
No significant drug interactions are known for topical application of this combination.
Pregnancy and Breastfeeding
- Pregnancy: Fluorometholone is Pregnancy Category C. Use only if the potential benefit outweighs the potential risk to the fetus.
- Breastfeeding: It is unknown whether fluorometholone is excreted in human milk. Exercise caution when administering to nursing mothers. Tobramycin’s effects on infants from topical administration to nursing mothers are also unknown.
Drug Profile Summary
- Mechanism of Action: Fluorometholone - Anti-inflammatory; Tobramycin - Antibiotic
- Side Effects: Eye discomfort, blurred vision, increased intraocular pressure, itching, burning.
- Contraindications: Hypersensitivity, herpes simplex keratitis, viral/fungal/mycobacterial eye infections.
- Drug Interactions: None significant for topical use.
- Pregnancy & Breastfeeding: Category C; use with caution.
- Dosage: 1-2 drops every 4-6 hours, initially every 2 hours for 24-48 hours.
- Monitoring Parameters: Intraocular pressure, visual acuity, signs of infection.
Popular Combinations
This combination itself is commonly used.
Precautions
- Monitor intraocular pressure, especially in patients with a history of glaucoma or diabetes.
- Do not use for extended periods without ophthalmologic supervision.
- Wash hands before and after application.
- Avoid touching the tip of the bottle to the eye.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Fluorometholone + Tobramycin?
A: The usual dose is 1-2 drops every 4-6 hours, which can be increased to every 2 hours for the initial 24-48 hours as directed by a doctor.
Q2: What conditions does this medication treat?
A: Steroid-responsive ocular inflammation with or at risk of bacterial infection, and anterior segment inflammation after cataract surgery.
Q3: Can I use this medication if I am pregnant or breastfeeding?
A: If pregnant, use with caution if the benefit outweighs the risk. Consult your physician before use if you are breastfeeding.
Q4: What are the most common side effects?
A: Discomfort, blurred vision, increased eye pressure, itching or burning.
Q5: Are there any serious side effects I should be aware of?
A: Yes, although rare, glaucoma, cataracts, and secondary eye infections are possible.
A: Generally, you should not wear contact lenses while using this medication. Consult with your ophthalmologist.
Q7: How long can I use this medication?
A: Use it as directed by your doctor. Do not discontinue prematurely without consultation.
Q8: What should I do if I miss a dose?
A: Instill the missed dose as soon as you remember, then return to your regular dosing schedule. Do not double dose.
Q9: Should I shake the bottle before use?
A: Yes, it’s essential to shake the bottle well before each use to ensure the medication is evenly distributed.
Q10: What should I do if my symptoms worsen or do not improve?
A: Consult with your ophthalmologist immediately if your condition worsens or doesn’t improve after a few days of treatment.
