Flurbiprofen + Hydroxypropylmethylcellulose

Usage

Flurbiprofen + Hydroxypropylmethylcellulose ophthalmic solution is primarily prescribed for ophthalmic procedures and conditions. It combines the anti-inflammatory action of flurbiprofen with the lubricating properties of hydroxypropyl methylcellulose (HPMC). It’s used to:

• Prevent miosis (pupil constriction): During cataract surgery and other ophthalmic procedures.
• Treat postoperative ocular inflammation: Reducing pain and swelling after eye surgery.
• Manage dry eye syndrome: Providing lubrication and relieving dryness and irritation.

It’s pharmacological classification is:

• Non-steroidal anti-inflammatory drug (NSAID) (Flurbiprofen)
• Lubricant (Hydroxypropyl methylcellulose)

Mechanism of Action: Flurbiprofen inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin production, which mediates inflammation and pain. HPMC provides lubrication, mimicking natural tears.

Alternate Names

While the combination itself doesn’t have a distinct international nonproprietary name (INN), its components do:

• Flurbiprofen: No widely used alternate names.
• Hydroxypropyl methylcellulose: Hypromellose, HPMC.

Brand Names: Flur, Ocufen, others (may vary by region)

How It Works

Pharmacodynamics: Flurbiprofen’s anti-inflammatory action results from COX inhibition, primarily COX-1 and COX-2, reducing prostaglandin synthesis. HPMC increases tear film stability, reducing evaporation and providing a soothing effect on the ocular surface.

Pharmacokinetics:

• Flurbiprofen: After ophthalmic administration, systemic absorption is minimal. It’s metabolized in the liver and excreted primarily via the kidneys.
• HPMC: Not absorbed systemically. Remains on the ocular surface.

Mode of Action: Flurbiprofen binds to COX enzymes, preventing the conversion of arachidonic acid to prostaglandins. HPMC physically interacts with the ocular surface, forming a viscous, lubricating layer.

Receptor Binding/Enzyme Inhibition: Flurbiprofen acts through non-selective COX inhibition. HPMC doesn’t have receptor binding or enzyme inhibition properties.

Elimination Pathways: Flurbiprofen undergoes hepatic metabolism, with renal excretion of metabolites. HPMC is eliminated from the eye through blinking and tear drainage.

Dosage

Standard Dosage

Adults:

• Cataract surgery: 1 drop every 30 minutes, starting 2 hours before surgery.
• Other indications: 1 drop in affected eye(s) up to four times daily, or as prescribed.

Children:

Use in children under 12 years of age is generally not recommended, unless specifically prescribed by a physician. Pediatric dosing should be determined by the doctor based on the child’s age and weight.

Special Cases:

• Elderly Patients: Use with caution. Start with a lower dose and adjust as needed based on tolerance and efficacy. Monitor renal function closely.
• Patients with Renal Impairment: Use with caution, especially in advanced renal disease. Dosage adjustments are needed.
• Patients with Hepatic Dysfunction: Use with caution. Dosage adjustments may be necessary in patients with moderate to severe hepatic impairment.
• Patients with Comorbid Conditions: Careful consideration is required for patients with conditions like hypertension, heart failure, or a history of gastrointestinal bleeding.

Clinical Use Cases

Dosing recommendations for specific clinical scenarios are provided above in the Standard Dosage and Special Cases section. Dosage will be adjusted based on the indication and patient condition by the physician.

Dosage Adjustments

Dosage adjustments are detailed above in the Special Cases section.

Side Effects

Common Side Effects

• Ocular burning or stinging
• Temporary blurred vision
• Eye redness or irritation
• Itching or watering of the eyes
• Sensitivity to light

Rare but Serious Side Effects

• Corneal damage (with prolonged use)
• Allergic reactions (rare)
• Systemic side effects of flurbiprofen (rare with ophthalmic use)

Long-Term Effects

• Potential for corneal complications with extended use

Adverse Drug Reactions (ADR)

Severe allergic reactions, though rare, require urgent attention. Corneal ulceration or perforation may occur with chronic, inappropriate use.

Contraindications

• Hypersensitivity to flurbiprofen, HPMC, or any component of the formulation.
• Active ocular infection.
• Third-trimester pregnancy.
• Patients with a history of severe hypersensitivity reactions to aspirin or other NSAIDs.

Drug Interactions

• Other ophthalmic medications (especially anti-inflammatory agents): Avoid concurrent use unless directed by an ophthalmologist.
• Anticoagulants (e.g., warfarin): Concomitant use may increase bleeding risk.
• Systemic NSAIDs: Concurrent use is best avoided as it increases the risk of systemic effects.

Pregnancy and Breastfeeding

• Pregnancy: Contraindicated in the third trimester. Use in the first and second trimesters only if the potential benefit outweighs the risk.
• Breastfeeding: Consult a physician before use. Flurbiprofen is excreted in breast milk in small amounts.

Drug Profile Summary

The Drug Profile Summary is already provided above in individual sections detailing the mechanism of action, side effects, contraindications, drug interactions, pregnancy/breastfeeding considerations, and dosage.

Popular Combinations

Flurbiprofen + HPMC is commonly used alone. Concomitant use with other eye drops during surgeries is possible but must be under strict ophthalmological supervision.

Precautions

• General Precautions: Avoid contact lens wear during treatment. Do not touch the dropper tip to any surface to prevent contamination.
• Specific Populations: As described above in “Dosage” - “Special Cases”.
• Lifestyle Considerations: Avoid driving or operating machinery if vision is blurred.

FAQs (Frequently Asked Questions)

• Q1: What is the recommended dosage for Flurbiprofen + Hydroxypropylmethylcellulose?

  • A: See detailed dosing recommendations provided in the “Dosage” section.

• Q2: Can I use contact lenses while using this medication?

  • A: Contact lens wear is generally not advised while using this medication.

• Q3: What are the most common side effects?

  • A: Common side effects include ocular burning/stinging, temporary blurred vision, eye redness/irritation.

• Q4: Is it safe to use during pregnancy?

  • A: It’s contraindicated in the third trimester. Consult a physician regarding use during the first and second trimesters.

• Q5: Are there any drug interactions I should be aware of?

  • A: Yes, potential interactions exist with other ophthalmic medications, anticoagulants, and systemic NSAIDs. Consult with the prescribing physician.

• Q6: How should I store this medication?

  • A: Store at room temperature and protect from light. Discard any remaining solution after the prescribed duration or expiry date.

• Q7: What should I do if I experience severe eye pain or vision changes?

  • A: Discontinue use and seek immediate medical attention from an ophthalmologist.

• Q8: Can I use this medication if I have glaucoma?

  • A: Consult your ophthalmologist before use, as some formulations may affect intraocular pressure.

• Q9: Is this medication safe for long-term use?

  • A: Long-term use should be under the guidance of an ophthalmologist, as there’s a potential for corneal complications.