Usage
This ophthalmic solution is primarily prescribed for the treatment of post-operative eye pain and inflammation, and for the prevention of intraoperative miosis (pupil constriction during surgery). It is also used in managing pain, irritation, and inflammation associated with various other eye conditions like dry eye syndrome, allergic conjunctivitis, and corneal injury or abrasion.
Its pharmacological classifications include:
- Non-steroidal anti-inflammatory drug (NSAID): Flurbiprofen
- Lubricant: Hydroxypropylmethylcellulose
- Antimicrobial preservative: Phenyl Mercuric Nitrate
The mechanism of action involves a synergistic effect of the three components: Flurbiprofen inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin production and thus inflammation and pain. Hydroxypropylmethylcellulose lubricates the ocular surface, mimicking natural tears and providing relief from dryness. Phenyl mercuric nitrate prevents bacterial contamination of the eye drops.
Alternate Names
This combination doesn’t have a universally recognized International Nonproprietary Name (INN). It is often referred to by the names of its components. Brand names include Ocuflur, Flur, Proflur, Flurin, Cadiflur (when combined with Phenyl Ethyl Alcohol), Ocupain, Flubi Eye, Flurbin Eye, Takflur, Lumat, and Rayflur among others. The brand name may vary depending on the manufacturer and region.
How It Works
Pharmacodynamics: Flurbiprofen, an NSAID, exerts its anti-inflammatory and analgesic effects by inhibiting COX-1 and COX-2 enzymes, thereby reducing the synthesis of prostaglandins, which are mediators of inflammation and pain. Hydroxypropylmethylcellulose increases tear film viscosity, providing lubrication and protection to the ocular surface. Phenyl mercuric nitrate acts as a preservative, preventing microbial growth in the ophthalmic solution.
Pharmacokinetics: Flurbiprofen, when applied topically as an eye drop, is absorbed systemically to a small extent. Its metabolism and elimination pathways are similar to oral flurbiprofen, primarily involving hepatic metabolism with renal excretion. Hydroxypropylmethylcellulose, being a polymer, is not absorbed systemically and is eliminated from the eye through the tear drainage system. Phenyl mercuric nitrate’s systemic absorption is minimal, also.
Mode of Action: Flurbiprofen competitively binds to the COX enzyme active site, preventing arachidonic acid from binding and being converted to prostaglandins. Hydroxypropylmethylcellulose, due to its high molecular weight and hydrophilic nature, forms a viscous gel on the ocular surface that enhances tear film stability and reduces evaporation. Phenyl mercuric nitrate exerts its antimicrobial effect by interacting with sulfhydryl groups in microbial enzymes, disrupting cell membrane function, and leading to cell death.
Elimination pathways: Primarily hepatic metabolism (Flurbiprofen) with renal excretion. HPMC is removed via tear drainage.
Dosage
Standard Dosage
Adults:
The typical dosage is one drop instilled into the affected eye(s) four times a day or as directed by the physician. For the prevention of intraoperative miosis, one drop may be instilled every 30 minutes, beginning two hours before surgery.
Children:
Dosage in children should be determined by a pediatric ophthalmologist. Some sources indicate use in children over 2 years old.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on renal function.
- Patients with Renal Impairment: Dosage modifications may be needed.
- Patients with Hepatic Dysfunction: Dosage adjustments may be required.
- Patients with Comorbid Conditions: Consider potential drug interactions and adjust the dosage if required.
Clinical Use Cases
Dosage recommendations for specific clinical situations should be based on individual patient needs and are best determined by the treating physician. General guidance is as follows:
- Intubation: Not typically indicated.
- Surgical Procedures: For miosis prevention, one drop every 30 minutes starting two hours before surgery. Post-operatively, as directed by the surgeon.
- Mechanical Ventilation: Not typically indicated.
- Intensive Care Unit (ICU) Use: Not specifically indicated.
- Emergency Situations: Not generally used in emergency situations.
Dosage Adjustments
Dosage adjustments should be made in consultation with a physician based on patient-specific factors such as renal or hepatic impairment, and other medical conditions.
Side Effects
Common Side Effects
Ocular burning or stinging, transient blurred vision, eye redness, itching, or watering of the eyes, sensitivity to light.
Rare but Serious Side Effects
Corneal damage, allergic reactions (including anaphylaxis), increased blood pressure, swelling, paresthesia, fever, chills, infection, hair loss, urticaria, dizziness.
Long-Term Effects
Prolonged use may lead to corneal complications or raise the risk of systemic effects of Flurbiprofen with chronic use (e.g., gastrointestinal bleeding, renal impairment).
Adverse Drug Reactions (ADR)
Severe allergic reactions, severe corneal complications.
Contraindications
Hypersensitivity to any of the components, active ocular infections, severe dry eyes, corneal abnormalities, or a known hypersensitivity to other NSAIDs.
Drug Interactions
Other ophthalmic NSAIDs, anticoagulants (increased bleeding risk), systemic NSAIDs. Interaction potential with other ophthalmic medications should be assessed.
Pregnancy and Breastfeeding
Pregnancy: Use only if clearly needed, especially during the third trimester. Consult a physician before use.
Breastfeeding: Use with caution. Consult a physician before use.
Drug Profile Summary
See above sections. Monitoring should include observing for any adverse reactions as well as general eye health such as corneal status and intraocular pressure.
Popular Combinations
Often combined with Hydroxypropyl Methylcellulose (HPMC) for lubrication.
Precautions
Monitor for corneal health during prolonged use. Caution in patients with asthma, bleeding disorders, or other NSAID hypersensitivity. Avoid contact of dropper tip with any surface. Patients should avoid driving or operating machinery if experiencing blurred vision. Advise patients to consult their physician for any persistent symptoms or if their condition worsens.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Flurbiprofen + Hydroxypropylmethylcellulose + Phenyl Mercuric Nitrate?
A: The standard dosage is one drop in the affected eye(s) four times a day. However, dosage may vary depending on the specific condition being treated and patient factors. Always consult with a physician for personalized recommendations.
A: Contact lenses should be removed before instilling the eye drops and reinserted after 15-20 minutes.
Q3: Is this a steroid eye drop?
A: No, Flurbiprofen is a non-steroidal anti-inflammatory drug (NSAID).
Q4: What should I do if I accidentally ingest the eye drops?
A: Seek immediate medical advice. While serious complications are unlikely with small amounts, ingestion is not recommended.
Q5: Can I drive after using this eye drop?
A: This medication can temporarily blur vision. Avoid driving or operating machinery until your vision clears.
Q6: What are the long-term effects of using this eye drop?
A: Long-term use should be monitored by an ophthalmologist, as it could lead to corneal issues or increased systemic effects of Flurbiprofen.
Q7: Is it safe to use this medication during pregnancy or while breastfeeding?
A: Consult with a doctor before using this eye drop during pregnancy or breastfeeding.
Q8: What should I do if I experience severe side effects?
A: Discontinue use immediately and consult your doctor.
Q9: What is the difference between flurbiprofen and phenyl mercuric nitrate?
A: Flurbiprofen reduces pain and inflammation, while phenyl mercuric nitrate acts as an antimicrobial preservative.
Q10: Can this medication be used to treat infections?
A: While the phenyl mercuric nitrate acts as a preservative against bacterial contamination in the bottle, this medication is not designed to treat active eye infections. Consult your doctor for appropriate treatment.
