Hydroxypropylmethylcellulose + Ofloxacin

Usage

Hydroxypropylmethylcellulose (HPMC) + Ofloxacin is prescribed for bacterial infections of the eye and ear. Ofloxacin falls under the pharmacological classification of fluoroquinolone antibiotics, while HPMC is a lubricant. Ofloxacin works by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes crucial for bacterial DNA replication, transcription, repair, and recombination, thus halting bacterial growth. HPMC increases tear film viscosity, providing lubrication and reducing friction between the eyelid and cornea.

Alternate Names

There are no widely recognized alternate names for this specific combination. Brand names vary regionally and internationally. Examples include Oflokem-D, Festive-Dee Optic, and others.

How It Works

Pharmacodynamics: Ofloxacin exerts its antibacterial effect by targeting bacterial DNA gyrase and topoisomerase IV. This inhibition disrupts DNA replication, transcription, repair, and recombination, leading to bacterial cell death. HPMC works locally by increasing tear film viscosity and providing a soothing protective layer on the ocular surface.

Pharmacokinetics (Ofloxacin):

• Absorption: Achieves therapeutic concentrations in ocular tissues when administered as eye drops and in systemic circulation when taken orally.
• Metabolism: Primarily hepatic.
• Elimination: Primarily renal excretion.

Pharmacokinetics (HPMC): Acts locally and is not systemically absorbed in significant amounts.

Mode of Action (Ofloxacin): Inhibits bacterial DNA gyrase and topoisomerase IV, thereby disrupting bacterial DNA function.

Receptor binding, enzyme inhibition, or neurotransmitter modulation (Ofloxacin): Inhibits bacterial DNA gyrase and topoisomerase IV.

Elimination pathways (Ofloxacin): Primarily renal excretion, with minor hepatic metabolism.

Dosage

Standard Dosage

Adults: One or two drops instilled into the affected eye(s) or ear(s) every 4 to 6 hours. For the first 24 to 48 hours, the dosage can be increased up to one or two drops every two hours depending on the severity of the infection. Oral ofloxacin is generally 200 to 400 mg every 12 hours, though the exact dose and duration of treatment is determined by the infection being treated.

Children: For ear infections, children aged 6 months to under 13 years can receive 5 drops once daily for 7 days (outer ear infection) or 5 drops twice daily for 10 days (middle ear infection with ear tubes). Dosage adjustments are necessary for children receiving oral ofloxacin and should be determined by the child’s physician.

Special Cases:

• Elderly Patients: Monitor renal function and adjust accordingly.
• Patients with Renal Impairment: Dosage adjustment is required. Reduce the dose or increase the dosing interval based on creatinine clearance.
• Patients with Hepatic Dysfunction: Caution advised; monitor for adverse events. Dosage adjustments may be necessary.
• Patients with Comorbid Conditions: Individualized assessment needed.

Clinical Use Cases

• Intubation: Pre- and post-operative prophylaxis.
• Surgical Procedures: Pre- and post-operative prophylaxis for ophthalmic procedures.
• Mechanical Ventilation: Not specifically indicated.
• Intensive Care Unit (ICU) Use: Based on individual patient needs and infection type.
• Emergency Situations: Systemic ofloxacin may be used in certain severe bacterial infections depending on susceptibility patterns.

Dosage Adjustments

Adjust dosage based on renal function, hepatic function and patient response.

Side Effects

Common Side Effects:

• Transient burning or stinging
• Blurred vision
• Eye/Ear discomfort or irritation
• Redness
• Watering of the eyes/ears

Rare but Serious Side Effects:

• Stevens-Johnson syndrome
• Toxic epidermal necrolysis
• Tendinitis or tendon rupture (especially Achilles tendon)
• Peripheral neuropathy
• Psychotic reactions
• Seizures

Long-Term Effects:

• Prolonged QT interval (with oral ofloxacin)

Adverse Drug Reactions (ADR):

• Allergic reactions
• Severe skin reactions
• Hepatotoxicity
• Pseudomembranous colitis

Contraindications

• Hypersensitivity to ofloxacin, other quinolones, or any component.
• Patients with a history of tendon disorders related to quinolone use.
• Children and growing adolescents (for oral ofloxacin)
• Pregnancy (for oral ofloxacin unless benefit outweighs risk).

Drug Interactions

• Antacids, sucralfate, metal cations, and multivitamins can reduce ofloxacin absorption.
• Co-administration with certain medications (e.g., phenytoin, theophylline, warfarin) may require monitoring and/or dosage adjustments due to potential interactions.
• Alcohol may increase the risk of dizziness with oral ofloxacin.

Pregnancy and Breastfeeding

• Pregnancy: Oral ofloxacin is generally avoided unless the potential benefit justifies the potential risk. Topical preparations are generally considered low risk but should be used with caution.
• Breastfeeding: Ofloxacin is present in breast milk. Weigh risks and benefits. Consider discontinuing breastfeeding or the drug.

Drug Profile Summary

• Mechanism of Action: Ofloxacin: inhibits bacterial DNA gyrase and topoisomerase IV. HPMC: Lubricates the ocular surface.
• Side Effects: See Side Effects section above.
• Contraindications: See Contraindications section above.
• Drug Interactions: See Drug Interactions section above.
• Pregnancy & Breastfeeding: See Pregnancy and Breastfeeding section above.
• Dosage: See Dosage section above.
• Monitoring Parameters: Renal function, hepatic function, ocular/aural status, and signs of adverse effects.

Popular Combinations

Ofloxacin is often combined with corticosteroids like dexamethasone for enhanced anti-inflammatory effects in treating eye and ear infections.

Precautions

Pre-existing conditions including myasthenia gravis and epilepsy should be assessed before use.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Hydroxypropylmethylcellulose + Ofloxacin eye/ear drops?

A: Instill 1-2 drops in the affected eye/ear every 4-6 hours. The dosage may be increased to 1-2 drops every 2 hours during the initial 24-48 hours for severe infections.

Q2: What is the mechanism of action of ofloxacin?

A: Ofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, essential enzymes for bacterial DNA replication and repair.

Q3: What are the common side effects of Hydroxypropylmethylcellulose + Ofloxacin eye/ear drops?

A: Common side effects include transient burning or stinging, blurred vision, eye/ear discomfort or irritation, redness, and watering.

Q4: What are the contraindications for using this combination?

A: Contraindications include hypersensitivity to ofloxacin or other quinolones, history of tendon disorders related to quinolone use, and in children and growing adolescents (for oral ofloxacin).

Q5: Can Hydroxypropylmethylcellulose + Ofloxacin eye/ear drops be used during pregnancy and breastfeeding?

A: Topical use is generally considered low risk, but caution is advised. Oral ofloxacin should be avoided during pregnancy unless the benefit clearly outweighs the risk. Discuss with your physician. Ofloxacin is present in breast milk; the decision to use it while breastfeeding should be made in consultation with a physician.

Q6: How does HPMC contribute to the effectiveness of the medication?

A: HPMC acts as a lubricant, enhancing the residence time of ofloxacin on the ocular surface and providing a soothing effect.

Q7: What are the serious side effects of ofloxacin?

A: Rare but serious side effects of oral ofloxacin include tendinitis or tendon rupture (especially Achilles tendon), peripheral neuropathy, and central nervous system effects such as seizures.

Q8: Does this combination interact with other medications?

A: Yes, particularly oral ofloxacin. Interactions can occur with antacids, sucralfate, metal ions, multivitamins, phenytoin, theophylline and warfarin. Inform your doctor about all other medications you are taking.

Q9: What should I do if I experience tendon pain while taking ofloxacin?

A: Stop taking the medication immediately and consult your doctor.

Q10: How long can this medication be used?

A: Topical preparations are typically used for 7-10 days. Oral ofloxacin treatment generally does not exceed 2 months. The duration depends upon the type and severity of the infection and should be determined by your physician.