Usage
Ketorolac + Moxifloxacin ophthalmic solution is prescribed for the treatment and prevention of bacterial eye infections and to reduce inflammation and pain following ocular surgery (e.g., cataract surgery, corneal refractive surgery). It is also sometimes used to alleviate ocular itching associated with seasonal allergies.
Pharmacological Classification:
- Ketorolac: Non-Steroidal Anti-Inflammatory Drug (NSAID) - analgesic, anti-inflammatory
- Moxifloxacin: Fluoroquinolone antibiotic - antibacterial
Mechanism of Action:
This combination drug works through two distinct mechanisms:
- Ketorolac: Inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. Prostaglandins are mediators of pain and inflammation.
- Moxifloxacin: Inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication, transcription, and repair, leading to bacterial cell death.
Alternate Names
This combination medication doesn’t have a universally recognized international nonproprietary name (INN). It is often referred to as Ketorolac + Moxifloxacin ophthalmic solution. It is marketed under various brand names, which can vary regionally. Some examples of brand names include: StayHappi Ketorolac + Moxifloxacin Eye Drop and Kapiket-M.
How It Works
Pharmacodynamics:
- Ketorolac: Exerts its analgesic and anti-inflammatory effects by inhibiting COX-1 and COX-2 enzymes. This reduces the production of prostaglandins, which are key mediators in pain and inflammation pathways.
- Moxifloxacin: A broad-spectrum antibiotic that exerts bactericidal activity by interfering with bacterial DNA replication and repair, primarily by inhibiting DNA gyrase and topoisomerase IV.
Pharmacokinetics:
- Ketorolac: After ophthalmic administration, Ketorolac reaches peak concentration in the aqueous humor relatively quickly. Systemic absorption is minimal. It is metabolized in the liver and excreted primarily by the kidneys.
- Moxifloxacin: Following topical ocular administration, moxifloxacin achieves therapeutic concentrations in the tear film and aqueous humor. Systemic absorption is low. Moxifloxacin is metabolized in the liver through Phase I (sulfoxidation) and Phase II (glucuronidation and conjugation with sulfate) pathways and eliminated mainly through the renal and to some extent biliary/fecal route.
Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation:
- Ketorolac: COX-1 and COX-2 enzyme inhibition.
- Moxifloxacin: DNA gyrase and topoisomerase IV inhibition.
Elimination Pathways:
- Ketorolac: Primarily renal excretion.
- Moxifloxacin: Primarily renal excretion, partially hepatic/biliary excretion.
Dosage
Standard Dosage
Adults:
Instill one drop in the affected eye(s) four times daily. The duration of treatment depends on the indication and can range from a few days for post-surgical inflammation to the duration of allergy season for allergic conjunctivitis.
Children:
Safety and efficacy in children younger than 2 years old have not been established. For children 2 years and older, the dosing is typically the same as for adults.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically required.
- Patients with Renal Impairment: Exercise caution. Monitor renal function.
- Patients with Hepatic Dysfunction: Exercise caution. Monitor hepatic function.
- Patients with Comorbid Conditions: Evaluate on a case-by-case basis. Special consideration should be given to patients with a history of hypersensitivity to NSAIDs or quinolone antibiotics, bleeding disorders, peptic ulcer disease, or corneal problems.
Clinical Use Cases
Dosing in clinical settings generally adheres to the standard adult dosage.
- Intubation: Not applicable for ophthalmic use.
- Surgical Procedures (post-operative): One drop four times a day, starting 24 hours after surgery.
- Mechanical Ventilation: Not applicable for ophthalmic use.
- Intensive Care Unit (ICU) Use: Not typically used in the ICU for ophthalmic indications.
- Emergency Situations: Not applicable for ophthalmic use.
Dosage Adjustments
Dosage adjustments may be necessary in patients with renal or hepatic impairment. Close monitoring is recommended.
Side Effects
Common Side Effects:
- Transient burning or stinging upon instillation
- Blurred vision
- Eye itching, redness, dryness, and discomfort
- Watery eyes
- Headache
Rare but Serious Side Effects:
- Corneal ulceration or perforation
- Vision loss
- Severe allergic reactions (anaphylaxis)
Long-Term Effects:
Prolonged use of topical NSAIDs can potentially increase the risk of corneal complications. Long-term use of fluoroquinolones can potentially, though rarely, contribute to the development of tendinitis or tendon rupture.
Adverse Drug Reactions (ADR):
Any signs of severe allergic reaction, significant worsening of eye condition, or sudden changes in vision should be considered an ADR and require immediate medical attention.
Contraindications:
- Hypersensitivity to Ketorolac, Moxifloxacin, other NSAIDs, or quinolone antibiotics.
Drug Interactions:
- Other topical ophthalmic medications: Administer with at least a 5-10 minute interval.
- Oral anticoagulants (e.g., warfarin): May increase bleeding risk.
- Oral NSAIDs: May increase the risk of gastrointestinal side effects.
Pregnancy and Breastfeeding:
The safety of this combination during pregnancy and breastfeeding has not been fully established. Use only if the potential benefit outweighs the potential risk to the fetus or nursing infant.
Drug Profile Summary
- Mechanism of Action: Ketorolac: COX inhibitor; Moxifloxacin: Bacterial DNA gyrase/topoisomerase IV inhibitor.
- Side Effects: Burning/stinging, blurred vision, eye irritation, headache.
- Contraindications: Hypersensitivity to the drug components or related drug classes.
- Drug Interactions: Anticoagulants, other NSAIDs.
- Pregnancy & Breastfeeding: Use with caution. Consult a physician.
- Dosage: 1 drop four times daily in the affected eye(s).
- Monitoring Parameters: Ocular signs and symptoms, visual acuity.
Popular Combinations
This is already a combination product. The use of other ophthalmic medications concomitantly requires careful evaluation.
Precautions
- Advise patients to avoid touching the dropper tip to any surface to prevent contamination.
- If patients wear contact lenses, they should remove them before instilling the drops and wait 10-15 minutes before reinserting them.
- Temporary blurred vision may occur. Advise patients to avoid driving or operating machinery until vision clears.
- Pre-existing eye conditions like dry eye syndrome or corneal problems should be evaluated before use.
- Caution should be exercised in patients with a history of bleeding disorders.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ketorolac + Moxifloxacin eye drops?
A: The usual dosage is one drop in the affected eye(s) four times daily.
Q2: Can I use Ketorolac + Moxifloxacin if I am pregnant or breastfeeding?
A: Consult with your obstetrician or pediatrician, as the safety of this combination during pregnancy and breastfeeding has not been fully established. Use only if clearly needed and the potential benefits outweigh the potential risks.
Q3: What should I do if I experience blurred vision after using the drops?
A: Blurred vision is a common side effect that is usually transient. Avoid driving or operating machinery until your vision clears. If blurring persists or worsens, consult a doctor.
A: Remove contact lenses before instilling the drops and wait 10-15 minutes before reinserting them.
Q5: How long can I use Ketorolac + Moxifloxacin eye drops?
A: The duration of treatment depends on the specific eye condition being treated. Follow your doctor’s instructions regarding the duration of use.
Q6: What are the most common side effects of Ketorolac + Moxifloxacin?
A: Common side effects include temporary burning or stinging upon instillation, blurred vision, eye itching, redness, dryness, discomfort, and headache.
Q7: Are there any serious side effects I should be aware of?
A: While rare, serious side effects such as corneal ulceration, vision loss, or severe allergic reactions can occur. Seek immediate medical attention if you experience any of these.
Q8: Can I use other eye drops with Ketorolac + Moxifloxacin?
A: Inform your doctor about all other medications you are using, including other eye drops. It is generally recommended to wait 5-10 minutes between the administration of different eye drops.
Q9: What should I do if I miss a dose?
A: Instill the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not double the dose to catch up.
