Individual generic drug information
Extracted information for Loteprednol etabonate only.
Treatment of post-operative inflammation following ocular surgery ▶TO THE EYE ▶Adult: Apply 4 times a day for maximum duration of treatment of 14 days, to be started 24 hours after surgery
Source page 1264
Extracted information for Loteprednol etabonate only.
MHRA/CHM ADVICE: CORTICOSTEROIDS: RARE RISK OF CENTRAL SEROUS CHORIORETINOPATHY WITH LOCAL AS WELL AS SYSTEMIC ADMINISTRATION (AUGUST 2017) See Corticosteroids, general use p. 707.
Source page 1264
▶Common or very common Dry eye. eye discomfort. eye disorders. headaches ▶Uncommon Conjunctival oedema. vision disorders ▶Rare or very rare Breast neoplasm. face oedema. muscle twitching. taste altered
Source page 1264
Extracted information for Loteprednol etabonate only.
There can be variation in the licensing of different medicines containing the same drug. Eye drops EXCIPIENTS: May contain Benzalkonium chloride, disodium edetate ▶Lotemax (Bausch & Lomb UK Ltd) Loteprednol etabonate 5 mg per 1 ml Lotemax 0.5% eye drops | 5 ml P £5.50 DT = £5.50 Glaucoma and ocular hypertension Glaucoma and ocular hypertension Description of condition Glaucoma is a group of eye disorders characterised by a loss of visual field associated with pathological cupping of the optic disc and optic nerve damage. While glaucoma is generally linked to raised intra-ocular pressure, which is the main treatable risk factor, it can also occur when the intra- ocular pressure is within the normal range. Other risk factors include age, family history, ethnicity, corticosteroid use, myopia, type 2 diabetes mellitus, cardiovascular disease, and hypertension. The most common form of glaucoma is chronic open- angle glaucoma (also known as primary open-angle glaucoma) where drainage of the aqueous humour through the trabecular meshwork is restricted, and the angle between the iris and the cornea is normal. Initially, this condition tends to be asymptomatic, however, as glaucoma progresses, patients may present with irreversible sight loss or visual field defects. Patients with ocular hypertension (an intra- ocular pressure greater than 21 mmHg) are at high risk of developing chronic open-angle glaucoma. The diagnosis, monitoring, and management of patients with ocular hypertension, suspected chronic open-angle glaucoma, or chronic open-angle glaucoma should be carried out by a specialist. Acute angle-closure glaucoma is less common and occurs when the outflow of aqueous humour from the eye is totally obstructed by bowing of the iris against the trabecular meshwork. It is characterised by its abrupt onset of symptoms, and it is a sight-threatening medical emergency that requires urgent reduction of intra-ocular pressure to prevent loss of vision. Aims of treatment The aim of treatment is to control intra-ocular pressure to prevent the development or progression of glaucoma and subsequent visual field damage, or sight loss. Ocular hypertension g A topical prostaglandin analogue, such as latanoprost p. 1247, tafluprost p. 1248, travoprost p. 1249, or bimatoprost p. 1250 (a synthetic prostamide), is recommended as first-line treatment in patients with an intra-ocular pressure of 24 mmHg or greater and who are at risk of visual impairment within their lifetime. When assessing patient’s risk of future visual impairment, the level of intra-ocular pressure, central corneal thickness measurement, family history, and life expectancy should be taken into consideration. Patients who are not at risk of visual impairment in their lifetime do not require treatment but should be monitored regularly. If initial treatment with a topical prostaglandin analogue is not tolerated, an alternative prostaglandin analogue should be tried before switching to a topical beta-blocker such as betaxolol below, levobunolol hydrochloride p. 1244, or timolol maleate p. 1244). If treatment is still not tolerated, alternative options include carbonic anhydrase inhibitors such as brinzolamide p. 1245 or dorzolamide p. 1246, a topical sympathomimetic such as apraclonidine p. 1251 [unlicensed use] or brimonidine tartrate p. 1251, or a topical miotic such as pilocarpine p. 1247 [unlicensed use], given either as monotherapy or as combination therapy. Alternatives as either monotherapy or combination therapy with drugs from different therapeutic classes (topical beta-blockers, carbonic anhydrase inhibitors, or topical sympathomimetics), should also be offered to patients with an intra-ocular pressure of 24 mmHg or more whose current treatment is not reducing intra-ocular pressure sufficiently to prevent the risk of progression to sight loss. The patient’s adherence and drop instillation technique should also be checked. If drug treatment still does not sufficiently reduce intra-ocular pressure to a satisfactory level, patients should be referred to a consultant ophthalmologist to discuss other options. Preservative free eye drops should be used in patients who are allergic to preservatives, or those who have clinically significant ocular surface disease and are at high risk of conversion to chronic open-angle glaucoma. h Note: based on cost-effective analysis, NICE guidelines 81 recommend treatment with generic prostaglandin analogues as first-line, and non-generic prostaglandin analogues as third - line if topical beta-blocker treatment is ineffective. Suspected chronic open-angle glaucoma g In patients with suspected chronic open-angle glaucoma and an intra-ocular pressure of 24 mmHg or greater, the same treatment recommendations as for the management of ocular hypertension should be followed. Patients with an intra-ocular pressure below 24 mmHg do not require drug treatment, but should be regularly monitored for changes in intra-ocular pressure and visual impairment. h Chronic open-angle glaucoma g Topical prostaglandin analogues such as latanoprost p. 1247, tafluprost p. 1248, travoprost p. 1249, or bimatoprost p. 1250 (a synthetic prostamide), are used first- line in patients with confirmed chronic open-angle glaucoma. If first-line treatment does not sufficiently reduce intra-ocular pressure and the patient’s adherence to treatment and eye drop instillation technique are both satisfactory, treatment with either a topical beta-blocker such as betaxolol below, levobunolol hydrochloride p. 1244, and timolol maleate p. 1244, a carbonic anhydrase inhibitor such as brinzolamide p. 1245 or dorzolamide p. 1246, a topical sympathomimetic such as apraclonidine p. 1251 or brimonidine tartrate p. 1251, or a combination of these, should be offered. When a particular drug is not tolerated, another drug from a different therapeutic class can be tried. Preservative free eye drops should be used in patients who are allergic to preservatives, or those who have clinically significant ocular surface disease. Alternative treatment options are laser trabeculoplasty or surgery with pharmacological augmentation (with mitomycin p. 970 [unlicensed indication]). Patients with advanced chronic open-angle glaucoma should be offered surgery with pharmacological augmentation (with mitomycin p. 970 [unlicensed indication]). Treatment with a topical prostaglandin analogue should be initiated and Eye continued until surgery takes place. If surgery fails to adequately reduce the intra-ocular pressure, alternative options include drug treatment (a combination of topical drugs from different therapeutic classes may be needed), further surgery, laser trabeculoplasty, or cyclodiode laser treatment. h Useful Resources Glaucoma: diagnosis and management. National Institute for Health and Care Excellence. NICE guideline 81. November 2017. www.nice.org.uk/guidance/ng81 BETA-ADRENOCEPTOR BLOCKERS
Source pages 1264, 1265
Filter the extracted dose blocks for this individual drug.
First line only; read the complete Indications and dose section above.
Apply 4 times a day for maximum duration of
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 1264
