Difluprednate

Pronunciation: DYE-floo-PRED-nate
Class: Corticosteroid

Trade Names

Durezol
- Emulsion, ophthalmic 0.05%

Pharmacology

Corticosteroids inhibit edema, fibrin deposition, capillary dilation, leukocyte migration, capillary and fibroblast proliferation, collagen deposition, and scar formation associated with inflammation. The mechanism of ocular corticosteroids is not known.

Slideshow: Fact or Fiction? The Top 15 Osteoarthritis Myths

Pharmacokinetics

Absorption

Systemic absorption after ocular installation is limited. Blood levels following ocular installation of 2 drops 4 times daily for 7 days were not quantifiable.

Metabolism

Difluprednate is deacetylated to an active metabolite.

Indications and Usage

Treatment of inflammation and pain associated with ocular surgery.

Contraindications

Most active viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella; mycobacterial infection of the eye; fungal disease of ocular structures.

Dosage and Administration

Adults

Ophthalmic Instill 1 drop into conjunctival sac of the affected eye(s) 4 times daily beginning 24 h after surgery and continuing throughout the first 2 wk of the postoperative period, followed by twice-daily instillation for 1 wk, and then taper based on response.

Storage/Stability

Store at 59° to 77°F. Do not freeze. Protect from light.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

EENT

Anterior chamber cells and flare, blepharitis, ciliary and conjunctival hyperemia, conjunctival edema, corneal edema, eye pain, photophobia, posterior capsule opacification (5% to 15%); eye inflammation, iritis, punctuate keratitis, reduced visual acuity (1% to 5%); elevated IOP, which may be associated with optic nerve damage; perforation of the globe where there is thinning of the cornea or sclera; posterior subcapsular cataract formation; secondary ocular infection from pathogens, including herpes simplex; visual acuity and field defects.

Precautions

Monitor

Monitor IOP if used for more than 10 days.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Elderly

No differences in safety and efficacy have been observed between elderly and younger patients.

Bacterial infection

Prolonged use may suppress the host response, increasing the hazard of secondary ocular infections.

Cataracts

Posterior subcapsular cataract formation may occur.

Fungal infections

Prolonged use may increase the risk of fungal infections of the cornea.

Glaucoma

Prolonged use may result in glaucoma with damage to the optic nerve, and defects in visual acuity and fields of vision.

Healing

Healing may be delayed and risk of bleb formation may be increased.

Viral infection

Prolonged use may prolong the course and exacerbate the severity of many ocular viral infections, including herpes simplex. Use with caution in patients with history of herpes simplex.

Overdosage

Symptoms

Systemic absorption is minimal following ocular instillation.

Patient Information

  • Instruct patient on the proper method of instillation.
  • Advise patient to consult health care provider if pain develops or if redness, itching, or inflammation becomes aggravated
  • Advise patient not to wear contact lenses when using difluprednate.

Copyright © 2009 Wolters Kluwer Health.

Hide
(web2)