Are We Aware of the Risk of Eye Irritation Caused by Some Eyedrops, Paradoxically, in the Treatment of Allergic Conjunctivitis ?

Home , Cromoglicic acid, Lodoxamide, Nedocromil

Patient PS-035 ARE WE AWARE OF THE RISK OF EYE IRRITATION CAUSED safety and

BY SOME EYEDROPS, PARADOXICALLY, management risk

Morocco IN THE TREATMENT OF ALLERGIC CONJUNCTIVITIS ?

Younes Rahali* *Hospital Pharmacy, Specialties Hospital of Rabat, University Mohammed V, Rabat, Morocco / [email protected]

OBJECTIVES The formulation of eye drops needs to prevent any microbial contamination of the eye. For this purpose, pharmaceutical manufacturer can use: the addition of a preservative, the use of a specific packaging including a sterilising filter or a single dose packaging. The purpose of the study is to check if the contents of eye drops indicated for the treatment of allergic conjunctivitis can be irritating for the eye.

METHODS For this purpose, based on Vidal® 2013, we searched for eye drops used in allergic conjunctivitis and we analysed their excipient formulas searching for those known irritating to the eye.

RESULTS The 21 analysed formulas revealed that the benzalkonium chloride is the only preservative used in this context. Although it is classified as an excipient known to be irritating to the eye, it is still used in 11 cases and cited as an excipient with known effect in only 1 case, while for the rest it is cited as an antimicrobial preservative. The single-dose packaging is used in 7 cases while the packaging including a sterilising filter is used in only 3 cases.

INN (INTERNATIONAL PRESERVATIVE BRAND NAME EXCIPIENTS PACKAGING NON-PROPRIETARY NAME) (NF = NOT FOUND) SODIUM CHLORIDE, DODECAHYDRATE DISODIUM PHOSPHATE, MULTIDOSE INCLUDING CROMABAK® EYEDROPS NF DISODIUM PHOSPHATE DIHYDRATE, WATER WFI (WATER FOR INJECTION) A STERILISING FILTER EDETATE SODIUM, POLYSORBATE 80, SORBITOL, SODIUM HYDROXIDE, CROMEDIL® EYEDROPS BENZALKONIUM CHLORIDE MULTIDOSE WATER WFI. PRESERVATIVE: BENZALKONIUM CHLORIDE CROMEDIL® EYEDROPS SODIUM CHLORIDE, WATER WFI NF SINGLE-DOSE CROMOGLICIC ACID HUMEX® EYEDROPS SODIUM CHLORIDE, WATER WFI NF SINGLE-DOSE SODIUM CHLORIDE, DODECAHYDRATE DISODIUM PHOSPHATE, MULTIDOSE INCLUDING MULTICROM® EYEDROPS NF DISODIUM PHOSPHATE DIHYDRATE, WATER WFI A STERILISING FILTER MULTICROM® EYEDROPS SODIUM CHLORIDE, WATER WFI NF SINGLE-DOSE OPTICRON® EYEDROPS EDETATE SODIUM, BENZALKONIUM CHLORIDE, WATER WFI BENZALKONIUM CHLORIDE MULTIDOSE OPTICRON® EYEDROPS SODIUM CHLORIDE, WATER WFI NF SINGLE-DOSE MULTIDOSE INCLUDING NAABAK® EYEDROPS SODIUM HYDROXIDE OR HYDROCHLORIC ACID FOR PH 7.2, WATER WFI NF A STERILISING FILTER NAAXIA® 19,6 MG/0,4 ML SODIUM HYDROXIDE OR HYDROCHLORIC ACID FOR PH 7.2, WATER WFI. SPAGLUMIC ACID BENZALKONIUM CHLORIDE MULTIDOSE EYEDROPS PRESERVATIVE: BENZALKONIUM CHLORIDE SODIUM HYDROXIDE OR HYDROCHLORIC ACID FOR PH 7.2, WATER WFI. NAAXIA® EYEDROPS BENZALKONIUM CHLORIDE MULTIDOSE PRESERVATIVE: BENZALKONIUM CHLORIDE AZELASTINE BENZALKONIUM CHLORIDE, HYPROMELLOSE, EDETATE SODIUM, ALLERGODIL® EYEDROPS BENZALKONIUM CHLORIDE MULTIDOSE HYDROCHLORIDE SORBITOL, SODIUM HYDROXIDE, WATER WFI ISODRIL PHENYLEPHRINE® MANNITOL, SODIUM GLUCONATE, EDETATE SODIUM, WATER WFI NF SINGLE-DOSE CHLORHEXIDINE EYEDROPS DIGLUCONATE VISIODOSE® EYEDROPS MANNITOL, POTASSIUM GLUCONATE, EDETATE SODIUM, WATER WFI NF SINGLE-DOSE SODIUM HYDROGEN PHOSPHATE, POLYSORBATE 80, SODIUM CHLORIDE, DEXAMETHASONE MAXIDEX® EYEDROPS BENZALKONIUM CHLORIDE MULTIDOSE METHYLHYDROXYPROPYLCELLULOSE, CITRIC ACID, WATER WFI BENZALKONIUM CHLORIDE, METHYLHYDROXYPROPYLCELLULOSE, FLUOROMETHOLONE FLUCON® EYEDROPS SODIUM HYDROGEN PHOSPHATE, POLYSORBATE 80, SODIUM CHLORIDE, BENZALKONIUM CHLORIDE MULTIDOSE EDETATE SODIUM, POLYVINYL ALCOHOL, WATER WFI LEVOCABASTINE PROPYLENE GLYCOL, SODIUM HYDROGEN PHOSPHATE, HYPROMELLOSE, LEVOPHTA® EYEDROPS BENZALKONIUM CHLORIDE MULTIDOSE HYDROCHLORIDE POLYSORBATE 80, WATER WFI BENZALKONIUM CHLORIDE, MANNITOL, EDETATE SODIUM, METHYLHYDROXYPROPYLCELLULOSE, SODIUM CITRATE, CITRIC ACID, ALMIDE® EYEDROPS BENZALKONIUM CHLORIDE MULTIDOSE TYLOXAPOL, SODIUM HYDROXIDE OR HYDROCHLORIC ACID FOR PH 7.2, LODOXAMIDE WATER WFI TROMETHAMINE MANNITOL, HYPROMELLOSE 2910, SODIUM CITRATE, CITRIC ACID, ALMIDE® EYEDROPS TYLOXAPOL, SODIUM HYDROXIDE OR HYDROCHLORIC ACID FOR PH 7.2, NF SINGLE-DOSE WATER WFI BENZALKONIUM CHLORIDE, EDETATE SODIUM, SODIUM CHLORIDE, NEDOCROMIL SODIUM TILAVIST® EYEDROPS BENZALKONIUM CHLORIDE MULTIDOSE WATER WFI MANNITOL, CARBOMERE (CARBOPOL 974 P), POLYSORBATE 80, SODIUM RIMEXOLONE VEXOL® EYEDROPS CHLORIDE, EDETATE SODIUM, SODIUM HYDROXIDE OR HYDROCHLORIC BENZALKONIUM CHLORIDE MULTIDOSE ACID FOR PH 7.2, WATER WFI. PRESERVATIVE: BENZALKONIUM CHLORIDE

DISCUSSION From these results we see that benzalkonium chloride is widely used. On the other hand, treating allergic conjunctivitis by a potentially irritating drug can be problematic when induced irritation takes over the symptoms of the allergy. This can lead to extend the treatment beyond the expected duration and also create doubts about the efficiency of the drug.

CONCLUSIONS It seems wise to choose a drug that does not contain benzalkonium chloride when it comes to treat an allergic conjunctivitis. However, if this is not possible, the ophthalmologist must be aware of this risk when it comes to the clinical evaluation of the patient.

REFERENCE : Vidal® expert database 2013 No conflict of interest