Eye and Ear Top Drugs

Brimonidine brand name and class

Alpha-adrenergic agonist, Alphagan P

Brimonidine MOA and IND

MOA: reduces aqueous humor production, increases outflow

Ind: elevated IOP, off-label - ocular redness (0.025% OTC)

Brimonidine forms and dosing

Drops 0.1,0.15,0.2%

1 drop in affected eye Q8H

kinetics for Brimonidine, Travoprost, Bimatoprost, latanoprost, Cyclosporine

none

Brimonidine P/CI

P/CI: don’t use if hypersensitive, MAOI’s

Brimonidine ADE

Allergic conjunctivitis, drowsiness, burning, HTN, fainting

Brimonidine Counseling and Monitoring

C: proper administration 

M: Check IOP 1 month after starting therapy

Travoprost brand name and class

Prostaglandin Analog, Travatan Z

Travoprost, Bimatoprost, Latanoprost MOA and IND

MOA: reduce IOP via aqueous humor outflow

Ind: ocular HTN, Glaucoma

Travoprost forms and dosing

Drops 0.004%

1 drop in affected eye QPM

Travoprost, Bimatoprost, Latanoprost P/CI

P/CI: don’t use if hypersensitive

Travoprost, Bimatoprost, Latanoprost ADE

Eyelash growth, iris/eyelid pigmentation, ocular itching, blurry vision, foreign body sensation

Travoprost, Bimatoprost, Latanoprost Counseling and Monitoring

C: take at bedtime, proper administration

M: IOP

Bimatoprost forms and dosing

Drops 0.01,0.03% 1 drop in affected eye QPM

Cyclosporine brand name and class

Calcineurin inhibitor, Restasis, Cequa, Vevye, Verkazia

Cyclosporine MOA and IND

MOA: reduces inflammation by stopping lymphocyte activation and death

Ind: dry eye disease

Cyclosporine forms and dosing

Restasis: 0.05% emulsion 1 drop BID

Cequa: 0.09% PF solution, 1 drop BID

Vevye: 0.1% solution 1 drop BID

Verkazia: 0.1% solution 1 drop QID

Cyclosporine P/CI

P/CI: don’t use with current eye infection or hypersensitivity

Cyclosporine ADE

Burning, eye pain, conjunctivitis, blurry vision, hypersensitivity

Cyclosporine Counseling and Monitoring

C: separate from artificial tears by 15 min, may take 3 months to see full effect

M: check in at 6 weeks for improvement

Timolol brand name and class

Ophthalmic beta blocker, Timoptic, Betimol

Timolol MOA and IND

MOA: beta-1 and 2 blocker, reduces aqueous humor

Ind: Elevated IOP, glaucoma, off-label - acute angle-closure glaucoma

Timolol forming and dosing

0.25,0.5% solution

1 drop in affected eye BID

Timolol Kinetics

Systemic absorption

Timolol P/CI and Interactions

P/CI: asthma, COPD, low HR, HF

I: oral beta-blockers, oral calcium channel blockers

Timolol ADE

Blurry vision, stinging, low HR, low BP, dizzy/drowsy, hypersensitivity

Timolol Monitoring

M: IOP, BP and HR

Gatifloxacin brand name and class

Fluroroquinolone antibiotic, Zymaxid

Gatilfloxacin, Moxifloxacin, and Ciprofloxacin MOA and IND

MOA: antibiotic

Ind: bacterial conjunctivitis, off-label - surgical preventative

Gatilfloxacin forms and dosing

0.5% solution

1 drop Q2Hx1 days, then QIDx6 days

Gatilfloxacin, Moxifloxacin, and Ciprofloxacin Kinetics

none floxicin

Gatilfloxacin and Moxifloxacin P/CI

P/CI: don’t use if hypersensitive

Gatilfloxacin and Moxifloxacin ADE

Hypersensitivity, superinfection, eye irritation

Gatilfloxacin and Moxifloxacin Counseling and Monitoring

C: finish course, no contact use during M: improve 1-2 days, check back if not resolved

Moxifloxacin forms and dosing

0.5% solution

1 drop BID or TIDx7 days

Ciprofloxacin forms and dosing

0.2% solution, 0.25 mL (single use)

1 dose into affected ear BIDx7 days

Ciprofloxacin P/CI

P/CI: don’t use if hypersensitive

Ciprofloxacin ADE

Burning, stinging, hypersensitivity, superinfection, headache

Ciprofloxacin Counseling and Monitoring

C: otic use only, finish course
M: improve in 2-3 days, resolve in 14 days, follow up if not better