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DOSAGE
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Allergic Conjunctivitis: 1gtt QID
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Moderate SPK: Mild Topical Steroid (FML 0.1% or Alrex 0.2%) QID x 1-4 weeks, followed by very slow taper. Then add on Restasis 0.50% qD-QID as an alternative or adjunctive treatment
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EKC (Viral) with mild SEI: Mild Topical Steroid (FML 0.1% or Alrex 0.2%) BID
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GENERIC
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loteprednol etabonate 0.2%
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INDICATIONS
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ALREX ophthalmic suspension is indicated for the temporary relief of the signs and symptoms of seasonal allergic conjunctivitis. Used off label for inflammatory dry eye and as a brief initial adjunctive with Restasis. Used off label to reduce inflammatory sequelae of EKC.
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MECHANISM OF ACTION
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Mast Cell Stabilizer (2nd generation)
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MICROBIOLOGY
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Corticosteroids inhibit the inflammatory response to a variety of inciting agents and probably delay or slow healing. They inhibit the edema, fibrin deposition, capillary dilation, leukocyte migration, capillary proliferation, fibroblast proliferation, deposition of collagen, and scar formation associated with inflammation. There is no generally accepted explanation for the mechanism of action of ocular corticosteroids. However, corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2. Corticosteroids are capable of producing a rise in intraocular pressure.
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CONTRAINDICATIONS & WARNINGS
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ALREX, as with other ophthalmic corticosteroids, is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures.
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ALREX is also contraindicated in individuals with known or suspected hypersensitivity to any of the ingredients of this preparation and to other corticosteroids.
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PEDIATRIC USE
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Safety and effectiveness in pediatric patients have not been established.
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PREGNANCY
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Category C: Teratogenic effects:Loteprednol etabonate has been shown to be embryotoxic (delayed ossification) and teratogenic (increased incidence of meningocele, abnormal left common carotid artery, and limb flexures) when administered orally to rabbits. There are no adequate and well controlled studies in pregnant women. ALREX ophthalmic suspension should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
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NOTE
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BAK preserved (.01%). Contains glycerin moisturizer.
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Should not be used to treat contact lens related irritation.
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Lotemax is the 0.5% preparation of loteprednol etabonate
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SHAKE VIGOROUSLY BEFORE USING.
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