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DOSAGE
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1-2 gtts QID, q4hr within 1st 48hrs if needed, then taper. If there is no improvement after 2 days, patient should be re-evaluated. Shake prior to use.
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Cornea SPK (Moderate/Severe) (1) AT 4-8x/day + Gel qHS (2) Mild Topical Steroid (FML 0.1% of Lotemax QID) x 1-4 weeks, then taper (3) Add on Restasis BID to QID as alternative or adjunctive treatment (if steroid responder)
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EKC (Viral) with mild SEI: Mild Topical Steroid/gel BID
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Inflammed Ping/PTG (moderate/Severe): (1) UV protection (2) AT 4/day (3) FML 0.1% or Lotemax 0.2% to 0.5% QID (3) NSAID like ketoralac 0.4% or Mast cell combo Pataday qD to decrease symptoms
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Severe GPC: Short-term use of FML 0.1% or Lotemax 0.2%-0.5% QID (d/c CL wear), addition to topical combo anti-allergies like Pataday 0.2% qD
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GENERIC
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fluorometholone alcohol 0.1%
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SIZE
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5mL,10mL,15mL
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INDICATIONS
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FML suspension is indicated for the treatment of corticosteroid-responsive inflammation of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe.
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Used off label for inflammatory dry eye and as a brief initial adjunctive with Restasis.
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Used off label to reduce inflammatory sequelae of EKC.
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MECHANISM OF ACTION
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Ketone, alcohol derived, fluorinated "soft" steroid
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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.
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CONTRAINDICATIONS & WARNINGS
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FML suspension 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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FML suspension 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 infants below the age of two years have not been established.
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PREGNANCY
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Teratogenic effects Category C Fluorometholone has been shown to be embryocidal and teratogenic in rabbits when administered at low multiples of the human ocular dose. Fluorometholone was applied ocularly to rabbits daily on days 6-18 of gestation, and dose-related fetal loss and fetal abnormalities including cleft palate, deformed rib cage, anomalous limbs and neural abnormalities such as encephalocele, craniorachischisis, and spina bifida were observed. There are no adequate and well-controlled studies of fluorometholone in pregnant women, and it is not known whether fluorometholone can cause fetal harm when administered to a pregnant woman. Fluorometholone 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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Fungal and bacterial overgrowth, cataract formation, globe perforation possible with long term use. FML (Allergan), Fluor-Op (Novartis). BAK preserved.
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