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DOSAGE
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Allergic Conjunctivitis/inflammation: 1-2gtts QID, up to 1 gtt q1hr in 1st week if needed.
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Post-Surgery (Pain/Inflammation): 1-2 gtts QID beginning 24 hours after surgery and for following 2 weeks (Shake prior to use)
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Moderate SPK: Mild Topical Steroid 1gtts QID x 1-4 weeks, followed by very slow taper. Then add on Restasis 0.50% qDay-QID as an alternative or adjunctive treatment
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EKC (Viral) with mild SEI: Mild Topical Steroid/gel BID
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Moderate/Severe Inflamed Ping/PTG: FML 0.1% or Lotemax 0.2% to 0.5% QID
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Severe GPC: Short-term use of Lotemax 0.2%-0.5% QID (d/c CL wear), addition to topical combo anti-allergies like Pataday 0.2% qDay
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GENERIC
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loteprednol etabonate 0.5%
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SIZE
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5mL, 10mL, 15mL
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INDICATIONS
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LOTEMAX is indicated for the treatment of steroid- responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitides, when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation.
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LOTEMAX is also indicated for the treatment of postoperative inflammation following ocular surgery.
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LOTEMAX is less effective than prednisolone acetate 1% for acute anterior uveitis
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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, and severe GPC
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MECHANISM OF ACTION
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Ester based "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. 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 (IOP).
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CONTRAINDICATIONS & WARNINGS
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LOTEMAX, 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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LOTEMAX 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 in rabbits at 1.2x the normal human dose. There are no adequate and well-controlled studies with loteprednol etabonate in pregnant women.
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NOTE
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Funga, viral, bacterial overgrowth, cataract formation, glaucoma, globe perforation possible with long term use.
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BAK preserved. Alrex is the 0.2% preparation of loteprednol etabonate. From the package insert: "As with all ophthalmic preparations containing benzalkonium chloride, patients should be advised not to wear soft contact lenses when using LOTEMAX."
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