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DOSAGE
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Surgery (Pain/Inflammation): 1-2 gtts QID beginning 24 hours after surgery and for following 2 weeks
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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/Pterygium: FML 0.1% or Lotemax 0.2% to 0.5% QID
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Iritis: FML 0.1% ung or Lotemax gel 0.5% qHS (optional), in addition to Predforte 1% q1-6hrs depending on severity
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GENERIC
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loteprednol etabonate 0.5%
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INDICATIONS
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LOTEMAX® SM is a corticosteroid indicated for the treatment of post-operative inflammation and pain following ocular surgery
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Use off-Label for: Gel often used for inflammatory dry eye, uveitis, inflamed pinguecula and pterygium. Ointment/Gel may be used for contact dermatitis.
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MECHANISM OF ACTION
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Ester based "soft" steroid
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MICROBIOLOGY
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Loteprednol etabonate is a corticosteroid. Corticosteroids have been shown to inhibit the inflammatory response to a variety of inciting agents. They inhibit the edema, fibrin deposition, capillary dilation, leukocyte migration, capillary proliferation, fibroblast proliferation, deposition of collagen, and scar formation associated with inflammation. While glucocorticoids are known to bind to and activate the glucocorticoid receptor, the molecular mechanisms involved in glucocorticoid/glucocorticoid receptor-dependent modulation of inflammation are not clearly established. However, corticosteroids are thought to inhibit prostaglandin production through several independent mechanisms.
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CONTRAINDICATIONS & WARNINGS
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LOTEMAX® SM, 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, in mycobacterial infection of the eye and fungal diseases of ocular structures.
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PEDIATRIC USE
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Safety and effectiveness of LOTEMAX® SM 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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Prolonged use may cause glaucoma, cataracts, bacterial and fungal overgrowth. Contact lenses should not be used during the course of therapy.
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SM = submicron particle size. Gel contains moisturizers glycerin and propylene glycol. BAK (0.003%). Contact lenses should not be used during course of therapy.
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Lotemax SM allows for faster drug dissolution and greater aqueous penetration.
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