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DOSAGE
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1 gtt q2hr while awake until complete re-epithelialization. Then 1 gtt q4hr x 7 days.
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GENERIC
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trifluridine 1.0%
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SIZE
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7.5 mL
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TREATMENT REGIMEN
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HERPES ZOSTER
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HERPES SIMPLEX
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Conjunctivitis: (1) Oral Antiviral (Choose one): Acyclovir 800 mg PO 5/day x 7-10 days, Valacyclovir 1000mg PO TID x 7-10 days or Famciclovir 500mg PO TID x 7-10 days (2) Cool compresses BID (3) Erythromycin ung BID
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Conjunctivitis: (1) Topical Antiviral (Choose one): Viroptic 1% 5x/day x 7 days or Zirgan 0.15% (gel) 5x/day x 7 days
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SPK Cornea: (1) Oral Antiviral (Choose one): Acyclovir 800 mg PO 5x/day x 7-10 days, Valacyclovir 1000mg PO TID x 7-10 days or Famciclovir 500mg PO TID x 7-10 days (2) Preservative-free artificial tears q1-2hrs + ung qHS
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Cornea Epithelial dendrites (1) Topical Antiviral (Choose one): Viroptic 1% 9x/day x 7 days or Zirgan 0.15% (gel) 5x/day x 7 days (2) Oral Antiviral (choose one): Acyclovir 400 mg PO 5x/day x 7-10 days, Valacyclovir 500mg PO TID x 7-10 days or Famciclovir 250mg PO TID x 7-10 days (3) Consider Cyclopentolate 1% TID if AC reaction or photophobia (4) DO NOT use topical steroids with epithelial
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Cornea Pseudodendrites: (1) Oral Antiviral (Choose one): Acyclovir 800 mg PO 5x/day x 7-10 days, Valacyclovir 1000mg PO TID x 7-10 days or Famciclovir 500mg PO TID x 7-10 days (2) Preservative-free artificial tears q1-2hrs + ung qHS (3) Topical antiviral: Zirgan 0.15% (gel) TID-QID x 7-10 days
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Cornea Stromal (Disciform Keratitis) (1) Cyclopentolate 1% TID (2) Antiviral prophylaxis Oral (choose one): Acyclovir 400 mg PO BID or Valacyclovir 500mg PO qDay to BID (3) Antiviral prophylaxis Drops (choose one): Viroptic 1% TID or Zirgan 0.15% (gel) 3-5x/day (4) If moderate/Severe with central vision loss: Add on Predforte 1% q2hr to QID
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Stromal Cornea Keratitis: (1) Oral Antiviral (Choose one): Acyclovir 800 mg PO 5/day x 7-10 days, Valacyclovir 1000mg PO TID x 7-10 days or Famciclovir 500mg PO TID x 7-10 days (2) Predforte 1% 4-8/day, then taper, usually with weaker steroid with goal of q1week.
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INDICATIONS
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Trifluridine Ophthalmic Solution is indicated for the treatment of primary keratoconjunctivitis and recurrent epithelial keratitis due to herpes simplex virus, types 1 and 2.
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MECHANISM OF ACTION
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modified deoxyuridine, a nucleoside analogue: replaces uracil, blocks base pairing
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MICROBIOLOGY
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Trifluridine is a fluorinated pyrimidine nucleoside with in vitro and in vivo activity against herpes simplex virus, types 1 and 2 and vacciniavirus. Some strains of adenovirus are also inhibited in vitro. Trifluridine interferes with DNA synthesis in cultured mammalian cells. However, its antiviral mechanism of action is not completely known.
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CONTRAINDICATIONS & WARNINGS
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Trifluridine Ophthalmic Solution is contraindicated for patients who develop hypersensitivity reactions or chemical intolerance to trifluridine.
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PEDIATRIC USE
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Safety and effectiveness in pediatric patients below six years of age have not been established.
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PREGNANCY
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Category C: Trifluridine was not teratogenic at doses up to 5 mg/kg/day (23 times the estimated human exposure) when given subcutaneously to rats and rabbits. However, fetal toxicity consisting of delayed ossification of portions of the skeleton occurred at dose levels of 2.5 and 5 mg /kg /day in rats and at 2.5 mg/kg/day in rabbits. In addition, both 2.5 and 5 mg/kg/day produced fetal death and resorption in rabbits. In both rats and rabbits, 1 mg/kg/day (5 times the estimated human exposure) was a no-effect level. There were no teratogenic or fetotoxic effects after topical application of trifluridine (approximately 5 times the estimated human exposure) to the eyes of rabbits on the 6th through the 18th days of pregnancy. In a non-standard test, trifluridine solution has been shown to be teratogenic when injected directly into the yolk sac of chicken eggs. There are no adequate and well-controlled studies in pregnant women. Trifluridine Ophthalmic Solution 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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Consider Zirgan for more convenient dosing and less potential surface toxicity. Consider Zovirax (oral acyclovir) if cost is an issue or for long term prophylaxis.
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If there are no signs of improvement after 7 days of therapy or complete re-epithelialization has not occurred after 14 days of therapy, other forms of therapy should be considered. Continuous administration of trifluridine for periods exceeding 21 days should be avoided because of potential ocular toxicity.
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