Indicated for short-term adjunctive therapy in patients on maximally tolerated medical therapy who require additional intraocular pressure (IOP) reduction. Patients on maximally tolerated medical therapy who are treated with Apraclonidine Ophthalmic Solution to delay surgery should have frequent follow-up examinations and treatment should be discontinued if the IOP rises significantly.
The addition of Apraclonidine Ophthalmic Solution to patients already using two aqueous suppressing drugs (i.e., beta-blocker plus carbonic anhydrase inhibitor) as part of their maximally tolerated medical therapy may not provide additional benefit. This is because Apraclonidine Ophthalmic Solution is an aqueous suppressing drug and the addition of a third aqueous suppressant may not significantly reduce IOP.
The IOP lowering efficacy of Apraclonidine Ophthalmic Solution diminishes over time in some patients. This loss of effect, or tachyphylaxis, appears to be an individual occurrence with a variable time of onset and should be closely monitored. The benefit for most patients is less than 1 month.
►Short-term adjunctive therapy in patients on maximally tolerated medical therapy who require additional reduction of intraocular pressure (IOP):
Preservatives may vary across product manufacturers. Consult individual package inserts.
Apraclonidine hydrochloride is relatively selective alpha-2-adrenergic agonist. When instilled in the eye, Apraclonidine Ophthalmic Solution, has the action of reducing elevated, as well as normal, intraocular pressure (IOP), whether or not accompanied by glaucoma. Ophthalmic apraclonidine has minimal effect on cardiovascular parameters.
Consult package insert for additional information.
Contraindicated in patients with hypersensitivity to apraclonidine or any other component of this medication, as well as systemic clonidine. It is also contraindicated in patients receiving monoamine oxidase inhibitors (MAO inhibitors).
None listed in package insert.
Indicated for: cycloplegia; mydriasis; penalization of the healthy eye in the treatment of amblyopia.
►Cycloplegia; mydriasis; penalization of the healthy eye in the treatment of amblyopia:
Preservatives may vary across product manufacturers. Consult individual package inserts.
Atropine is a reversible antagonist of muscarine-like actions of acetylcholine and is therefore classified as an antimuscarinic agent. Atropine is relatively selective for muscarinic receptors. Its potency at nicotinic receptors is much lower, and actions at non-muscarinic receptors are generally undetectable clinically. Atropine does not distinguish among the M1, M2, and M3 subgroups of muscarinic receptors.
The pupillary constrictor muscle depends on muscarinic cholinoceptor activation. This activation is blocked by topical atropine resulting in unopposed sympathetic dilator activity and mydriasis. Atropine also weakens the contraction of the ciliary muscle, or cycloplegia. Cycloplegia results in loss of the ability to accommodate such that the eye cannot focus for near vision.
Should not be used in anyone who has demonstrated a previous hypersensitivity or known allergic reaction to any ingredient of the formulation because it may recur.
None listed in package insert.
Indicated for the treatment of: skin infections; sinusitis; hordeolum; preseptal cellulitis; dacryocyctitis.
►Skin infections; sinusitis; hordeolum; preseptal cellulitis; dacryocystitis:
None listed in package insert.
Amoxicillin is a semisynthetic antibiotic with a broad spectrum of bactericidal activity against many gram-positive and gram-negative microorganisms. Amoxicillin is, however, susceptible to degradation by β-lactamases, and therefore, the spectrum of activity does not include organisms which produce these enzymes. Clavulanic acid is a β-lactam, structurally related to the penicillins, which possesses the ability to inactivate a wide range of β-lactamase enzymes commonly found in microorganisms resistant to penicillins and cephalosporins. In particular, it has good activity against the clinically important plasmid-mediated β-lactamases frequently responsible for transferred drug resistance.
The formulation of amoxicillin and clavulanic acid in AUGMENTIN protects amoxicillin from degradation by β-lactamase enzymes and effectively extends the antibiotic spectrum of amoxicillin to include many bacteria normally resistant to amoxicillin and other β-lactam antibiotics. Thus, AUGMENTIN possesses the distinctive properties of a broad-spectrum antibiotic and a β-lactamase inhibitor.
Amoxicillin/clavulanic acid has been shown to be active against most strains of the listed microorganisms, both in vitro and in clinical infections as described in INDICATIONS AND USAGE in the package insert.
Consult package insert for additional information.
Contraindicated in patients with a history of serious hypersensitivity reactions (e.g., anaphylaxis or Stevens-Johnson syndrome) to amoxicillin, clavulanate or to other beta-lactam antibacterial drugs (e.g., penicillins and cephalosporins). It is also contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with AUGMENTIN.
None listed in package insert.
Used for the treatment of patients with neovascular (wet) age-related macular degeneration, macular edema following retinal vein occlusion, diabetic macular edema, diabetic retinopathy, myopic choroidal neovascularization, or choroidal neovascularization due to presumed ocular histoplasmosis.
►Macular degeneration, wet age-related or choroidal retinal neovascularization:
►Macular edema following retinal vein occlusion:
►Diabetic macular edema or diabetic retinopathy:
None listed in package insert.
Bevacizumab binds VEGF and prevents the interaction of VEGF to its receptors (Flt-1 and KDR) on the surface of endothelial cells. The interaction of VEGF with its receptors leads to endothelial cell proliferation and new blood vessel formation in in vitro models of angiogenesis. Administration of bevacizumab to xenotransplant models of colon cancer in nude (athymic) mice caused reduction of microvascular growth and inhibition of metastatic disease progression.
None listed in package insert.
None listed in package insert.
Indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following microorganisms: CDC coryneform group G*; Haemophilus influenzae; Staphylococcus aureus; Streptococcus mitis group; Streptococcus pneumonia.
*Efficacy for this orgaeptiblenism was studied in < 10 infections.
►Bacterial conjunctivitis caused by susceptible isolates of the listed microorganisms, recommended:
►Recurrent corneal erosion:
benzalkonium chloride
Azithromycin is a macrolide antibiotic [See Clinical Pharmacology (12.4) in package insert].
Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and interfering with microbial protein synthesis.
Azithromycin has been shown to be active against most isolates of the following microorganisms, both in vitro and clinically in conjunctival infections [See Indications and Usage (1) in package insert].
*Efficacy for this organism was studied in fewer than 10 infections.
Consult package insert for additional information.
Contraindicated in patients with hypersensitivity to any component of this product.
None listed in package insert.
Indicated for the treatment of itching of the eye associated with allergic conjunctivitis.
►Itching associated with allergic conjunctivitis, recommended:
Preservatives may vary across product manufacturers. Consult individual package inserts.
Azelastine hydrochloride is a relatively selective histamine H1 antagonist and an inhibitor of the release of histamine and other mediators from cells (e.g. mast cells) involved in the allergic response. Based on in vitro studies using human cell lines, inhibition of other mediators involved in allergic reactions (e.g. leukotrienes and PAF) has been demonstrated with azelastine hydrochloride. Decreased chemotaxis and activation of eosinophils has also been demonstrated.
Consult package insert for additional information.
Contraindicated in persons with known or suspected hypersensitivity to any of this medication's components.
None listed in package insert.
Indicated for the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms: uncomplicated skin and skin structure infections in adults due to Staphylococcus aureus, Streptococcus pyogenes, or Streptococcus agalactiae. Abscesses usually require surgical drainage. Recommended dosages and durations of therapy in adult and pediatric patient populations vary in these indications.
►Skin/skin structure (uncomplicated):
►Inclusion (chlamydial) conjunctivitis:
►Hordeolum:
Preservatives may vary across product manufacturers. Consult individual package inserts.
Azithromycin is a macrolide antiibiotic that acts by binding the 23S rRNA of the 50S ribosomal subunit of susceptible microorganisms inhibiting bacterial protein synthesis and impeding the assembly of the 50S ribosomal subunit.
Contraindicated in patients with known hypersensitivity to azithromycin, erythromycin, any macrolide or ketolide drug.
Contraindicated in patients with a history of cholestatic jaundice/hepatic dysfunction associated with prior use of azithromycin.
None listed in package insert.
Indicated for the treatment of elevated intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma.
Elevated intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma, recommended:
benzalkonium chloride
Carbonic anhydrase (CA) is an enzyme found in many tissues of the body including the eye. It catalyzes the reversible reaction involving the hydration of carbon dioxide and the dehydration of carbonic acid. In humans, carbonic anhydrase exists as a number of isoenzymes, the most active being carbonic anhydrase II (CA-II), found primarily in red blood cells (RBCs), but also in other tissues. Inhibition of carbonic anhydrase in the ciliary processes of the eye decreases aqueous humor secretion, presumably by slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport. The result is a reduction in intraocular pressure (IOP).
AZOPT (brinzolamide ophthalmic suspension) 1% contains brinzolamide, an inhibitor of carbonic anhydrase II (CA-II). Following topical ocular administration, brinzolamide inhibits aqueous humor formation and reduces elevated intraocular pressure. Elevated intraocular pressure is a major risk factor in the pathogenesis of optic nerve damage and glaucomatous visual field loss.
Contraindicated in patients who are hypersensitive to any component of this product.
None listed in package insert.
Indicated for the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms.
►Superficial ocular infections involving the conjunctiva and/or cornea caused by susceptible organisms:
►Recurrent corneal erosion:
Preservatives may vary across product manufacturers. Consult individual package inserts.
The antibiotic, Bacitracin, exerts a profound action against many gram-positive pathogens, including the common Streptococci and Staphlococci. It is also destructive for certain gram-negative organisms. It is ineffective against fungi.
This product should not be used in patients with a history of hypersensitivity to Bacitracin.
None listed in package insert.
None listed in package insert.
Used in the treatment of lacrimal infections, preseptal cellulitis, and/or soft tissue infections.
This medication has a broad FDA approval for the treatment of "infections due to susceptible strains of bacteria." Under our interpretation of this indication we have linked this medication with conditions we understand may be "infections due to susceptible strains of bacteria." This is our medical opinion and may not be true in all clinical circumstances.
►Lacrimal infections, preseptal cellulitis, and/or soft tissue infections, recommended:
alcohol, methylparaben, sodium benzoate (oral suspension); sodium benzoate (tablets).
Sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with paraaminobenzoic acid (PABA). Trimethoprim blocks the production of tetrahydrofolic acid from dihydrofolic acid by binding to and reversibly inhibiting the required enzyme, dihydrofolate reductase. Thus, sulfamethoxazole and trimethoprim blocks two consecutive steps in the biosynthesis of nucleic acids and proteins essential to many bacteria.
Consult package insert for additional information.
Contraindicated in patients with a known hypersensitivity to trimethoprim or sulfonamides, in patients with a history of drug-induced immune thrombocytopenia with use of trimethoprim and/or sulfonamides, and in patients with documented megaloblastic anemia due to folate deficiency.
BACTRIM is contraindicated in pediatric patients less than 2 months of age. BACTRIM is also contraindicated in patients with marked hepatic damage or with severe renal insufficiency when renal function status cannot be monitored.
None listed in package insert.
Indicated for the treatment of neovascular (wet) age-related macular degeneration.
►Neovascular (wet) age-related macular degeneration, recommended:
None listed in package insert.
Brolucizumab is a human VEGF inhibitor. Brolucizumab binds to the three major isoforms of VEGF-A (e.g., VEGF110, VEGF121, and VEGF165), thereby preventing interaction with receptors VEGFR-1 and VEGFR-2. By inhibiting VEGF-A, brolucizumab suppresses endothelial cell proliferation, neovascularization, and vascular permeability.
None listed in package insert.
Additional information for Dosage and Administration:
Indicated for the treatment of itching associated with signs and symptoms of allergic conjunctivitis.
►Itching associated with allergic conjunctivitis:
benzalkonium chloride
Bepotastine is a topically active, direct H1-receptor antagonist and an inhibitor of the release of histamine from mast cells.
Contraindicated in patients with a history of hypersensitivity reactions to bepotastine or any of the other ingredients [See Adverse Reactions (6.2) in package insert].
None listed in package insert.
Indicated for the treatment of bacterial conjunctivitis caused by susceptible isolates of the following bacteria: Aerococcus viridians*; CDC coryneform group G; Corynebacterium pseudodiphtheriticum*; Corynebacterium striatum*; Haemophilus influenzae; Moraxella catarrhalis*; Moraxella lacunata*; Pseudomonas aeruginosa*; Staphylococcus aureus; Staphylococcus epidermidis; Staphylococcus hominis*; Staphylococcus lugdunensis*; Staphylococcus warneri*; Streptococcus mitis group; Streptococcus oralis; Streptococcus pneumoniae; Streptococcus salivarius*.
*Efficacy for this organism was studied in fewer than 10 infections
►Bacterial conjunctivitis caused by susceptible isolates of the listed bacteria:
►Recurrent corneal erosion, recommended:
benzalkonium chloride
Besifloxacin is an 8-chloro fluoroquinolone with a N-1 cyclopropyl group. The compound has activity against Gram-positive and Gram-negative bacteria due to the inhibition of both bacterial DNA gyrase and topoisomerase IV. DNA gyrase is an essential enzyme required for replication, transcription and repair of bacterial DNA. Topoisomerase IV is an essential enzyme required for partitioning of the chromosomal DNA during bacterial cell division. Besifloxacin is bactericidal with minimum bactericidal concentrations generally within one dilution of the minimum inhibitory concentrations (MICs).
The mechanism of action of fluoroquinolones, including besifloxacin, is different from that of aminoglycoside, macrolide, and β-lactam antibiotics. Therefore, besifloxacin may be active against pathogens that are resistant to these antibiotics and these antibiotics may be active against pathogens that are resistant to besifloxacin. In vitro studies demonstrated cross-resistance between besifloxacin and some fluoroquinolones.
Consult package insert for additional information.
None listed in package insert.
None listed in package insert.
Indicated for prepping of the periocular region (lids, brow, and cheek) and irrigation of the ocular surface (cornea, conjunctiva, and palpebral fornices).
►Prepping of the periocular region (lids, brow, and cheek) and irrigation of the ocular surface (cornea, conjunctiva, and palpebral fornices):
None listed in package insert.
Povidone iodine is a broad-spectrum microbicide.
Contraindicated in individuals known to be sensitive to iodine, or other components of this product.
None listed in package insert.
Has been shown to be effective in lowering intraocular pressure (IOP) and may be used in patients with chronic open-angle glaucoma or ocular hypertension.
►Elevated intraocular pressure (IOP) in patients with chronic open-angle glaucoma or ocular hypertension, recommended:
benzalkonium chloride
Levobunolol HCl is a noncardioselective beta-adrenoceptor blocking agent, equipotent at both beta1 and beta2 receptors. Levobunolol HCl is greater than 60 times more potent than its dextro isomer in its betablocking activity, yet equipotent in its potential for direct myocardial depression. Accordingly, the levo isomer, levobunolol HCl, is used. Levobunolol HCl does not have significant local anesthetic (membrane-stabilizing) or intrinsic sympathomimetic activity.
Beta-adrenergic receptor blockade reduces cardiac output in both healthy subjects and patients with heart disease. In patients with severe impairment of myocardial function, beta-adrenergic receptor blockade may inhibit the stimulatory effect of the sympathetic nervous system necessary to maintain adequate cardiac function.
Beta-adrenergic receptor blockade in the bronchi and bronchioles results in increased airway resistance from unopposed parasympathetic activity. Such an effect in patients with asthma or other bronchospastic conditions is potentially dangerous.
Consult package insert for additional information.
Contraindicated in those individuals with bronchial asthma, or with a history of bronchial asthma, or severe chronic obstructive pulmonary disease (See WARNINGS in package insert); sinus bradycardia; second and third degree atrioventricular block; overt cardiac failure (See WARNINGS in package insert); cardiogenic shock; or hypersensitivity to any component of these products.
None listed in package insert.
Indicated for the treatment of ocular hypertension and chronic open-angle glaucoma. It may be used alone or in combination with other anti-glaucoma drugs.
►Elevated intraocular pressure (IOP) in patients with ocular hypertension or chronic open-angle glaucoma, recommended:
Preservatives may vary across product manufacturers. Consult individual package inserts.
Betaxolol, a cardioselective (beta-1-adrenergic) receptor blocking agent, does not have significant membrane-stabilizing (local anesthetic) activity and is devoid of intrinsic sympathomimetic action. Orally administered beta-adrenergic blocking agents reduce cardiac output in healthy subjects and patients with heart disease. In patients with severe impairment of myocardial function, beta-adrenergic receptor antagonists may inhibit the sympathetic stimulatory effect necessary to maintain adequate cardiac function.
When instilled in the eye, Betaxolol has the action of reducing elevated as well as normal intraocular pressure, whether or not accompanied by glaucoma. Ophthalmic betaxolol has minimal effect on pulmonary and cardiovascular parameters.
Consult package insert for additional information.
Contraindicated in patients with hypersensitivity to any component of this product. Betaxolol ophthalmic solution is contraindicated in patients with sinus bradycardia, greater than a first degree atrioventricular block, cardiogenic shock, or patients with overt cardiac failure.
None listed in package insert.
Indicated for the treatment of elevated intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma.
►Elevated intraocular pressure (IOP) in patients with ocular hypertension or open-angle glaucoma, recommended:
benzalkonium chloride
Timolol is a non-selective beta-adrenergic antagonist.
It blocks both beta1- and beta2-adrenergic receptors. Timolol does not have significant intrinsic sympathomimetic activity, local anesthetic (membrane-stabilizing) or direct myocardial depressant activity.
Timolol, when applied topically in the eye, reduces normal and elevated intraocular pressure (IOP) whether or not accompanied by glaucoma. Elevated intraocular pressure is a major risk factor in the pathogenesis of glaucomatous visual field loss. The higher the level of IOP, the greater the likelihood of glaucomatous visual field loss and optic nerve damage. The predominant mechanism of ocular hypotensive action of topical beta-adrenergic blocking agents is likely due to a reduction in aqueous humor production.
In general, beta-adrenergic blocking agents reduce cardiac output both in healthy subjects and patients with heart diseases. In patients with severe impairment of myocardial function, beta-adrenergic receptor blocking agents may inhibit sympathetic stimulatory effect necessary to maintain adequate cardiac function. In the bronchi and bronchioles, beta-adrenergic receptor blockade may also increase airway resistance because of unopposed parasympathetic activity.
Contraindicated in patients with overt heart failure, cardiogenic shock, sinus bradycardia, second- or third-degree atrioventricular block, bronchial asthma or history of bronchial asthma, or severe chronic obstructive pulmonary disease, or hypersensitivity to any component of this product.
None listed in package insert.
Indicated for the treatment of elevated intraocular pressure (IOP) in patients with chronic open-angle glaucoma or ocular hypertension.
►Elevated intraocular pressure (IOP) in patients with chronic open-angle glaucoma or ocular hypertension:
benzalkonium chloride
Store upright at 36° – 77°F (2° – 25°C).
Betaxolol is a cardioselective (beta-1-adrenergic) receptor blocking agent, does not have significant membrane-stabilizing (local anesthetic) activity and is devoid of intrinsic sympathomimetic action. Orally administered beta-adrenergic blocking agents reduce cardiac output in healthy subjects and patients with heart disease. In patients with severe impairment of myocardial function, beta-adrenergic receptor antagonists may inhibit the sympathetic stimulatory effect necessary to maintain adequate cardiac function.
When instilled in the eye, BETOPTIC® S has the action of reducing elevated as well as normal intraocular pressure, whether or not accompanied by glaucoma. Ophthalmic betaxolol has minimal effect on pulmonary and cardiovascular parameters.
Consult package insert for additional information.
Contraindicated in patients with sinus bradycardia, greater than a first degree atrioventricular block, cardiogenic shock, patients with overt cardiac failure, and hypersensitivity to any component of this product.
None listed in package insert.
Indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.
►Elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension, recommended:
Preservatives may vary across product manufacturers. Consult individual package inserts.
Bimatoprost, a prostaglandin analog, is a synthetic structural analog of prostaglandin with ocular hypotensive activity. It selectively mimics the effects of naturally occurring substances, prostamides. Bimatoprost is believed to lower intraocular pressure (IOP) in humans by increasing outflow of aqueous humor through both the trabecular meshwork and uveoscleral routes. Elevated IOP presents a major risk factor for glaucomatous field loss. The higher the level of IOP, the greater the likelihood of optic nerve damage and visual field loss.
Contraindicated in patients with hypersensitivity to bimatoprost or to any of the ingredients [See Adverse Reactions (6.2) in package insert].
None listed in package insert.
Indicated for the treatment of conjunctivitis and other superficial ocular infections due to susceptible microorganisms and as an adjunctive in systemic sulfonamide therapy of trachoma: Escherichia coli; Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus (viridans group); Haemophilus influenzae; Klebsiella species; Enterobacter species.
Topically applied sulfonamides do not provide adequate coverage against Neisseria species, Serratia marcescens and Pseudomonas aeruginosa. A significant percentage of staphylococcal isolates are completely resistant to sulfa drugs.
►Conjunctivitis and other superficial ocular infections:
►Conjunctivitis:
►Trachoma:
►Recurrent corneal erosion:
benzalkonium chloride
The sulfonamides are bacteriostatic agents and the spectrum of activity is similar for all. Sulfonamides inhibit bacterial synthesis of dihydrofolic acid by preventing the condensation of the pteridine with aminobenzoic acid through competitive inhibition of the enzyme dihydropteroate synthetase. Resistant strains have altered dihydropteroate synthetase with reduced affinity for sulfonamides or produce increased quantities of aminobenzoic acid.
Topically applied sulfonamides are considered active against susceptible strains of the following common bacterial eye pathogens: Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus (viridans group), Haemophilus influenzae, Klebsiella species, and Enterobacter species.
Topically applied sulfonamides do not provide adequate coverage against Neisseria species, Serratia marcescens and Pseudomonas aeruginosa. A significant percentage of staphylococcal isolates are completely resistant to sulfa drugs.
Contraindicated in individuals who have a hypersensitivity to sulfonamides or to any ingredient of the preparation.
None listed in package insert.