The most common manifestations of allergic reactions from the organ of vision, such as allergic and dermatitis. Sometimes, in more severe cases, the allergic reaction spreads to all the membranes of the eye. In this case, the internal structures of the eyeball can be affected, which manifests itself in the form of edema of the optic nerve, etc. For the treatment of local manifestations of allergic eye reactions, liquid dosage forms of drugs are used - eye drops for allergies.

Types of antiallergic eye drops

Vasoconstrictor drops

These drops cause vasoconstriction of the mucous membrane of the eye and reduce such manifestations of an allergic reaction as conjunctival edema and, due to spasm of the conjunctival vessels. drops for an allergic process are used for a short time: more than two or three days. With prolonged use, a "withdrawal effect" may develop - all allergy symptoms come back abruptly. This group of drugs includes such eye drops: "Octylia", "Vizin", "Okumetil".

Antihistamine eye drops

For the treatment of allergic manifestations of the eye, antihistamine eye drops should be used as the first remedy. They prevent the accumulation of the main mediator of immediate allergic reactions, histamine. With the help of these drops, such manifestations of an allergic reaction as edema are reduced. Antihistamine eye drops that should be used for emergency treatment for allergies include Spersallerg, Lekrolin, Allergodil, Opatanol.

Anti-inflammatory eye drops used for allergies

To stop the manifestations of acute allergic reactions, eye drops are prescribed, which contain anti-inflammatory active ingredients. These drugs are divided into two groups: non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.

Non-steroidal anti-inflammatory drops

In order to reduce inflammation, edema and other manifestations of an allergic reaction of the eye, such non-steroidal anti-inflammatory drugs as "", "Naklof", "Diklo F", "" can be used in the form of eye drops.

Corticosteroids

To stop an acute allergic reaction, eye drops containing corticosteroids are often prescribed. These drugs can have side effects with long-term use, so they are only prescribed for short-term use. Corticosteroid drops include Prenacid, Dexamethasone, Maxidex.

Mast Cell Stabilizers

Drugs in this group cause specific changes in the main (mast) cells involved in the allergic process, from which histamine is released. They are not a remedy for emergency treatment, as their effect appears only after accumulation. Mast cell stabilizers should be used to prevent allergic reactions on the eve of seasonal allergies. For this purpose, such eye drops as "Kromohexal", "Lekrolin", "Alomid" are prescribed.

Tear substitutes

An allergic reaction causes eye irritation, which becomes red and dry. This increases itching, swelling, and discomfort in the organ of vision. To moisturize the conjunctiva of the eyes, substitutes should also be used that have no side effects and contraindications and can be instilled in the anterior as often as needed. They need to be kept refrigerated as the cool liquid is more soothing. Tear substitutes such as "Artificial Tear", "Natural Tear", "Sistane", "Vidisik" are absolutely safe.

Rules for instilling eye drops:

wash your hands thoroughly with soap on the eve of the procedure for instilling drops into the anterior chamber of the eye;
check for cracks or chips on the tip of the dropper;
the dropper tip should not be touched by hands;
tilt your head slightly back;
pull the lower one forward with your index finger;
bring the pipette or dropper, with the tip turned down, with the other hand to the eye;
do not touch the tip of the dropper to the organ of vision;
during the instillation of drops, the patient needs to look up;
when instilled, the drop should fall into the pocket of the lower eyelid;
after the end of the manipulation, it is necessary to close the bottle with eye drops with a lid;
do not rinse or wipe the eye drop tip;
in order to remove drugs from fingers, wash them thoroughly under running water.

Glucocorticoids(corticosteroids) are very popular in the treatment of eye diseases. They are deservedly considered powerful anti-inflammatory, desensitizing and immunosuppressive agents. However, even topical application of these drugs, which does not require large doses, can produce undesirable side effects. Ophthalmologists know a slowdown in the regeneration processes in the eye, a worsening of the course and a more frequent manifestation of its viral (herpetic) diseases, the formation of opacities in the lens under the influence of steroids. Also described are trophic lesions of the cornea, mydriasis, ptosis, accommodation disorders, opacity of the vitreous humor, congestive discs, allergic reactions in the form of conjunctivitis and superficial keratitis [Margolis MG, 1972].

Very heavy and by no means rare complications cause steroid drugs in their general use: symptoms of Itsenko-Cushing's disease, especially in children, their growth retardation, myopathies at any age, emotional and neuropsychiatric disorders, osteoporosis, vasculitis, changes in hemostasis and immunogenesis, hormone dependence, gastrointestinal suffering from epigastric discomfort to stomach ulcers, etc. There is no complete direct dependence of the development of these side reactions and complications from drugs, the duration of their use, doses, age, sex, the nature of the disease in the treatment of corticosteroids. Some patients tolerate well the treatment carried out for years, often taking medications in large doses, while in others, negative effects occur after 3-4 weeks when using medium doses. Nevertheless, natural glucocorticoids (cortisone, hydrocortisone) produce significantly more adverse reactions, and complications occur more often, the higher the dose and the longer the use of these drugs.

Much better carry over patients with modern synthetic drugs of intermediate (triamciolop, prednisolone, prednisone, methylredpizolone), long-term (dexamethasone, betamethasone, paramethasone) and prolonged action (kenalog). However, their features should be taken into account. So, the anti-inflammatory effect of triamcinolone is 1.5-2 times higher than that of andredpizoloia, therefore it can be prescribed to patients with high blood pressure, disorders of carbohydrate metabolism and the elderly.

Prednisone and prednisolone less than cortisone and hydrocortisone, they affect blood pressure, electrolyte metabolism, fluid retention, but have an increased ulcerogenic effect, and therefore are not indicated for patients with hyperactive gastritis and gastric ulcer.

Dexamethasone, the anti-inflammatory effect of which is 4-10 times higher than that of prednisolone, has an effect 30 times higher than the effect of the latter on the adrenal cortex, therefore it should be prescribed in short courses and under the control of the functional state of this cortex. Cancellation of the drug is possible only with a slow decrease in its doses to the minimum.

Parametazone and especially kenalog, one injection of which lasts for 7g-1 month, due to their better tolerance, are indicated for long-term use in chronic diseases and can be prescribed (kenalog) even on an outpatient basis.

The negative effect of hormones reduce diet, as well as certain medications. For oral administration, as a rule, smaller doses are required than for parenteral administration. When treating eye diseases, the first way is preferable to the second.

The above features of modern corticosteroid drugs allow, in necessary cases, with great benefit to prescribe them to patients with diabetes mellitus, obesity, peptic ulcers of the stomach, as well as patients over 60 years of age and pregnant women, although all these diseases and conditions were considered contraindications to hormone therapy. “It is important to choose the right drug, to determine the most rational method and time of hormone administration with the simultaneous administration of drugs that neutralize the side effects of corticosteroids” [Egorova LI et al., 1978]. However, in these cases, the doses of drugs should be reduced by 25-30%. For most patients, moderate doses of glucocorticosteroids are sufficient; only for special indications they can be increased to the maximum.

Duration of hormone therapy for eye diseases, as a rule, should be small: courses from 10 to 25-30 days, less often 1.5 - 2 months. The dose is highest in the first 2-8 days of treatment and is gradually reduced in the following days. For example, the dose of dexamethasone should be reduced by 1/4 tablet, prednisolone - by 0.5 - 1 tablet every 2-4 days. With certain chronic eye diseases or general suffering affecting the organ of vision (Still's, Felty's, rheumatism, etc.), longer courses of hormone therapy are required, for which long-acting and prolonged-acting glucocorticosteroids are more suitable.

Eye drops (eye drops) - classification, features and indications for use, analogs, reviews, prices

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Eye drops- These are solutions of various medicinal substances that are intended for administration to the eyes. For the production of eye drops, oil and water solutions of various active substances are used. Any drops are sterile, stable and chemically isotonic (non-irritating to the mucous membrane of the eye) solutions. Depending on the active (active) substance, eye drops are used to treat various diseases and eliminate unpleasant symptoms.

Eye drops - instructions for correct use

Eye drops in most cases cannot be used while wearing soft contact lenses, since the active component of the drug can accumulate on the mucous membrane, resulting in an overdose. During the period of application of eye drops, it is necessary to abandon soft lenses, replacing them with glasses. If it is impossible to refuse soft contact lenses, then they should be put on at least 20 - 30 minutes after the drops are injected into the eyes.

If it is necessary to apply simultaneously two or more types of eye drops, then it is necessary to maintain the interval between their introduction at least 15 minutes, and optimally - half an hour. That is, first, one drops are buried, then after 15 - 30 minutes the second, after another 15 - 30 minutes the third, etc.

The frequency and duration of the use of eye drops depends on their type, the pharmacological properties of the active substance and the fact for the treatment of which disease or the elimination of symptoms they are used. In acute infections of the eye, drops are injected 8 to 12 times a day, in chronic non-inflammatory diseases - 2 to 3 times a day.

Any eye drops must be stored in a dark place at room temperature, not exceeding 30 o C, so that they retain their therapeutic effect. After opening the package with the solution, it must be used within one month. If the eye drops have not been used in one month, then this open bottle should be discarded and a new one started.

Eye drops must be used strictly following the following rules:

Before instilling eyes, wash your hands with soap and water;
Open the bottle;
Draw up the solution into a pipette if the bottle is not equipped with a dropper;
Tilt your head back so that your eyes look at the ceiling;
Pull the lower eyelid downward with your index finger to reveal the conjunctival sac;
Without touching the tip of the pipette or dropper of the bottle to the surface of the eye and eyelashes, release a drop of the solution directly into the conjunctival sac formed when the lower eyelid is pulled back;
Try to keep your eye open for 30 seconds;
If it is impossible to keep the eye open, then gently blink it, trying to prevent the medicinal solution from leaking out;
To improve the penetration of drops into the mucous membrane, you must press your finger on the outer corner of the eye;
Close the bottle.

If, during the instillation of one eye, the tip of the pipette or dropper of the bottle accidentally touches the eyelashes or the surface of the conjunctiva, then these instruments should no longer be used. That is, to instill a second eye, you will have to take a new pipette or open another bottle of medicine.

How to properly instill eye drops - video

How to instill eye drops for children - video

Classification of eye drops by type of action and scope

The entire set of eye drops available on the modern pharmaceutical market, depending on the type of action and scope of application, are divided into the following groups:
1. Drops intended for the treatment of infectious eye diseases:

Antibiotic eye drops. Designed to treat eye infections caused by bacteria, mycoplasmas and chlamydia. Currently, the following antibiotic eye drops are available - Levomycetin, Vigamox, Tobrex, Gentamicin, Tsipromed, Tsiprolet, Oftaquiks, Normaks, Floxal, Colistimitate, Maksitrol, Futsitalmik;
Antiviral eye drops for treating viral infections. The following funds are available - Aktipol, Poludan, Trifluridin, Berofor, Oftan-IMU;
Antifungal eye drops for treating fungal infections. In Russia, not a single antifungal eye drops have been registered. In Europe and the USA, a 5% ophthalmic suspension of natamycin is used as antifungal eye drops. Also, if necessary, solutions of amphotericin B, Fluconazole, Ketoconazole, Flucitazine, Miconazole and Nystatin are instilled into the eyes, however in Russia all these drugs are used only for oral administration or intravenous administration;
Sulfanilamide eye drops for the treatment of bacterial and viral infections. There are various preparations based on sodium sulfacil (Albucid, etc.);
Eye drops with antiseptics intended for the treatment of infections caused by any microorganisms (viruses, fungi, bacteria). Drops with antiseptics are Ophthalmo-septonex, Miramistin, Avitar, 2% boric acid solution, 0.25% zinc sulfate solution, 1% silver nitrate solution, 2% collargol solution and 1% protargol solution.

2. Anti-inflammatory eye drops:

Drops containing non-steroidal anti-inflammatory drugs (NSAIDs) as active substances. These include - Voltaren ofta, Naklof, Indokollyr. Drops with NSAIDs are often used to relieve inflammation in various functional states (fatigue, irritation, etc.) and eye diseases (infections, glaucoma, etc.);
Drops containing glucocorticoid hormones as active substances. These include Prednisolone, Dexamethasone, Betamethasone, Prenacid. This type of eye drops is used to eliminate a strong inflammatory process in various eye diseases. It is not recommended to use eye drops with glucocorticoids for viral, mycobacterial and fungal eye infections;
Combined drops containing as active substances and NSAIDs, and glucocorticoids, and antibiotics or antiviral agents. These include Sofradex (anti-allergic + anti-inflammatory + antibacterial action), Ophthalmoferon (antiviral + anti-inflammatory + anti-allergic action), Tobradex (anti-inflammatory + antibacterial action).

3. Eye drops for the treatment of allergic eye lesions (antiallergic):

Drops containing membrane stabilizers as active substances. These include Cromohexal, Lekrolin, Lodoxamide, Alomid. The drugs are used in courses;
Drops containing antihistamines as active substances. These include Antazolin, Azelastine, Allergodil, Levocabastine, Feniramine, Histimet and Opatonol. These drugs are used in courses;
Drops containing vasoconstrictor agents as active substances. These include Tetrizolin, Naphazoline, Oxymetazoline, Phenylephrine, Vizin, Allergophthal, Spersallerg. These drugs are used only as needed to eliminate severe redness of the eyes, relieve swelling and stop lacrimation. It is allowed to use vasoconstrictor drops for no more than 7 - 10 days in a row.

4. Eye drops used to treat glaucoma (reduce intraocular pressure):

Drops that improve the outflow of intraocular fluid. These include Pilocarpin, Karbakhol, Latanoprost, Ksalatan, Ksalakom, Travoprost, Travatan;
Drops that reduce the formation of intraocular fluid. These include Clonidine (produced in Russia under the name Clonidine), Proxofelin, Betaxolol, Timolol, Proxodolol, Dorzolamid, Brinzolamid, Trusopt, Azopt, Betoptik, Arutimol, Kosopt, Ksalakom. In addition, in many countries, Aproclonidine and Brimonidine eye drops, which are not registered in Russia, are used;
Drops containing neuroprotective agents that support the functioning of the optic nerve and prevent its edema. These include Erisod, Emoxipin, 0.02% solution of histochrome.

5. Eye drops used for the treatment and prevention of cataracts:

M-anticholinergics - 0.5 - 1% atropine solution, 0.25% homatropine solution, 0.25% scopolamine solution;
Alpha adrenomimetic - Mezaton 1%, Irifrin 2.5 and 10%;
Drops that activate metabolic processes in the lens of the eye. These include Taurine, Oftan-katakhrom, Azapentatsen, Taufon, Quinax. Long-term use of these drops can slow down or completely stop the progression of cataracts.

6. Eye drops containing local anesthetics (used to relieve eye pain in severe diseases or during diagnostic and surgical interventions). These include Tetracaine, Dicaine, Oxybuprocaine, Lidocaine, and Inocaine.

7. Eye drops used for various diagnostic procedures (dilate the pupil, allow you to see the fundus, differentiate lesions of various eye tissues, etc.). These include Atropine, Midriacil, Fluorescein.

8. Eye drops that moisturize the surface of the eye ("artificial tear"). They are used for dry eyes against the background of any condition or disease. "Artificial tear" preparations include Vidisik, Oftagel, Hilo chest of drawers, Oksial, Sistane and "natural tear".

9. Eye drops that stimulate the restoration of the normal structure of the cornea of the eye. The drugs of this group improve the nutrition of the eye tissues and activate metabolic processes in them. These include Etaden, Erisod, Emoxipin, Taufon, Solcoseryl, Balarpan, histochrome 1%, retinol acetate 3.44%, cytochrome C 0.25%, blueberry extract, retinol acetate or palmitate, and tocopherol acetate. Drugs are used to accelerate the recovery of eye tissue after burns, injuries, as well as against the background of degenerative processes in the cornea (keratinopathies).

10. Eye drops for the treatment of fibrinoid and hemorrhagic syndrome. These include Collalizin, Gemaza, Emoxipin, Histochrome. These syndromes occur with a large number of different eye diseases, therefore, drops for their relief are used as part of the complex therapy of many pathologies.

11. Eye drops containing vitamins, trace elements, amino acids and other nutrients that improve metabolic processes in the tissues of the eye, thereby reducing the rate of progression of cataracts, myopia, hyperopia, retinopathies. These include Quinax, Ophthalm-katachrom, Catalin, Vitayodurol, Taurin, Taufon.

12. Eye drops containing vasoconstrictor substances as active components. These include Vizin, Octylia. These drops are used for the symptomatic treatment of lacrimation, elimination of edema, redness and discomfort in the eyes against the background of any diseases or functional conditions. Drops do not cure the disease, but only eliminate painful symptoms, therefore they can only be used as part of complex therapy. The funds should not be used for more than 7 - 10 days in a row, as addiction may develop.

Features of the use of eye drops for certain diseases and conditions

Consider the features and main areas of application of eye drops, which are most often used in the practice of an ophthalmologist.

Eye drops for fatigue

To eliminate the symptoms of eye fatigue (redness, itching, swelling, discomfort in the eyes, feeling of "sand", etc.), you can use artificial tear preparations (Vidisik, Oftagel, Hilo chest of drawers, Oxial, Sistane) or tetrizoline-based vasoconstrictors (Vizin, Oktilia, VizOptik, Vizomitin). At the same time, doctors recommend first 1 - 2 days to use vasoconstrictor drugs, instilling them 3-4 times a day until the painful symptoms disappear. And then, within 1 - 1.5 months, use any artificial tear preparation, instilling it into the eyes 3-4 times a day.

In addition, to relieve eye fatigue, you can use Taufon drops, containing a complex of nutrients, vitamins and minerals that improve metabolic processes. Taufon drops can be used for a long time - from 1 to 3 months continuously.

The most effective drops for relieving eye fatigue are artificial tears, followed by Taufon, and finally, vasoconstrictors. Taufon and artificial tears are used in about the same way, and vasoconstrictor drops can only be used as an emergency.

Allergy eye drops

For long-term treatment of allergic reactions and eye diseases (for example, conjunctivitis), two main types of eye drops are used:
1. Preparations with membrane stabilizers (Kromohexal, Ifiral, Krom-allerg, Kromoglin, Kuzikrom, Lekrolin, Stadaglycin, Hi-Krom, Allergo-Komod, Vividrin, Lodoxamid, Alomid);
2. Antihistamines (Antazolin, Allergophthal, Oftofenazole, Spersallerg, Azelastine, Allergodil, Levocabastine, Histimet, Vizin Alerji, Reactin, Feniramine, Opcon A and Opatonol).

The most pronounced therapeutic effect is possessed by drugs from the group of membrane stabilizers, therefore they are used to treat severe allergic reactions or eye diseases, as well as when antihistamines are ineffective. In principle, for the course of treatment of allergic eye diseases, you can choose a drug from any group, which, in case of insufficient effectiveness, can always be replaced with another.

Membrane stabilizers and antihistamines are used for the course of treatment of allergies, and as "ambulance" drops, which can quickly eliminate itching, swelling, lacrimation and discomfort in the eyes, use vasoconstrictor drugs (Tetrizolin, Naphazoline, Oxymetazoline, Phenylephrine, Vizin, Allergophthal, Spersallerg ). Membrane stabilizers and antihistamines are used in courses lasting from 2 to 3 weeks to 2 months, and vasoconstrictors - a maximum of 7 to 10 days.

Eye drops for conjunctivitis

Eye drops for conjunctivitis are selected depending on what is the cause of the inflammation of the mucous membrane of the eye. If the conjunctivitis is bacterial (there is purulent discharge), then use eye drops with antibiotics (Levomycetin, Vigamox, Tobrex, Gentamicin, Tsipromed, Ciprolet, Oftaquiks, Normaks, Floxal, Colistimitate, Maxitrol, Futsitalmik, etc.). If the conjunctivitis is viral (there is only mucous discharge without pus in the eyes), then drops with antiviral components (Aktipol, Poludan, Trifluridin, Berofor, Oftan-IDU) are used. In addition, for any conjunctivitis - both viral and bacterial, you can use drops with universal sulfanilamide agents (Albucid, Sulfacil sodium) or antiseptics (Ophthalmo-septonex, Miramistin, Avitar, 2% boric acid solution, 0.25% zinc sulfate solution, 1% silver nitrate solution, 2% collargol solution and 1% protargol solution).

If a person has allergic conjunctivitis, then antiallergic drops should be used.

In addition to the listed treatment aimed at eliminating the cause of conjunctivitis, anti-inflammatory, vasoconstrictive and analgesic drops are used as part of complex therapy. Anesthetic drops (Tetracaine, Dikain, Oxybuprocaine, Lidocaine and Inocaine) are used only if necessary to relieve pain, if anti-inflammatory drugs have not been able to eliminate the pain syndrome. Vasoconstrictor agents (Vizin, Octylia) are used only as "first aid" drops, when it is necessary to reduce the amount of discharge for a while, quickly remove the swelling and redness of the eyes. Anti-inflammatory drugs are presented in two groups:

Drops containing non-steroidal anti-inflammatory drugs (NSAIDs) as active substances. These include - Voltaren ofta, Naklof, Indokollyr;
Drops containing glucocorticoid hormones as active substances. These include Prednisolone, Dexamethasone, Betamethasone, Prenacid.

Drops with glucocorticoid hormones can only be used for bacterial conjunctivitis with severe inflammation. In all other cases, you should use drops with NSAIDs.

In the treatment of various conjunctivitis, the following complex drops can be used:
1. Sofradex and Tobradex - with bacterial conjunctivitis;
2. Ophthalmoferon - with viral conjunctivitis.

After recovery from conjunctivitis, in order to accelerate the restoration of the normal structure of tissues, eye drops with reparants can be used (Etaden, Erisod, Emoxipin, Taufon, Solcoseryl, Balarpan, histochrome 1%, retinol acetate 3.44%, cytochrome C 0.25%, blueberry extract , retinol acetate or palmitate and tocopherol acetate) and vitamins (Quinax, Ophthalm-katachrom, Catalin, Vitaiodurol, Taurine, Taufon;).

Scope of application of some eye drops

Levomycetin

Levomycetin eye drops are used to treat infectious and inflammatory diseases of various parts of the eyes (conjunctivitis, keratitis, keratoconjunctivitis, blepharitis, episcleritis, scleritis) caused by bacteria.

Tobrex

Tobrex eye drops are also used to treat bacterial infections of the eye (conjunctivitis, keratitis, keratoconjunctivitis, blepharitis, episcleritis, scleritis) and surrounding tissues (eyelids, orbits, etc.).

Tsipromed and Tsiprolet

Cipromed and Ciprolet eye drops are synonymous because they contain the same active ingredient - ciprofloxacin. These drops are used to treat eye infections caused by bacteria, mycoplasmas or chlamydia.

Floxal

Floxal eye drops are used to treat infections of the front of the eye (conjunctivitis, blepharitis, barley, dacryocystitis, keratitis, keratoconjunctivitis, corneal ulcer, episcleritis, scleritis) caused by bacteria, chlamydia or mycoplasma. Also, drops are used for the prevention and treatment of bacterial infections after trauma or eye surgery.

Ophthalmoferon

Ophthalmoferon eye drops have decongestant, antipruritic, antihistamine, antiallergic, immunomodulatory and antiviral effects, therefore they are used to treat the following eye diseases:

Adenoviral and herpetic keratitis;
Adenoviral and herpetic keratoconjunctivitis;
Herpetic uveitis and keratouveitis;
Prevention of the "graft-versus-host" reaction during organ and tissue transplantation of the eye;
Prevention and treatment of complications of laser surgery on the cornea of the eye.

Sofradex

Sofradex eye drops are used to treat bacterial infections of the front of the eye (blepharitis, conjunctivitis, keratitis, iridocyclitis, scleritis, episcleritis) and eyelids.

Sulfacil sodium (Albucid)

Sulfacil sodium (Albucid) eye drops are used to treat purulent and viral infections of the front of the eye.

Taufon and Taurine

Eye drops Taufon and Taurine contain the same active ingredient and are therefore synonymous. These drops improve the metabolic process and accelerate the restoration of the normal structure of the cornea of the eye, therefore they are used in the complex treatment of traumatic injuries, cataracts and corneal dystrophy.

Emoxipin

Emoxipin eye drops improve metabolic processes and promote the regeneration of corneal tissues, and therefore are used in the complex therapy of various diseases associated with circulatory disorders, intraocular hemorrhages and exposure to high intensity light (for example, laser, direct sunlight, etc.). Indications for the use of Emoxipin drops are the following diseases and conditions:

Hemorrhage in the eye;
Diabetic retinopathy;
Corneal dystrophy;
Retinal vein thrombosis;
Glaucoma;
Acute and chronic disorders of cerebral circulation;
High intensity light ("welding", direct sunlight, laser).

Dexamethasone

Dexamethasone eye drops are used to quickly relieve the inflammatory process in any disease or condition. These drops are an "emergency aid" that is used only when needed.

Quinax

Quinax eye drops improve the regeneration processes in the tissues of the eye, and therefore are used in the complex therapy of cataracts, as well as to accelerate the healing of traumatic injuries.

Irifrin

Irifrin eye drops are a vasoconstrictor drug that is used as a symptomatic agent to relieve swelling, redness and eliminate discomfort in the eye. Irifrin is used in the complex therapy of the following eye diseases:

Iridocyclitis;
Dilation of the pupil during diagnostic procedures;
Provocative test for the presence of angle-closure glaucoma;
Diagnosis of deep and superficial hemorrhage in the eyeball;
As a preparation for laser fundus surgery;
Crisis therapy for glaucoma;
Red eye syndrome.

Aktipol

Aktipol eye drops contain antiviral and immunostimulating components as an active substance. Therefore, Aktipol is used to treat eye infections (conjunctivitis, keratoconjunctivitis, keratouveitis) caused by viruses of the herpes family or adenoviruses. Also, drops can be used to restore the cornea after injuries, burns, operations and degeneration caused by various reasons, including the constant wearing of contact lenses.

Systein

Systane eye drops are artificial tears that are designed to wet the surface of the eye. The drops moisturize the eye, protect it from dryness, irritation, burning sensation, foreign body, sand or grit caused by any environmental factors (for example, dust, smoke, sunlight, heat, air conditioner, wind, cosmetics, screen light). Drops are used for dry eye caused by any reason. Ophthalmologists recommend using Systein or other artificial tears under contact lenses, as well as to eliminate eye fatigue or redness caused by irritation.

Eye drops analogs

Eye drops are dosage forms for topical use only. This means that they are introduced (buried) directly onto the surface of the eyeball, from where they are partially absorbed into deep tissues. In order for the drugs to exert their therapeutic effect as efficiently as possible, it is necessary to constantly maintain their certain concentration on the surface of the eye. To do this, they resort to frequent application of drops to the eyes - every 3 to 4 hours. This is necessary because tears and blinking quickly wash away the drug from the surface of the eye, as a result of which its therapeutic effect ceases.

Analogs of eye drops can only be drugs intended also for topical use - application to the eyes. To date, there are only a few dosage forms that can be attributed to analogs of eye drops - these are eye ointments, gels and films. Ointments, gels and films, as well as drops, may contain various active substances, and therefore be used for various diseases. The most commonly used ointments with antibiotics (for example, Tetracycline, Chloramphenicol, Erythromycin, etc.), gels with reparants (for example, Solcoseryl) and films with Albucid. Usually, ointments, gels and films complement eye drops and are included in the complex treatment of various diseases. So, in the daytime, drops are usually used, and films and ointments are placed in the eyes at night, since they have a longer effect.

Eye drops - price

The cost of eye drops varies greatly depending on which active ingredients are included in the drug, where they are produced and what the volume of the bottle is. Each drops has its own cost. Imported eye drops, of course, are more expensive than domestic ones. As a rule, imported eye drops have cheaper domestic counterparts that are practically not inferior to them in quality. Therefore, you can always choose the optimal drug based on the wishes of the person, as well as taking into account the required therapeutic effect and acceptable cost.

Pharmaceutical Wards: Symptomatic Treatment of Conjunctivitis

I. A. Zupanets, N. V. Bezdetko, P. A. Bezdetko
National Pharmaceutical Academy of Ukraine
Kharkiv State Medical University

Diseases of the conjunctiva are among the most common eye pathologies and in more than 40% of cases are the reason why patients seek help from an ophthalmologist.

The conjunctiva is the connective membrane of the eye that covers the inner surface of the eyelids and the outer surface of the sclera. It is delicate, smooth, translucent and therefore has the color of the fabric it covers. Due to the fact that the conjunctiva is abundantly irrigated with a tear, friction of the eyelids against the cornea of the eye is minimal. The glands embedded in the conjunctiva produce both lacrimal fluid and mucus. With inflammation of the conjunctiva, mucus can be secreted so much that it even sticks together the edges of the eyelids. The conjunctiva is abundantly vascularized and richly innervated.

Conjunctivitis occupies the main place among diseases of the connective membrane of the eye.

Conjunctivitis

Conjunctivitis (conjunctivitis) - inflammation of the connective membrane of the eye (conjunctiva).

The main causes of conjunctivitis

Depending on the etiological factors and characteristics of the clinical picture, they are currently distinguished:

Conjunctivitis of endogenous origin:

conjunctivitis with common diseases;
autoallergic conjunctivitis.

Conjunctivitis of infectious origin are especially common, which is explained by the abundance and diversity of flora in the conjunctival cavity: over 60 different microbial forms have been found in it.

Factors contributing to the development of acute infectious conjunctivitis are:

dust in the eye;
hypothermia or overheating;
swimming in a stagnant body of water (pool);
acute respiratory diseases.

A common feature of acute infectious conjunctivitis is their high contagiousness. In case of non-observance of the rules of personal hygiene, certain sanitary standards, with a number of pathogens, acute conjunctivitis within a short time can affect not only all family members, but also entire groups, especially children (in kindergarten, school).

Acute infectious conjunctivitis usually begins first in one eye, and soon in the other. The main complaints are a feeling of clogging ("sand") in the eye, burning or itching in one or both eyes, redness of the eye, lacrimation or mucopurulent discharge from the eye. Often, waking up in the morning, the patient hardly opens his eyes, as the eyelids stick together with mucopurulent discharge dried on the eyelashes.

It is important to know that acute bacterial conjunctivitis can be caused by such pathogenic pathogens as Koch-Weeks bacillus, Neisser's gonococcus, Frenkel-Vekselbaum's pneumococcus, Leffler's diphtheria bacillus, etc. In such cases, conjunctivitis is often the first manifestation and / or one of the manifestations of a common disease requiring serious complex treatment in a hospital setting. In case of late identification of the pathogen and the absence of specific treatment, such conjunctivitis can, in a large part of cases, lead to severe complications from the cornea and, as a consequence, to varying degrees of vision loss.

For viral conjunctivitis characterized by pronounced redness and swelling of the conjunctiva, a small amount of discharge. In most cases, viral conjunctivitis is accompanied by general symptoms: malaise, headache, decreased performance, appetite, enlargement and soreness of the submandibular lymph nodes, fever with fever is possible. With viral conjunctivitis, there is a high probability of involvement of the cornea in the pathological process. The first signs of corneal damage are increased lacrimation, photophobia.

Trachoma occupies a special place among infectious conjunctivitis. Trachoma is an infectious disease caused by a special pathogen from the group of galprovia, which occupy an intermediate position between viruses and rickettsia. Starting with clinical signs of conjunctival inflammation, trachoma then leads to serious complications from the eyeball. Trachoma is widespread in all countries of the world and is one of the main causes of blindness.

Allergic conjunctivitis are observed, as a rule, in persons with hypersensitivity to various substances and prone to other manifestations of allergies. Allergic conjunctivitis is characterized by pronounced lacrimation, photophobia, severe burning and itching in the eyes, a combination of conjunctivitis with rhinitis. A special form of allergic conjunctivitis is spring catarrh - a chronic inflammatory disease of the conjunctiva that is aggravated in the spring and summer period, in the occurrence of which the hypersensitivity to the action of the ultraviolet part of the spectrum of the sun's rays plays a leading role.

Drug-induced allergic conjunctivitis can develop in sensitive patients after prolonged (in some people - even after a single) use of eye drops for the treatment of any eye disease (cataract, glaucoma, iridocyclitis, etc.).

It is important to remember that redness of the eye in combination with discomfort, lacrimation, in addition to conjunctivitis, can be signs of more serious diseases of the organ of vision, such as:

glaucoma- eye disease, characterized by a constant or periodic increase in intraocular pressure with the subsequent development of optic nerve atrophy, visual field defects and blindness;
uveitis- inflammation of the choroid of the eye;
keratitis- inflammation of the cornea of the eye of an infectious, traumatic, neuroparalytic, metabolic-dystrophic and other etiology.

In the absence of timely proper treatment, the nature and volume of which can only be determined by an ophthalmologist, the above diseases can lead to a significant decrease in vision, and in some cases even to blindness.

"Threatening" symptoms which make it possible to suspect a serious illness in a patient that requires an obligatory visit to an ophthalmologist, with conjunctivitis are:

pain in the eye;
the appearance of pain on palpation of closed eyes;
the appearance of painful sensations in the eye during visual work (reading, watching TV, etc.);
a combination of symptoms of conjunctivitis with an increase in temperature above 38 ° C;
combination of symptoms of conjunctivitis with headache;
a combination of symptoms of conjunctivitis with a decrease in visual acuity;
increased lacrimation;
the appearance of photophobia;
copious mucopurulent (purulent) discharge from the eye.

General recommendations for patients and preventive measures for acute infectious conjunctivitis

if the symptoms of conjunctivitis persist for 2 days, you should definitely consult an ophthalmologist;
if symptoms of conjunctivitis occur in one eye, do not touch the healthy eye with unwashed hands;
if symptoms of conjunctivitis occur in one of the family members, exclude the use of common soap, a common towel;
if there is discharge, use a separate pillow and change the pillowcase daily;
before the cessation of secretion, use an individual towel, which must be changed daily;
in no case should a bandage be applied to the eye: under the bandage, blinking movements of the eyelids are impossible, contributing to the evacuation of the discharge from the conjunctival cavity, favorable conditions are created for the development of microbial flora and complications from the cornea;
before using eye drops to remove purulent or mucopurulent discharge, thoroughly rinse the conjunctival cavity with a solution of furacilin 1: 5000 or potassium permanganate 1: 5000;
for persons who have been in contact with a patient with conjunctivitis, for prophylactic purposes, it is recommended to instill a 30% solution of sulfacyl sodium into the eyes for 2-3 days.

Comparative characteristics of dosage forms of drugs used for the symptomatic treatment of conjunctivitis

Dosage form	Advantages	disadvantages
Eye drops	Ease of use. The speed of the onset of the effect.	The ability to use mainly water-soluble active ingredients. Difficulty in exact dosage. The complexity of the selection of an individual dose. When applied, they can enter the nasopharynx, have an effect on the nasal mucosa (especially vasoconstrictor drugs). With abundant mucous discharge, drops are poorly retained in the conjunctival cavity.
Eye gels	Prolonged action.	Not all active ingredients can be incorporated into gels and, accordingly, used in a given dosage form. Diffusion of the active substance into the tissue from the “gel” dosage form occurs more slowly than from the solution. At the same time, this property makes it possible to achieve a prolonged action of the drug. Gels have a pronounced systemic effect, which is not always desirable. The gel is difficult to apply with an abundant amount of mucous discharge. In some cases, morphological substances can be used by microorganisms as nutrients, which contributes to the development of a secondary infection.
Eye Films	Prolonged action. Possibility to apply at night.	Not all active ingredients can be incorporated into the ophthalmic films and, accordingly, used in a given dosage form. Diffusion of the active substance into the tissue from the “film” dosage form occurs more slowly than from the solution. At the same time, this property makes it possible to achieve a prolonged action of the drug. An increase in mucous discharge is possible (due to local irritating action).

General approaches to the treatment of infectious conjunctivitis

For the treatment of acute infectious conjunctivitis, antibacterial drugs are used in ophthalmic dosage forms for topical application in the conjunctival cavity. When using over-the-counter drugs, preference should be given to eye drops. Eye gels (ointments), films are used only as directed by a doctor and under the control of the state of the organ of vision by an ophthalmologist. Drugs from the group of antiseptics, sulfonamides and antibiotics are used.

Comparative characteristics of drugs used for local treatment of acute infectious (bacterial and viral) conjunctivitis

International name	Tradename	Possibility of appointment
International name	Tradename	pregnant	children
Antibiotics
Chloramphenicol (eye drops, eye ointment)	Levomycetin, Chlorsig		+	The pyogenic flora does not develop resistance. It has an antiexudative effect. When applied topically, it creates a high concentration in the cornea, iris, aqueous humor and vitreous humor.
Gentamicin (eye drops, eye ointment)	Gentamicin	Not recommended, especially in the first trimester	+	Broad-spectrum antibiotic. Possible erythema, pruritus and other manifestations of hypersensitivity.
Tobramycin (eye drops)	Brulamycin, tobrex	Carefully	+	Broad-spectrum antibiotic. A local reaction is possible - a burning sensation or pain, conjunctival edema.
Norfloxacin (eye drops)	Norfloxacin, Normax, Shibroxin	Carefully	+	A broad-spectrum antibiotic, active against most gram-negative microorganisms, including those resistant to other antibiotics. Resistance is rare. A local reaction is possible - a burning sensation or pain, conjunctival edema, photophobia.
Sulfonamides
Sulfacetamide (eye drops)	Sulfacyl sodium	+	+	A local reaction is possible - a burning sensation or pain, conjunctival edema. Contraindicated in case of hypersensitivity to sulfonamides.
Antiseptics
Zinc sulfate (eye drops)	Tsidelon, solution of zinc sulfate 0.25%	+	+	Possible local manifestations of hypersensitivity reactions
Decamethoxin	Dexalong, decacilong, oftadek	+	+	Potentiates the action of other antimicrobial agents.
Boric acid	Ophthalmo-septonex	+	+	It has an antiseptic, fungistatic, astringent effect. Local manifestations of hypersensitivity reactions are possible. It is well absorbed through the mucous membranes and, with prolonged use, can accumulate (nausea, vomiting, diarrhea, skin rashes are noted).
Antiviral drugs
Acyclovir * (gl. Ointment)	Zovirax, virolex	-	+	It is active against the herpes simplex virus type I, cytomegalovirus. A local reaction is possible - a burning sensation or pain, conjunctival edema.
Idoxuridine * (eye drops)	Oftan Idu	-	After 1 year	It is included in the DNA of the virus with the formation of then defective viral proteins. Active against herpes simplex virus type I and chickenpox. Combined use with glucocorticosteroids is contraindicated. The duration of treatment should not exceed 10 days.
Combined antiseptics
Tradename	Composition	Possibility of appointment		Features and Side Effects
Tradename	Composition	pregnant	children	Features and Side Effects
Solution zinc sulfate 0.25% and boric acid 0.25% (eye drops)	Zinc sulfate 0.25%, boric acid 0.25%	+	+	It has an antiseptic effect against staphylococci, streptococci, pathogens of demodicosis. Local manifestations of hypersensitivity reactions are possible.
Decacilong	Zinc sulfate 0.25%, decamethoxin	+	+	Has a wide range of antimicrobial action against gram-positive and gram-negative microorganisms, protozoa, chlamydia, fungi of the genus Candida. Local manifestations of hypersensitivity reactions are possible.
Ophthalmo-septonex	Carbetopendicinium bromide, boric acid, sodium tetraborate	+	+	It has a disinfectant and antiseptic effect. Contraindicated in dry conjunctivitis, hypersensitivity to drug components. When applied, a local irritating effect is possible.

Clinical and pharmaceutical characteristics of the main groups of drugs used for the symptomatic treatment of acute infectious conjunctivitis

Antibiotics

Despite the fact that antibiotic eye drops are non-prescription drugs, they should be used after consulting a doctor and taking into account the sensitivity of the microflora of the discharge from the eye. The most commonly used antibiotics from the group of chloramphenicol and aminoglycosides, which have a wide spectrum of action.

Combined eye drops containing antibiotics and corticosteroids should only be used as directed by your doctor!

Antiseptics

The drugs of this group have a wide spectrum of action against various microorganisms. In relation to them, resistance slowly develops. They can be used both for the treatment and for the prevention of infectious conjunctivitis.

Sulfonamides

They block the absorption of para-aminobenzoic acid and the synthesis of folic acid by the microbial cell. They have a bacteriostatic effect mainly on gram-positive flora. In ophthalmology, sulfacetamide is used, which has good water solubility.

Antiviral drugs

Viral conjunctivitis is characterized by an extremely high contagiousness, severity of the clinical course, a high frequency of complications from the eye, therefore, they require compulsory treatment by an ophthalmologist.

Given this circumstance, ophthalmic antiviral drugs are prescription drugs.

Combined eye drops containing antibacterials and corticosteroids

It should be emphasized once again that in view of similar symptoms in infectious, allergic conjunctivitis and a number of other eye diseases, there is a high likelihood of developing complications from the organ of vision with irrational drug therapy, combined preparations containing antibacterial agents and corticosteroids should be used only after consulting an ophthalmologist.

Comparative characteristics of combined drugs for the local treatment of conjunctivitis containing corticosteroids

Tradename	Composition of active ingredients	Features and Side Effects
Garazon *	Betamethasone, gentamicin	The local anti-inflammatory effect is more pronounced than that of other corticosteroids. Contraindicated in viral, fungal and tuberculous eye infections, trachoma.
Dexagentamicin *	Dexamethasone, gentamicin sulfate	It has anti-inflammatory and anti-allergic effects. Possesses a wide spectrum of antibacterial activity. When applied, requires monitoring of intraocular pressure. Contraindicated in pregnancy and lactation.
Dexon *	Dexamethasone, neomycin	It has anti-inflammatory and anti-allergic effects. Possesses a wide spectrum of antibacterial activity. Contraindicated in viral, fungal and tuberculous eye infections, trachoma, glaucoma and cataracts. When applied, requires monitoring of intraocular pressure. Contraindicated in pregnancy and lactation.
Maxitrol *	Dexamethasone, neomycin, polymyxin B	It has anti-inflammatory and anti-allergic effects. Possesses a wide spectrum of antibacterial activity, is especially active against gram-negative flora. Contraindicated in viral, fungal and tuberculous eye infections, trachoma, glaucoma. When applied, requires monitoring of intraocular pressure. Contraindicated in pregnancy and lactation.
Sofradex *	Dexamethasone, gramicidin, framycetin	When applied, requires monitoring of intraocular pressure. Contraindicated in pregnancy and lactation. Should not be used for more than 7 days. With prolonged use, a systemic effect is possible.
Sofrax *	Dexamethasone, gramicidin, framycetin sulfate	It has anti-inflammatory, anti-allergic and antipruritic effects; when applied topically, it reduces pain, burning sensation, photophobia, lacrimation. Possesses a wide spectrum of antibacterial activity, is active against both gram-positive and gram-negative flora. Contraindicated in viral, fungal and tuberculous eye infections, trachoma, glaucoma, cataracts, thinning of the cornea. When applied, requires monitoring of intraocular pressure. Contraindicated in pregnancy and lactation. Should not be used for more than 7 days. With prolonged use, systemic action is possible; there is a danger of corneal perforation.
Pharmadex *	Dexamethasone phosphate disodium salt, boric acid, sodium tetraborate, benzalkonium chloride	It has anti-inflammatory, anti-allergic, disinfecting and antiseptic effects. It is indicated for non-purulent conjunctivitis. Contraindicated in viral, fungal and tuberculous eye infections, trachoma, glaucoma, cataracts, thinning of the cornea. When applied, requires monitoring of intraocular pressure. Contraindicated in pregnancy and lactation, hypersensitivity to the components of the drug. When applied, a local irritating effect is possible. With prolonged use, there is a danger of corneal perforation.

* - prescription drugs

General approaches to the treatment of allergic conjunctivitis

For the treatment of allergic conjunctivitis, eye drops with a vasoconstrictor effect, antiallergic drugs of the group of mast cell membrane stabilizers and glucocorticosteroids are used.

Clinical and pharmaceutical characteristics of the main groups of drugs used for the symptomatic treatment of allergic conjunctivitis

Sympathomimetics

They constrict the vessels, thereby reducing exudation, hyperemia of the conjunctival vessels. Due to the excitation of a-adrenergic receptors, dryness of the mucous membrane is possible, with frequent and / or prolonged use - headache, insomnia, increased blood pressure.

Antihistamines

From this group of drugs in ophthalmology, azelastine and levocabastine are used. They are highly effective when applied topically, practically do not have a sedative effect.

Azelastine not only blocks H1-histamine receptors, but also inhibits the formation of free radicals, prevents the entry of calcium ions into the cytoplasm and the release of intracellular calcium, and inhibits the release of inflammatory mediators.

Mast cell membrane stabilizers

By stabilizing the membranes of mast cells, drugs of this group prevent the release of histamine and other mediators of allergy. The clinical effect develops a few days after the start of use, so these drugs are used mainly for the prevention of seasonal allergic conjunctivitis. They are used from several days to 4 weeks or more.

Glucocorticosteroids

Glucocorticosteroids have a powerful anti-inflammatory and antiallergic effect, have a pronounced positive effect on the clinical course of inflammation of the conjunctiva of an allergic nature. At the same time, the drugs of this group are characterized by an immunosuppressive effect, due to which they create favorable conditions for the addition of infection, and in the presence of an infectious process, for its generalization. These drugs can slow wound healing for corneal injuries, which can also be accompanied by symptoms of conjunctivitis. For steroid drugs, an increase in intraocular pressure is characteristic, and therefore they are contraindicated in glaucoma.

Considering the fact that infectious and allergic conjunctivitis at the onset of the disease have a very similar clinical picture, as well as the possibility of a conjunctival reaction as a manifestation of glaucoma, drugs from the group of glucocorticosteroids (including complex eye preparations containing glucocorticosteroids) can be used only after consulting an ophthalmologist and accurate clinical diagnosis.

Comparative characteristics of drugs used to treat allergic conjunctivitis

International name	Tradename	Possibility of appointment		Features and Side Effects
International name	Tradename	pregnant	children	Features and Side Effects
Antiallergic drugs - sympathomimetics
Tetrizoline	Vizin	Not recommended	After 6 years	Should not be mixed with other solutions. Not assigned to persons with hypertension and ischemic heart disease. When applied, a burning sensation, diplopia, visual impairment are possible (it is dangerous to drive a car).
Oxymetazoline	Afrin	Not recommended	After 6 years	The effect develops in 5-10 minutes. and lasts 6-8 hours. Burning sensation is possible during application. With excessive use, an increase in blood pressure, increased irritability is possible.
Naphazoline	Sanorin, nafkon-a	Carefully	After 2 years	The effect develops in 5-10 minutes. and lasts 6-8 hours. A burning sensation is possible In case of overdose, increased irritability is possible.
Antiallergic drugs - blockers of histamine H1 receptors
Azelastine	Allergodil	Forbidden in the first trimester and during lactation	After 12 years	Perhaps a burning sensation, itching, watery eyes, a bitter taste in the mouth.
Levocabastine	Histimet	Not recommended	After 6 years	Perhaps a burning sensation, itching, watery eyes. Does not have a sedative effect.
Antiallergic agents - stabilizers of mast cell membranes
Lodoxamide	Alomid	Carefully	After 4 years	Possible burning sensation, itching, watery eyes
Cromoglycic acid	Allergokrom, lecrolin, cromohexal, hi-crom	Not recommended	After 4 years	When applied, a burning sensation, diplopia, visual impairment is possible (it is dangerous to drive a car)
Combined non-steroidal antiallergic drugs
Tradename	Composition	Possibility of appointment		Features and Side Effects
Tradename	Composition	pregnant	children	Features and Side Effects
Betadrine	Naphazoline nitrate, diphenhydramine hydrochloride, boric acid	Carefully	After 2 years	It has a pronounced vasoconstrictor, antihistamine and antiseptic effect.
Sanorin-analergin	Naphazoline nitrate, antazoline mesylate	Carefully	After 2 years	It has a pronounced vasoconstrictor and antihistamine effect. In case of an overdose, drowsiness and lethargy are possible.

Pharmaceutical care for the use of drugs for the symptomatic treatment of conjunctivitis

On your own, as part of self-medication, eye drops should be used to relieve the symptoms of conjunctivitis. Treatment with eye ointments requires medical advice.
Contact lens wearers must always remove the lenses when using eye drops! Eye drops containing antibiotics are not recommended for common infections due to the risk of developing resistant strains of microorganisms.
Eye drops used to treat viral conjunctivitis should not be used for more than 10 days.
When taking antiallergic drops, visual impairment (fogging, double vision) may rarely occur, so it is not recommended to drive a car when using these drugs.
Antiallergic drugs from the group of sympathomimetics should not be used by persons with diseases of the cardiovascular system (ischemic heart disease, hypertension), thyroid gland.
Antiallergic drugs from the group of sympathomimetics should not be used for more than 4–5 days.
Antiallergic drugs from the group of sympathomimetics should not be used during pregnancy and lactation.
Eye drops containing corticosteroids should only be used on the advice of a doctor!
With prolonged use of combined eye drops containing corticosteroids, there is a high likelihood of developing glaucoma (increased intraocular pressure), secondary infection, corneal perforation).

Literature

Abramov I.G., The main diseases of the eyes in childhood and their clinical features, Moscow: Mobile, 1993, 495 p.
Eye diseases / Ed. By G. D. Zhaboedov., N. M. Sergienko. - Kiev. - 1999. - 307 p.
Gushchin I.S., Allergic inflammation and its pharmacological control, Moscow: Farmarus-Print, 2001, 154 p.
Compendium 2001/2002 - Medicines / Ed. V.N. Kovalenko, A.P. Viktorova.- K .: Morion, 2001.- 1564 p.
Modern non-prescription drugs / Ed. A. L. Tregubova. - M .: OOO Gamma-S. A. ", 1999.- 362 p.
Trinchuk V.V. Spring catarrh.- Kiev: Health, 1990.- 88 p.
Pharmaceutical care / Ed. V.P. Chernykh, I.A.Zupantsa, V.A.Usenko.- Kh .: Golden Pages, 2002.- 264 p.
Pharmaceutical and biomedical aspects of drugs / Ed. I. M. Pertseva, I. A. Zupantsa. - Kh .: Publishing house of NFAU, 1999.- In 2 volumes - T. 1.- 464 p., T. 2.- 448 p.
Shapovalova V.M., Danilenko V.S., Shapovalov V.V., Bukhtiarova T.A. Medicines dispensed without a doctor's prescription.- Kh .: Torsing, 1998.- 528 p.

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Introduction (characteristics of drugs)

Natural corticosteroids

Corticosteroids- common name hormones adrenal cortex, which include glucocorticoids and mineralocorticoids. The main glucocorticoids formed in the human adrenal cortex are cortisone and hydrocortisone, and the mineralocorticoid is aldosterone.

Corticosteroids have many very important functions in the body.

Glucocorticoids refer to steroids, which has an anti-inflammatory effect, they participate in the regulation of the metabolism of carbohydrates, fats and proteins, control puberty, kidney function, the body's response to stress, and contribute to the normal course of pregnancy. Corticosteroids are inactivated in the liver and excreted in the urine.

Aldosterone regulates sodium and potassium metabolism. Thus, under the influence mineralocorticoids Na + is retained in the body and the excretion of K + ions from the body is increased.

Synthetic corticosteroids

Synthetic corticosteroids, which have the same properties as natural ones, have found practical application in medical practice. They are capable of temporarily suppressing the inflammatory process, but they have no effect on the infectious principle, on the causative agents of the disease. After the corticosteroid drug stops acting, the infection resumes.

Corticosteroids cause tension and stress in the body, and this leads to a decrease in immunity, since immunity is provided at a sufficient level only in a relaxed state. Considering the above, we can say that the use of corticosteroids promotes a protracted course of the disease, blocks the regeneration process.

In addition, synthetic corticosteroids suppress the function of the natural hormones corticosteroids, which leads to impaired adrenal function in general. Corticosteroids affect the work of other endocrine glands, the hormonal balance of the body is disrupted.

Corticosteroid drugs, by eliminating inflammation, also have an analgesic effect. Synthetic corticosteroid drugs include Dexamethasone, Prednisolone, Sinalar, Triamcinolone and others. These drugs are more active and cause fewer side effects than natural ones.

Forms of release of corticosteroids

Corticosteroids are available in the form of tablets, capsules, solutions in ampoules, ointments, liniment, and creams. (Prednisolone, Dexamethasone, Budenofalm, Cortisone, Cortinef, Medrol).

Internal preparations (tablets and capsules)

Prednisolone;
Celeston;
Triamcinolone;
Kenacort;
Kortineff;
Polcortolone;
Kenalog;
Metipred;
Barleycourt;
Florinef;
Medrol;
Lemod;
Decadron;
Urbazon and others.

Preparations for injection

Prednisolone;
Hydrocortisone;
Diprospan (betamethasone);
Kenalog;
Flosterone;
Medrol et al.

Topical preparations (topical)

Prednisolone (ointment);
Hydrocortisone (ointment);
Locoid (ointment);
Corteid (ointment);
Afloderm (cream);
Latikort (cream);
Dermovate (cream);
Fluorocort (ointment);
Lorinden (ointment, lotion);
Sinaflan (ointment);
Flucinar (ointment, gel);
Clobetasol (ointment), etc.

Topical corticosteroids are classified as more or less active.
Weakly active agents: Prednisolone, Hydrocortisone, Corteid, Locoid;
Moderately active: Afloderm, Latikort, Dermovate, Ftorokort, Lorinden;
Highly active: Akriderm, Advantan, Kuterid, Apulein, Kutiveit, Sinaflan, Sinalar, Sinoderm, Flucinar.
Very highly active: Clobetasol.

Inhaled corticosteroids

Beclamethasone in the form of metered-dose aerosols (Bekotid, Aldecim, Beclomet, Beklokort); in the form of bekodisks (powder in a single dose, inhaled with a dischaler); in the form of a metered-dose aerosol for inhalation through the nose (Beclomethasone-nasal, Beconase, Aldecim);
Flunisolide in the form of metered-dose aerosols with a spacer (Ingacort), for nasal administration (Sintaris);
Budesonide - dosed aerosol (Pulmicort), for nasal use - Rinocort;
Fluticasone in the form of aerosols Flixotide and Fliksonase;
Triamcinolone - metered dose aerosol with a spacer (Azmakort), for nasal use - Nazacort.

Indications for use

Corticosteroids are used to suppress the inflammatory process in many branches of medicine, for many diseases.

Indications for the use of glucocorticoids

Rheumatism;
rheumatoid and other types of arthritis;
collagenoses, autoimmune diseases (scleroderma, systemic lupus erythematosus, periarteritis nodosa, dermatomyositis);
blood diseases (myeloblastic and lymphoblastic leukemia);
some types of malignant neoplasms;
skin diseases (neurodermatitis, psoriasis, eczema, seborrheic dermatitis, discoid lupus erythematosus, atopic dermatitis, erythroderma, lichen planus);
bronchial asthma;
allergic diseases;
pneumonia and bronchitis, fibrosing alveolitis;
ulcerative colitis and Crohn's disease;
acute pancreatitis;
hemolytic anemia;
viral diseases (infectious mononucleosis, viral hepatitis and others);
otitis externa (acute and chronic);
shock treatment and prevention;
in ophthalmology (for non-infectious diseases: iritis, keratitis, iridocyclitis, scleritis, uveitis);
neurological diseases (multiple sclerosis, acute spinal cord injury, optic neuritis;
with organ transplantation (to suppress rejection).

Indications for the use of mineralocorticoids

Addison's disease (chronic insufficiency of hormones of the adrenal cortex);
myasthenia gravis (an autoimmune disease manifested by muscle weakness);
disorders of mineral metabolism;
weakness and muscle weakness.

Contraindications

Contraindications for the appointment of glucocorticoids:

hypersensitivity to the drug;
severe infections (other than tuberculous meningitis and septic shock);
immunization with live vaccine.

Carefully glucocorticosteroids should be used for diabetes mellitus, hypothyroidism, gastric ulcer and duodenal ulcer, ulcerative colitis, high blood pressure, liver cirrhosis, cardiovascular insufficiency in the stage of decompensation, increased thrombus formation, tuberculosis, cataract and glaucoma, mental illness.

Contraindications for the appointment of mineralocorticoids:

high blood pressure;
diabetes;
low blood potassium levels;
renal and hepatic failure.

Adverse Reactions and Precautions

Corticosteroids can cause a wide variety of side effects. When using mild or moderately active agents, side reactions are less pronounced and rarely occur. High doses of drugs and the use of highly active corticosteroids, long-term use of them can cause the following side effects:

the appearance of edema due to sodium and water retention in the body;
increased blood pressure;
an increase in blood sugar (possibly even the development of steroid diabetes mellitus);
osteoporosis due to increased calcium excretion;
aseptic necrosis of bone tissue;
exacerbation or occurrence of gastric ulcer; gastrointestinal bleeding;
increased thrombus formation;
increase in body weight;
the occurrence of bacterial and fungal infections due to a decrease in immunity (secondary immunodeficiency);
violation of the menstrual cycle;
neurological disorders;
the development of glaucoma and cataracts;
skin atrophy;
increased sweating;
the appearance of acne;
suppression of the process of tissue regeneration (slow wound healing);
excess facial hair growth;
suppression of adrenal function;
instability of mood, depression.

Long-term courses of corticosteroids can lead to a change in the patient's appearance (Itsenko-Cushing syndrome):

excessive deposition of fat in certain parts of the body: on the face (the so-called "moon face"), on the neck ("bull's neck"), chest, on the abdomen;
the muscles of the limbs are atrophied;
bruising on the skin and stretch marks (stretch marks) on the abdomen.

With this syndrome, growth retardation, disturbances in the formation of sex hormones (menstrual irregularities and male type of hair growth in women, and signs of feminization in men) are also noted.

To reduce the risk of developing adverse reactions, it is important to respond in a timely manner to their appearance, adjust doses (use of small doses if possible), control body weight and calorie content of consumed foods, and limit the use of sodium chloride and liquids.

How do I use corticosteroids?

Glucocorticosteroids can be used systemically (in the form of tablets and injections), locally (intra-articular, rectal administration), topically (ointments, drops, aerosols, creams).

The dosage regimen is prescribed by the doctor. The tablet preparation should be taken from 6 a.m. (first dose) and no later than 2 p.m. subsequent ones. Such conditions of admission are necessary to approach the physiological flow of glucocorticoids into the blood during their production by the adrenal cortex.

In some cases, at high doses and depending on the nature of the disease, the dose is distributed by the doctor for a uniform intake throughout the day for 3-4 doses.

The tablets should be taken with food or immediately after a meal with a little water.

Corticosteroid treatment

There are such types of corticosteroid therapy:

intense;
limiting;
alternating;
intermittent;
pulse therapy.

At intensive care(in the case of an acute, life-threatening pathology), the drugs are administered intravenously and, upon reaching the effect, are canceled at once.

Limiting therapy used for long-term, chronic processes - as a rule, tablet forms are used for several months or even years.

To reduce the inhibitory effect on the function of the endocrine glands, intermittent drug regimens are used:

alternating therapy - use glucocorticoids with short and medium duration of action (Prednisolone, Methylprednisolone) once from 6 to 8 am every 48 hours;
intermittent therapy - short, 3-4-day courses of taking the drug with 4-day breaks between them;
pulse therapy- rapid intravenous administration of a large dose (at least 1 g) of the drug for emergency care. The drug of choice for this treatment is Methylprednisolone (it is more readily available for administration to the affected area and has fewer side effects).

Daily doses of drugs(in terms of Prednisolone):

Low - less than 7.5 mg;
Medium - 7.5-30 mg;
High - 30-100 mg;
Very high - above 100 mg;
Pulse therapy - above 250 mg.

Treatment with corticosteroids should be accompanied by the appointment of calcium and vitamin D preparations for the prevention of osteoporosis. The patient's diet should be rich in proteins, calcium and include a limited amount of carbohydrates and table salt (up to 5 g per day), liquid (up to 1.5 liters per day).

For prevention undesirable effects of corticosteroids on the gastrointestinal tract before taking the tablets, you can recommend the use of Almagel, jelly. It is recommended to exclude smoking, alcohol abuse; moderate exercise.

Corticosteroids for children

Systemic glucocorticoids assigned to children exclusively for absolute indications. In case of bronchial obstruction syndrome, which threatens the child's life, intravenous administration of prednisolone is used at a dose of 2-4 mg per 1 kg of the child's body weight (depending on the severity of the course of the disease), and in the absence of effect, the dose increases by 20-50% every 2-4 hours until getting the effect. After that, the drug is canceled immediately, without a gradual reduction in dosage.

Children with hormonal dependence (with bronchial asthma, for example) after intravenous administration of the drug are gradually transferred to a maintenance dose of prednisolone. With frequent relapses of asthma, Beklamethasone dipropionate is used in the form of inhalation - the dose is selected individually. After receiving the effect, the dose is gradually reduced to a maintenance one (selected individually).

Topical glucocorticoids(creams, ointments, lotions) are used in children's practice, but children have a higher predisposition to the systemic action of drugs than adult patients (delayed development and growth, Itsenko-Cushing's syndrome, suppression of the function of the endocrine glands). This is because children have a greater body surface area to weight ratio than adults.

For this reason, it is necessary to use topical glucocorticoids in children only in limited areas and in a short course. This is especially true for newborns. For children in the first year of life, you can use only ointments containing no more than 1% hydrocortisone or a fourth-generation drug - Prednicarbat (Dermatol), and at the age of 5 years - Hydrocortisone 17-butyrate or ointments with medium strength drugs.

For the treatment of children over 2 years old, Mometasone can be used as directed by a doctor (ointment, has a prolonged effect, is applied 1 p. Per day).

There are other drugs for the treatment of atopic dermatitis in children, with a less pronounced systemic effect, for example, Advantan. It can be used for up to 4 weeks, but its use is limited due to the possibility of local adverse reactions (dryness and thinning of the skin). In any case, the choice of a drug for treating a child remains with the doctor.

Corticosteroids during pregnancy and lactation

The use of glucocorticoids, even short-term, can "program" the work of many organs and systems in an unborn child for decades to come (blood pressure control, metabolic processes, behavior formation). The synthetic hormone mimics the stress signal for the fetus from the mother and thereby forces the fetus to force the use of reserves.

This negative effect of glucocorticoids is enhanced by the fact that modern long-acting drugs (Metipred, Dexamethasone) are not deactivated by placental enzymes and have a long-term effect on the fetus. Glucocorticoids, by suppressing the immune system, help to reduce the resistance of a pregnant woman to bacterial and viral infections, which can also adversely affect the fetus.

Glucocorticoid drugs can be prescribed to a pregnant woman only if the result of their use outweighs the risk of possible negative consequences for the fetus.

Such indications can be:
1. The threat of premature birth (a short course of hormones improves the readiness of the premature fetus for birth); the use of a surfactant for a baby after birth has made it possible to minimize the use of hormones in this indication.
2. Rheumatism and autoimmune diseases in the active phase.
3. Hereditary (intrauterine) hyperplasia in the fetus of the adrenal cortex is a difficult to diagnose disease.

Previously, there was a practice of prescribing glucocorticoids to maintain pregnancy. However, no convincing data on the effectiveness of such a technique have been obtained, therefore, it is currently not used.

In obstetric practice more commonly used are Metypred, Prednisolone and Dexamethasone. They penetrate the placenta in different ways: Prednisolone is destroyed by enzymes in the placenta to a greater extent, and Dexamethasone and Metipred - by only 50%. Therefore, if hormonal drugs are used to treat a pregnant woman, it is preferable to prescribe Prednisolone, and if for the treatment of the fetus, Dexamethasone or Metipred. In this regard, Prednisolone and adverse reactions in the fetus are less common.

For severe allergies, glucocorticoids are prescribed both systemic (injections or tablets) and local (ointments, gels, drops, inhalations). They have a powerful anti-allergic effect. The following drugs are mainly used: Hydrocortisone, Prednisolone, Dexamethasone, Betamethasone, Beclomethasone.

Of the topical glucocorticoids (for local treatment), intranasal aerosols are used in most cases: for hay fever, allergic rhinitis, nasal congestion (sneezing). They usually have a good effect. Fluticasone, Dipropionate, Propionate and others are widely used.

In allergic conjunctivitis, due to the higher risk of side effects, glucocorticoids are rarely used. In any case, in case of allergic manifestations, hormonal drugs cannot be used on their own in order to avoid undesirable consequences.

Corticosteroids for psoriasis

Glucocorticoids for psoriasis should be used mainly in the form of ointments and creams. Systemic (injections or pills) hormonal drugs can contribute to the development of a more severe form of psoriasis (pustular or pustular), so they are not recommended.

Glucocorticoids for topical use (ointments, creams) are usually used 2 p. per day: creams during the day without bandages, and at night together with coal tar or anthralin using an occlusive dressing. In case of extensive lesions, approximately 30 g of the drug is used for the treatment of the whole body.

The choice of a glucocorticoid drug according to the degree of activity for topical application depends on the severity of the course of psoriasis and its prevalence. As the lesions of psoriasis decrease in the course of treatment, the drug should be changed to a less active one (or used less often) to minimize the occurrence of side effects. If you get the effect after about 3 weeks, it is better to replace the hormonal drug with an emollient for 1-2 weeks.

The use of glucocorticoids over large areas for a long period can aggravate the process. Recurrence of psoriasis after discontinuation of the drug occurs earlier than with treatment without the use of glucocorticoids.
, Coaxil, Imipramine and others) in combination with glucocorticoids can cause an increase in intraocular pressure.

Glucocorticoids (with prolonged use) enhance the effectiveness of adrenergic agonists (Adrenaline, Dopamine, Norepinephrine).

Theophylline in combination with glucocorticoids promotes the appearance of a cardiotoxic effect; enhances the anti-inflammatory effect of glucocorticoids.

Amphotericin and diuretics in combination with corticosteroids increase the risk of hypokalemia (a decrease in the level of potassium in the blood) and an increase in the diuretic effect (and sometimes sodium retention).

The combined use of mineralocorticoids and glucocorticoids increases hypokalemia and hypernatremia. With hypokalemia, side effects of cardiac glycosides are possible. Laxatives can worsen hypokalemia.

Indirect anticoagulants, Butadion, Ethacrynic acid, Ibuprofen in combination with glucocorticoids can cause hemorrhagic manifestations (bleeding), and salicylates and Indomethacin - the formation of ulcers in the digestive organs.

Glucocorticoids increase the toxic effect of paracetamol on the liver.

Retinol preparations reduce the anti-inflammatory effect of glucocorticoids and improve wound healing.

The use of hormones together with Azathioprine, Methandrostenolone and Hingamin increases the risk of developing cataracts and other adverse reactions.

Glucocorticoids reduce the effect of Cyclophosphamide, the antiviral effect of Idoxuridine, and the effectiveness of antihyperglycemic drugs.

Estrogens potentiate the action of glucocorticoids, which may reduce their dosage.

Androgens (male sex hormones) and iron preparations increase erythropoiesis (the formation of red blood cells) when combined with glucocorticoids; reduce the process of excretion of hormones, contribute to the appearance of side effects (increased blood clotting, sodium retention, menstrual irregularities).

The initial stage of anesthesia with the use of glucocorticoids is lengthened and the duration of anesthesia is shortened; doses of fentanyl are reduced.

Corticosteroid withdrawal rules

With prolonged use of glucocorticoids, drug withdrawal should be gradual. Glucocorticoids suppress the function of the adrenal cortex, therefore, with rapid or sudden withdrawal of the drug, adrenal insufficiency may develop. There is no standardized regimen for corticosteroid withdrawal. The mode of cancellation and dose reduction depends on the duration of the previous course of treatment.

If the duration of the course of glucocorticoid is up to several months, then the dose of Prednisolone can be reduced by 2.5 mg (0.5 tablets) every 3-5 days. With a longer course duration, the dose is reduced more slowly - by 2.5 mg every 1-3 weeks. With great care, the dose is reduced below 10 mg - 0.25 tablets every 3-5-7 days.

If the initial dose of Prednisolone was high, then at first the decrease is made more intensively: by 5-10 mg every 3 days. Upon reaching a daily dose equal to 1/3 of the initial dose, reduce by 1.25 mg (1/4 tablet) every 2-3 weeks. As a result of this reduction, the patient receives maintenance doses for a year or more.

The drug reduction regimen is prescribed by the doctor, and a violation of this regimen can lead to an exacerbation of the disease - treatment will have to be started again with a larger dose.

Corticosteroid prices

Since there are so many different forms of corticosteroids on the market, only a few of them are priced here:

Hydrocortisone - suspension - 1 bottle 88 rubles; eye ointment 3 g - 108 rubles;
Prednisolone - 100 tablets of 5 mg - 96 rubles;
Metipred - 30 tablets of 4 mg - 194 rubles;
Metipred - 250 mg 1 bottle - 397 rubles;
Triderm - ointment 15 g - 613 rubles;
Triderm - cream 15 g - 520 rubles;
Dexamed - 100 ampoules of 2 ml (8 mg) - 1377 rubles;
Dexamethasone - 50 tablets 0.5 mg each - 29 rubles;
Dexamethasone - 10 ampoules of 1 ml (4 mg) - 63 rubles;
Oftan Dexamethasone - eye drops 5 ml - 107 rubles;
Medrol - 50 tablets of 16 mg - 1083 rubles;
Flixotide - aerosol 60 doses - 603 rubles;
Pulmicort - aerosol 100 doses - 942 rubles;
Benacort - aerosol 200 doses - 393 rubles;
Symbicort - aerosol with a dispenser 60 doses - 1313 rubles;
Beklazon - aerosol 200 doses - 475 rubles.

Before use, you must consult a specialist.