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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Loteprednol (Lotemax) Eye Drops - Uses, Dose, MOA, Brands

Loteprednol is a corticosteroid medication used primarily in ophthalmology for the treatment of various eye conditions such as inflammation, pain, and swelling. It is available in various forms including eye drops and ointments.

Loteprednol works by reducing inflammation in the eye. It is often prescribed for conditions such as allergic conjunctivitis, anterior uveitis, and post-operative inflammation following eye surgery.

One advantage of loteprednol over some other corticosteroids is its lower propensity to cause elevated intraocular pressure (IOP) or cataract formation, which are potential side effects associated with long-term corticosteroid use in the eye.

Loteprednol (Lotemax) is a corticosteroid that is used to treat allergic and inflammatory conditions of the eyes (allergic conjunctivitis and inflammation of the eyes after ocular surgery)

Loteprednol Uses

Ophthalmic inflammatory conditions (0.5% suspension):
- Works well on eye-related inflammatory conditions.
Postoperative inflammation/pain (0.38% gel; 0.5% suspension/ ointment/ gel; 1% suspension):
- Reduces symptoms that develop after ocular surgery.
Seasonal allergic conjunctivitis (0.2% suspension):
- Transiently improves allergic conjunctivitis.

Loteprednol (Lotemax) Dose in Adults:

Loteprednol (Lotemax) Dose in the treatment of Ophthalmic inflammatory conditions:

Put 1 to 2 drops of the suspension into the affected eye(s) four times a day.
During the first week of treatment, you might need to use it more often, even every hour if your doctor recommends it.
Don't stop using the medication suddenly. If you've been using it for a while, your doctor will gradually reduce the dose before you stop completely.
If your symptoms don't get better after two days, talk to your doctor again for further evaluation.

Loteprednol (Lotemax) Dose in the treatment of Postoperative ophthalmic inflammation/pain:

If you're using the 0.38% gel: Apply 1 drop into the affected eye(s) three times a day. Start this 24 hours after your surgery and continue for the first 2 weeks after the surgery.
If you're using the 0.5% ointment: Apply a ribbon about the size of ~ / inch into the affected eye(s) four times a day. Start this 24 hours after your surgery and continue for the first 2 weeks after the surgery.
If you're using the 0.5% gel or suspension: Put 1 to 2 drops into the affected eye(s) four times a day. Start this 24 hours after your surgery and continue for the first 2 weeks after the surgery.
If you're using the 1% suspension: Put 1 to 2 drops into the affected eye(s) twice a day. Start this the day after your surgery and continue for the first 2 weeks after the surgery.

Loteprednol (Lotemax) Dose in the treatment of Seasonal allergic conjunctivitis:

Put 1 drop into the affected eye(s) four times a day.

Loteprednol (Lotemax) Dose in Children:

Loteprednol (Lotemax) Dose in Postoperative inflammation and pain:

For infants, children, and adolescents experiencing postoperative inflammation and pain, Loteprednol, in the form of 0.5% gel (marketed as Lotemax), is used.

Instill 1 to 2 drops into the conjunctival sac of the affected eye(s) four times daily.
Start using it on the first day after the surgery and continue for the first 2 weeks of the postoperative period.
This dosage has been studied in young pediatric patients with a mean age of 3 years who underwent cataract surgery.

Loteprednol (Lotemax) Pregnancy Category: C

Adverse effects have been seen in animal studies when loteprednol was taken orally during pregnancy.
However, when used in the eyes, it's expected that very little of the medication is absorbed into the bloodstream, likely less than 1 ng/mL.
If someone needs to use eye drops containing loteprednol during pregnancy, it's recommended to use the lowest effective dose possible and to combine it with punctal occlusion (blocking the tear ducts) to further reduce the chance of the medication reaching the fetus.

Use during breastfeeding:

Systemic corticosteroids, including loteprednol, can enter breast milk.
However, the extent to which this happens after using loteprednol eye drops is uncertain.
As a precaution, the manufacturer suggests being cautious when giving loteprednol to breastfeeding mothers.

Dose in Kidney Disease:

The manufacturer's labeling for loteprednol doesn't include any specific dosage adjustments for people with renal impairment.
This is likely because the medication is not significantly absorbed into the bloodstream, so it's unlikely to have a substantial impact on kidney function.
Therefore, dosage adjustments are not typically necessary for individuals with renal impairment.

Dose in Liver disease:

The manufacturer's labeling for loteprednol does not include any dosage adjustments for individuals with hepatic impairment.
This is likely because the medication is minimally absorbed into the bloodstream after ophthalmic administration, so it is unlikely to have a significant impact on liver function.
Therefore, dosage adjustments are generally not necessary for individuals with hepatic impairment.

Common Side Effects of Loteprednol (Lotemax):

Central Nervous System:
- Foreign Body Sensation Of Eye
- Headache
Endocrine & Metabolic:
- Chemosis
Local:
- Application Site Burning
Ophthalmic:
- Anterior Chamber Inflammation
- Blurred Vision
- Epiphora
- Eye Discharge
- Eye Pruritus
- Injected Sclera
- Photophobia
- Visual Disturbance
- Xerophthalmia
Respiratory:
- Pharyngitis
- Rhinitis

Less Common Side Effects Of Loteprednol (Lotemax):

Dermatologic:
- Erythema Of Eyelid
Ophthalmic:
- Conjunctival Hyperemia
- Corneal Edema
- Eye Pain
- Conjunctivitis
- Corneal Changes
- Eye Discomfort
- Eye Irritation
- Keratoconjunctivitis
- Uveitis
- Increased Intraocular Pressure
- Posterior Capsule Opacification
Miscellaneous:
- Papilla

Contraindications to Loteprednol (Lotemax):

Loteprednol should not be used if you have a known hypersensitivity or allergy to loteprednol, other corticosteroids, or any component of the formulation.
Additionally, it's essential to avoid using loteprednol if you have an untreated ocular infection, including bacterial, viral (such as herpes simplex), varicella (chickenpox), fungal, or mycobacterial infections.
Using loteprednol in these situations could worsen the infection or delay appropriate treatment.

Warnings and precautions

Cataracts

Corticosteroids, including loteprednol, can lead to the formation of cataracts, particularly posterior subcapsular cataracts.
Using loteprednol after cataract surgery might slow down healing and increase the chances of bleb formation.

Corneal thinning

Conditions affecting the eyes and prolonged use of corticosteroids can cause thinning of the cornea and sclera (the white part of the eye).
Continued use of loteprednol in individuals with thinning of the cornea may result in perforation (tearing).

Glaucoma:

Long-term use of corticosteroids like loteprednol can increase pressure inside the eye, leading to elevated intraocular pressure (IOP) and potentially causing glaucoma.
Loteprednol should be used cautiously in individuals with glaucoma, and IOP should be monitored in patients receiving treatment for ten days or more.

Immunosuppression:

Extended use of corticosteroids, including ophthalmic preparations like loteprednol, may raise the risk of secondary ocular infections, including fungal infections.
Acute purulent (pus-filled) ocular infections might be concealed or worsened with corticosteroid use.
If a patient has persistent corneal ulcers after corticosteroid use, fungal infection should be considered.

Systemic absorption

Studies have shown that corticosteroids applied topically to the eyes can be absorbed into the bloodstream, potentially reducing the body's natural corticosteroid production.
Prolonged use of topical ophthalmic corticosteroids like loteprednol should be approached with caution due to the risk of systemic immunosuppression and other hazards associated with corticosteroid exposure.

Herpes simplex

Corticosteroids should not be used to treat ocular herpes simplex infections, as they can make the infection more severe.
Extreme caution is advised when using loteprednol in patients with a history of herpes simplex infections.

Loteprednol: Drug Interaction

Risk Factor C (Monitor therapy)
Ritodrine	Corticosteroids may enhance the adverse/toxic effect of Ritodrine.

Monitoring parameters:

Intraocular Pressure (if >10 days of treatment):

If loteprednol is used for more than 10 days, it's essential to monitor intraocular pressure (IOP), which is the pressure inside the eye.
Elevated IOP can be a side effect of prolonged corticosteroid use and may lead to glaucoma.
Regular monitoring of IOP helps detect any increase early, allowing for timely intervention if needed.

Signs and Symptoms of Infection:

It's crucial to be vigilant for any signs or symptoms of infection while using loteprednol.
These signs may include redness, swelling, pain, discharge, or changes in vision.
If any signs of infection occur, such as worsening redness or discharge, prompt medical attention should be sought to prevent potential complications.

How to administer Loteprednol (Lotemax)?

For Topical Ophthalmic Use Only:

Loteprednol is meant to be used only on the eyes and should not be ingested or used on other parts of the body.

To Avoid Contamination:

When using loteprednol, avoid touching the dropper or tube tip to the eyelids or any other surfaces to prevent contamination.

Contact Lens Removal:

Prior to administering loteprednol, remove contact lenses. Contact lenses should not be worn when using ophthalmic gel, ointment, or suspension.

Reinsertion of Contact Lenses:

Contact lenses can be reinserted 15 minutes after using loteprednol ophthalmic gel, ointment, or suspension.

Seasonal Allergic Conjunctivitis:

If using loteprednol for seasonal allergic conjunctivitis and the eyes are red, do not wear contact lenses.

Instructions for Gel:

Before using loteprednol gel, invert the bottle while it is closed and shake it once to fill the tip before instilling drops.

Instructions for Suspension:

Shake the loteprednol suspension well before using it to ensure uniform distribution of the medication.

Mechanism of action of Loteprednol (Lotemax):

Corticosteroids like loteprednol work by inhibiting the body's inflammatory response.
This includes reducing swelling (edema), widening of small blood vessels (capillary dilation), movement of white blood cells (leukocyte migration), and formation of scars.
Loteprednol is particularly effective because it's highly soluble in lipids (fats) and can easily enter cells.
Once inside cells, it stimulates the production of proteins called lipocortins.
These lipocortins help regulate the activity of chemicals in the body known as prostaglandins and leukotrienes, which play key roles in the inflammatory process.
By modulating these chemicals, loteprednol helps to control inflammation in the eyes.

Onset of Action:

For seasonal allergic conjunctivitis, symptoms are typically reduced within 2 hours of using loteprednol eye drops.

Absorption:

Loteprednol is minimally absorbed into the bloodstream when used chronically in the eyes.
Even with long-term use, levels of loteprednol and its metabolites in the blood remain below the level of detection (less than 1 ng/mL).

Distribution:

Loteprednol penetrates most effectively into the cornea (the clear front part of the eye), followed by the iris/ciliary body (structures that control the shape of the lens) and the aqueous humor (the fluid in the front part of the eye).

Metabolism:

In the cornea, loteprednol is metabolized by enzymes called esterases into inactive carboxylic acid metabolites.
Once activated by binding to glucocorticoid receptors, loteprednol undergoes rapid metabolism, which helps to minimize adverse effects associated with corticosteroid use in the eye.

International Brand Names of Loteprednol:

Alrex
Inveltys
Lotemax
Lotemax SM
Disolot
Lacrison
Lopred
Loteflam
Lotemax
Lotenol
Lotep
Lotepred
Loteprol
Loterex
Lotesoft
Oftal
Oftol Forte
Olopred

Loteprednol Brand Names in Pakistan:

Loteprednol Eye Drops 0.5 %w/v in Pakistan
Lotepred Forte	Elko Organization (Pvt) Ltd.