Patients with glaucoma use eye drops to reduce IOP - intraocular pressure. Only a doctor can prescribe such drugs - after diagnosis, taking into account the person’s age and state of health. These drugs reduce damage to the optic nerve. They are effective in the early stages of pathology development. But eye drops intended to treat glaucoma must be used on an ongoing basis. They provide a stable hypotensive effect only with long-term use. In this case, you must strictly follow the instructions and observe the dosage prescribed by your doctor. If violated, side effects may occur.
How do drugs work?
The main principle of action of antiglaucomatous drugs is to reduce IOP. Pharmaceutical concerns produce different groups of these drugs, but they are all based on eliminating hypertension, only with the help of different substances.
Drops for the treatment of glaucoma mainly have a local effect. They almost completely enter the choroidal vessels. But sometimes a small amount of them ends up in the blood. There, their active substance can affect the cardiovascular and respiratory systems. Before prescribing such drugs, the doctor must conduct an examination to find out whether the patient has chronic diseases of these organs. If you are intolerant to the active ingredients contained in the drops, a different treatment regimen will be prescribed.
Garasone
Garazon is for topical use only. Do not inject subconjunctivally or directly into the anterior chamber of the eye.
The absence of a rapid clinical effect after using the drug serves as the basis for additional examination to clarify the diagnosis.
If signs of the disease persist or in the event of its relapse, it is necessary to conduct a bacteriological study to determine the sensitivity of the pathogen to antibiotics.
When prescribing Garazon for a period of 10 days or more, it is necessary to measure intraocular pressure. It is recommended to perform eye tonometry using a slit lamp. Patients with a family history of patients with open-angle glaucoma, high myopia, or diabetes mellitus are at risk of increased intraocular pressure as a result of topical use of GCS.
It is known that in diseases that cause thinning of the cornea or sclera, local use of GCS can lead to perforation of the eyeball. In this regard, it is not recommended to begin with the use of a combination of an antibiotic and corticosteroids for the treatment of corneal ulcers of bacterial etiology, which can be caused by Pseudomonas aeruginosa
. It is advisable to use only an antibacterial agent at the beginning of treatment. If there is a response to antibiotic therapy, it may be recommended to add an anti-inflammatory agent to the treatment to minimize the fibrotic reaction and prevent corneal scar formation.
In acute purulent processes in the eye, GCS can mask an existing infection or potentiate it.
When treating an infection caused by the herpes simplex virus, GCS should be used with extreme caution.
In the case of local administration of an antibiotic from the group of aminoglycosides, the possibility of ototoxicity should be kept in mind.
Animal studies have shown that gentamicin, when applied topically to the external auditory canal, can be absorbed into the blood because after use in this way, it was determined in blood serum and urine.
Long-term local use of antibiotics or corticosteroids may lead to increased growth of insensitive microorganisms, including fungi.
Cross-allergic reactions have been observed between various aminoglycosides and corticosteroids.
To avoid contamination and cross-infection, do not use the same vial of the drug to treat eye and ear infections at the same time. If the open end of the dropper bottle touches any surface, the solution may become contaminated. Sharing the dropper bottle by more than one person may spread the infection.
During long-term treatment with the drug, it is recommended to discontinue it gradually.
Use in pediatrics
The safety and effectiveness of Garazon in children under 6 years of age has not been established.
Types of drops for glaucoma
There are several types of antiglaucoma drops:
- reducing the production of intraocular fluid;
- improving its outflow;
- having a combined effect.
From the point of view of chemical composition, a different classification of eye drops for glaucoma is used. Here the active substance comes first. Depending on it, there are synthetic prostaglandins, beta blockers, carbonic anhydrase inhibitors, as well as other agents.
Synthetic prostaglandins
These are the most common drops that reduce intraocular pressure. They have a hypotensive effect as they improve fluid outflow. These include “Travatan”, “Taflotan”, “Glauprost” and others. You must act in accordance with the manufacturer's instructions. But in most cases, using the product once a day is sufficient.
The reduction in pressure is noticeable within two hours after use, and the effect gradually intensifies. The maximum reduction in pressure is achieved after 12 hours. The effect of the drug lasts for a day. The number of eye drops is prescribed by the doctor.
Prostaglandin analogues are completely safe drugs. The pressure is reduced due to the fact that they provide an additional route for the outflow of fluid. But these drugs can also have side effects:
- the eyes turn red due to dilation of the conjunctival vessels;
- swelling occurs, accompanied by a burning sensation;
- Eye color changes due to the accumulation of melanin pigment.
All these changes are temporary. After stopping the drug, everything quickly returns to normal. Interestingly, the use of these drops makes the eyelashes darker (also due to the accumulation of pigment). They may even become thicker.
Beta blockers
This is a common type of antiglaucomatous eye drop that works by reducing the production of intraocular fluid. The group includes Betoptik, Timolol, Okupres and others. They also lower IOP. This type has a long-lasting effect - 12-24 hours. Therefore, you need to instill medications for glaucoma once or twice a day. Sometimes they are combined with synthetic prostaglandins to increase the effectiveness of treatment.
These medications also have side effects:
- lacrimation;
- redness, feeling of dryness in the eyes;
- swelling of the conjunctiva;
- development of inflammation.
Usually the patient experiences only mild discomfort. But in rare cases, more serious problems arise. These are bronchospasms or bradycardia. Therefore, such drops are not prescribed to patients suffering from cardiovascular diseases and/or bronchial asthma. If you are intolerant to antiglaucomatous eye drops of this group, the doctor selects another treatment.
Carbonic anhydrase inhibitors
These include Trusopt, Dorzopt and Azopt. Sometimes such eye drops are called antienzymes. The principle of their action is the same as that of beta blockers - they suppress the production of intraocular fluid. But they are safer, since they have almost no side effects, except for discomfort and slight blurred vision (it goes away quickly). The disadvantage of such antiglaucomatous eye drops is their shorter duration of action. They need to be instilled 2-3 times a day.
Cholinomimetics
This group includes Pilocarpine and Carbacholine. These are drops that reduce IOP by improving fluid outflow. They are prescribed to people with closed- or narrow-angle glaucoma.
The duration of action of such solutions is shorter than that of drugs belonging to other groups. Therefore, they need to be used more often - up to 4-6 times a day. But it is necessary that the frequency and number of instillations be determined by a doctor, because an overdose increases the risk of side effects. Among them are headaches (in the area of the temples and brow ridges) or spasm of accommodation; arrhythmia, increased sweating, and a strong decrease in blood pressure are less common.
You can use a few drops for the eyes, combining cholinomimetics with antienzymes or beta blockers.
Combination drugs
The hypotensive effect can be enhanced by combining several active ingredients. For this purpose, combined drops were developed. You don’t have to use several combined medications at once, but buy one drug. In addition to enhancing the effect, in this case its duration also increases. This allows you to reduce the frequency of use.
Combined preparations have all the positive and negative properties of the active substances included in their composition. This group includes “Fotil” (a combination of “Timolol” and “Pilocarpine”), “Xalacom” (a combination of “Xalatan” and “Timolol”) and others.
Sympathomimetics
This group includes Epinephrine, the active ingredient of which is adrenaline hydrochloride. It not only improves fluid circulation, but also has a beneficial effect on the autonomic nervous system. But its use can increase blood pressure and cause pupil dilation. In some cases, an allergic reaction occurs.
Other types of drugs
In addition to the drops listed, there are other compositions. Brimonidine belongs to the same group as Clonidine, but is safer. It reduces fluid production and at the same time increases the contraction of the ciliary muscle to improve outflow.
Garazon eye and ear drops 5ml
Active substance
Betamethasone + Gentamicin
Manufacturer
Schering-Plow Labo N.V. (Belgium)
Shelf life
3 years
Storage conditions
At a temperature not exceeding 25 °C
Registration certificate number
P N013526/01 dated 07/31/2008
Description of the dosage form
A transparent, colorless or slightly yellowish solution that does not contain foreign matter.
Pharmacodynamics
Garazon® is a combination drug, the effect of which is determined by the components included in its composition.
Gentamicin sulfate is a broad-spectrum antibiotic from the aminoglycoside group. Has a bactericidal effect. Effective against coagulase-positive and coagulase-negative staphylococci (including Staphylococcus aureus
),
Escherichia coli
, indole-positive and indole-negative
Proteus
,
Pseudomonas aeruginosa,
various species of the
Klebsiella spp. group, Enterobacter spp., Serratia spp.,
and
Citrobacter spp., Salmonella spp., Shigella spp., Moraxella spp.
(including
Moraxella lacunata
),
Neisseria spp.,
in particular
Neisseria gonorrhoeae
.
Betamethasone sodium phosphate - GCS, has a local anti-inflammatory effect, suppressing cellular and fibrinous exudation and normalizing increased capillary permeability, which is manifested by a decrease in local hyperemia, edema and effusion.
In case of allergic or traumatic lesions of the cornea, GCS suppresses the proliferation of fibroblasts and post-inflammatory neovascularization of the cornea, i.e. while maintaining its transparency.
Contraindications
hypersensitivity to any of the components of the drug;
keratitis caused by the herpes simplex virus (dendritic keratitis);
viral diseases of the cornea and conjunctiva (for example, chickenpox);
mycobacterial and fungal infections of the eye or ear;
trachoma;
conditions accompanied by thinning of the cornea and sclera (for example, after removal of a foreign body from the cornea);
absence or perforation of the eardrum;
children under 8 years of age;
pregnancy;
lactation period (due to lack of information);
wearing soft contact lenses (due to the presence of benzalkonium chloride in the composition).
Carefully:
open-angle glaucoma, high myopia;
family history of diabetes mellitus;
infection caused by the herpes simplex virus.
Use during pregnancy and breastfeeding
Should not be prescribed during pregnancy unless the expected effect of therapy outweighs the potential risk to the fetus.
It is not known whether the components of Garazon® are excreted in breast milk. Therefore, breastfeeding may need to be stopped during treatment.
Directions for use and doses
Eye diseases
Conjunctivally,
the dosage must be determined for each patient individually.
Usually 1-2 drops are instilled into the conjunctival sac of the affected eye 3-4 times a day.
In the acute stage, the frequency of use can be increased to 2 drops every hour or every 2 hours. Later, when the course of the disease becomes controlled, the frequency of use is reduced. The total duration of treatment depends on the nature and severity of the disease. If there is no therapeutic effect within 14 days after the start of treatment, further use of the drug seems inappropriate.
Ear diseases
In the external auditory canal,
Before using the drug, the external auditory canal must be free.
The recommended initial dose is 3-4 drops 2-4 times a day. The patient should lie on his side with the affected ear facing upward; After instilling the solution, you should remain in this position for a few more minutes to ensure penetration of the drug into the ear canal.
As inflammation decreases, the dosage should be gradually reduced and use of the drug should be discontinued after the symptoms of the disease disappear.
If necessary, a cotton swab soaked in Garazon® can be inserted into the external auditory canal. The tampon must be kept moist by wetting it with the drug every 4 hours. The tampon should be replaced every 24 hours.
For chronic diseases, treatment should be discontinued gradually by reducing the frequency of drug use.
Side effects
There may be a short-term sensation of burning, itching or dry skin at the site of application.
Adverse events associated with the effects of GCS on the eyes:
increased intraocular pressure, glaucoma, damage to the optic nerve, decreased acuity and narrowing of the visual field, development of posterior subcapsular cataracts, delayed wound healing, the appearance of filterable vesicles after cataract surgery, development of secondary eye infections (eg
Herpes zoster
), acute anterior uveitis, corneal perforation and sclera, mydriasis, impaired accommodation of the eye, ptosis.
When using antibiotics
for eye treatment, allergic reactions may develop. Transient eye irritation has been reported in association with the use of gentamicin sulfate.
Overdose
Symptoms:
Excessive or prolonged use of topical corticosteroids can lead to suppression of the function of the pituitary gland and adrenal glands, up to the development of secondary adrenal insufficiency.
Treatment:
symptomatic therapy, incl. correction of water and electrolyte balance. Gradual withdrawal of the drug.
special instructions
Garazon® is intended for topical use only. Do not inject subconjunctivally or into the anterior chamber of the eye.
The absence of a rapid clinical effect after using the drug serves as the basis for additional examination to clarify the diagnosis.
If signs of the disease persist or in the event of its relapse, despite a complete course of treatment, it is advisable to conduct a bacteriological examination of smears from the conjunctiva to determine the sensitivity of the pathogen to antibiotics.
When prescribing Garazon® for a period of 10 days or more, it is necessary to measure intraocular pressure. It is recommended to perform eye tonometry using a slit lamp. Patients with a family history of open-angle glaucoma, high myopia, and diabetes mellitus are at risk for increased intraocular pressure when treated with topical corticosteroids.
It is known that in diseases that cause thinning of the cornea or sclera, local use of GCS can lead to perforation of the eyeball. In this regard, it is not recommended to begin with the use of an antibiotic-anti-inflammatory drug combination for the treatment of corneal ulcers of bacterial etiology, which can be caused by Pseudomonas aeruginosa
. It is advisable to use only an antibacterial agent at the beginning of treatment. If there is a response to antibiotic therapy, it may be recommended to add an anti-inflammatory agent to the treatment to minimize the fibrotic reaction and prevent the formation of corneal scars.
In acute purulent processes in the eye, GCS can mask an existing infection or potentiate it.
When treating an infection caused by the herpes simplex virus, GCS should be used with extreme caution.
In the case of local administration of an antibiotic from the group of aminoglycosides, one should keep in mind the possibility of its ototoxic effect.
Animal studies have shown that gentamicin, when applied topically to the external auditory canal, can be absorbed into the blood because after administration in this way, it was determined in blood serum and urine.
Long-term local use of antibiotics or corticosteroids can lead to an increase in the number of resistant strains of microorganisms, including fungi.
In this case, as well as if irritation or hypersensitivity to the drug Garazon® occurs, treatment with this drug should be interrupted and appropriate therapy should be carried out.
Cross-allergic reactions have been observed between various aminoglycosides and corticosteroids.
To prevent widespread infection, it is necessary to avoid using the same vial for the simultaneous treatment of otitis media and eye infections. The use of a pipette by more than one person is prohibited (causes the spread of infection).
During long-term treatment with the drug, its withdrawal should be carried out gradually.
Use in pediatrics
The safety and effectiveness of the drug in children under 8 years of age has not been established.
Pharmaceutical actions
anti-inflammatory, antiallergic
Neuroprotectors and their action
Antiglaucoma medications are not just drops. Neuroprotectors are also prescribed during drug treatment. Their basic principle differs from all the listed means. They have a neuroprotective effect and improve microcirculation, including in the area of the optic nerve. Such drugs are effective even in advanced stages of pathology - in combination with other methods. This category includes Nootropil, Retinalamin and other medications.
Some types of drops, such as synthetic prostaglandins and beta blockers, also have neuroprotective effects. But this effect is more pronounced in the tablet form. To increase blood circulation in the problem area, the doctor may prescribe Trental or a drug based on ginkgo biloba. To improve tissue trophism - Semax or Cortexin. Drugs can be combined with each other. The treatment strategy is selected individually in each specific case.
