Fast Pharmaceutical Facts
Our pocket guide puts key prescribing information at your fingertips.
By Alan Aker, M.D., F.A.C.S.

I'm pleased to introduce a new feature for Ophthalmology Management magazine, the Pocket-Sized Ophthalmic Drug Guide. This handy, easy-to-use reference (call Todd Galles at 707.256.1412) lets you quickly check the ingredients, dosages and bottle sizes of the drugs you use most frequently.

In researching this year's guide, we had the opportunity to take a closer look at some of the newer ophthalmic drugs. Here's a brief rundown of some of the latest entries.

The year of glaucoma

Several new glaucoma drugs were launched in early 2001, and we're happy to include these on our drug guide:

• Lumigan (bimatoprost) 0.03% from Allergan is a synthetic prostamide with powerful ocular hypotensive effects. When used once daily, this medication can reduce intraocular pressure (IOP) by about 35%. It does not require refrigeration.
• Rescula (unoprostone isopropyl) 0.15%, a docosanoid from Novartis Ophthalmics, has ocular hypotensive effects that are similar to those of betaxolol. Clinical studies have shown that unoprostone improves ocular blood flow to the retina, choroid and optic nerve tissues, suggesting that the drug might be neuroprotective in patients with primary open-angle glaucoma or normal-tension glaucoma. Unlike other drugs in the prostaglandin family, unoprostone must be dosed twice daily.
• Travatan (travoprost) from Alcon is the newest prostaglandin analog approved for use in the United States. Formulated as a 0.004% solution, Travatan is dosed once daily in the evening and yields ocular hypotensive effects comparable to those of latanoprost (Xalatan). Unlike Xalatan, however, Travatan doesn't require refrigeration before dispensing. Studies are underway to determine whether Travatan is more effective than Xalatan in African-American patients.

The next two drugs are FDA-approved, but not officially launched. Watch for them in the coming months:

• Alphagan P from Allergan contains the active ingredient brimonidine tartrate 0.15% and the preservative Purite in 0.005% concentration. An oxychloro-complex that breaks down to sodium chloride and water upon exposure to ultraviolet radiation, Purite is better tolerated than the more commonly used benzalkonium chloride and is less apt to cause ocular toxicity. Studies indicate that Alphagan P lowers IOP as well as Alphagan 0.2%. As with Alphagan, the recommended dosage for Alphagan P is three times daily, although many practitioners will prescribe it only twice daily.
• Betaxon, Alcon's levobetaxolol 0.5%, is the levo-isomer of betaxolol. It has the same systemic safety advantages of the parent compound but is somewhat more effective than betaxolol in reducing IOP. Betaxon does not have the same ocular hypotensive effect as timolol or other nonselective beta-blockers.

Anti-infective approved

Santen Pharmaceutical Co., Ltd., received FDA approval last August of its ocular anti-infective medication, Quixin (levofloxacin ophthalmic solution) 0.5%, which is indicated for the treatment of bacterial conjunctivitis.

Levofloxacin is a potent, broad-spectrum fluoroquinolone. Its higher solubility at neutral pH allows this drug to be formulated at a higher concentration as compared to other currently marketed ophthalmic fluoroquinolones.

Quixin has been shown effective against a wide range of causative organisms, including Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae.

Allergy options expand

Within the past 2 years, several new drugs for the treatment of itching associated with allergic conjunctivitis have made their way to market. The range of ocular allergy medication options now available lets us tailor our therapy to individual patients based on their specific symptoms, lifestyles and budgets.

On the accompanying guide, you'll find two new mast-cell stabilizers: Alamast (pemirolast potassium ophthalmic solution), from Santen, and Alocril (nedocromil sodium ophthalmic solution), from Allergan.

Zaditor (ketotifen fumarate ophthalmic solution), from Novartis Ophthalmics, has joined Alcon's Patanol (olopatadine hydrochloride ophthalmic solution) in the dual-action category. Ketotifen is a relatively selective, non-competitive histamine antagonist (H1-receptor) and mast-cell stabilizer.

Our patients are eager for allergy relief, and today's prescription medications give us the tools to deliver it.

To request a pocket-sized Ophthalmic Drug Guide please call Todd Galles, 707.256.1412, at Santen.