various steroid eye drops...

[echinoderm]

can someone explain the differences in steroid eye drops?? the different indications? i know pred forte is very commonly used.. but when do we resort to the others, such as FML?

---

Members don't see this ad.

 

[MR1]

Pred Forte is very common and it is cheap although I know some don't think the generic doesn't work as well.

FML is weaker but has less steroid response

there are others, Lotamax, Vexol, etc that are synethic ones and maybe have less steroid response but are as strong as PF. I think all these are still on patent and therefore more expense.

This is my limited knowledge at least

 

[MstaKing10]

pred forte is the most widely used as it is effective and cheap. Omni pred is equivalent and we seem to have tons of samples of the stuff in our clinic so the one I end up using the most.

FML and the like are weaker in terms of anti-inflammatory effects but less likely to lead to IOP issues. Most use it for steroid responders or for more long term use or when inflammation is mild.

Lots of others available but more expensive and I have less experience with them

 

[Graham Lakkis]

can someone explain the differences in steroid eye drops?? the different indications? i know pred forte is very commonly used.. but when do we resort to the others, such as FML?

There are a whole range of ocular steroids which vary in their intraocular penetration and potency, and it is good to develop some sophistication in tailoring their use, rather than prescribing predforte for everything.

As has been mentioned, the newer "soft steroids" have excellent potency with less side effects because they use an ester rather than a ketone group in the steroid molecule. Any unbound drug in the eye is rapidly metabolised before it can cause problems.

Even within the same class of drug, there is different potency depending on the molecular structure; eg. fluromethalone alcohol is less potent than fluromethalone acetate; prednisolone sodium phosphate is less potent that prednisolone acetate.

So, in order of weakest to strongest, I am pretty sure the steroid strength is:

hydrocortisone
fluromethalone (FML)
fluromethalone acetate (Flarex)
prednisolone phosphate (Predsol)
prednoisolone actetate (Pred Forte)
dexamethasone (Maxidex)

I am unsure exactly where the new steroids fit in because they are not available here in Australia yet, but their potency is pretty much in the order (weakest to strongest): Alrex, Lotemax, Durezol

 

[echinoderm]

thanks all for the replies... not sure if this is shifting gears, but where does triamcinolone fall on the spectrum?

 

[Visionary]

thanks all for the replies... not sure if this is shifting gears, but where does triamcinolone fall on the spectrum?

Triamcinolone acetonide is not a topical preparation. It's for periocular/intravitreal use. Can't really compare with the topical spectrum, then. Dexamethasone is also used this way. Comparing Dex to TA, Dex is more potent, but has a shorter duration of action.

Regarding the topicals, Durezol is the newest and definitely the most potent. It's at least twice as potent as Pred Forte, putting it above Dex.

As mentioned by MstaKing10, the more potent the steroid, the more likely you are to have IOP (and cataract) issues.