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Medical Forum / General / Vision / June 2009Alrex long term
Can anyone comment on the safety of using Alrex long term? My doc has started me on it for mild (but annoying) dry eye. The idea was to use it twice per day for a month, then if things are good, taper down to once or twice per week indefinitely. If things aren't all better, we could then go on to Restasis. I'm finding conflicting information on-line regarding the risk of cataracts from Alrex long term, but maybe twice weekly usage is no problem? I'm assuming the initial month is no issue. -- > Can anyone comment on the safety of using Alrex long term? My doc has > started me on it for mild (but annoying) dry eye. The idea was to use [quoted text clipped - 5 lines] > issue. > -- It's preserved with Benzalkonium Chloride ("BAK") BAK is horrible for eyes, cytotoxic to corneas (kills off the healthy cells), and CAUSES dry eyes in people with otherwise healthy eyes. For people WITH dry eyes ... you may as well use Drano, instead. Avoid BAK whenever and wherever possible. One of the selling points of loteprednol is reduced penetration compared to other steroids. They tell me that makes it least likely to cause cataracts and glaucoma. Also you're using the milder preparation; I prescribe Lotemax fairly often without worrying about cataracts. But what do you mean by "long term?" Topical steroids are often used before Restasis, and often continued for 2-3 weeks after starting Restasis. But I don't know many docs recommending long-term steroids as a treatment for dry eye. If long-term steroids were called for, Alrex is the one I'd want. -MT > Can anyone comment on the safety of using Alrex long term? My doc has > started me on it for mild (but annoying) dry eye. The idea was to use [quoted text clipped - 4 lines] > twice weekly usage is no problem? I'm assuming the initial month is no > issue. I was told if I had significant improvement he'd recommend using it once or twice per week indefinitely ("forever"), in lieu of restasis. I'm just the patient, so I don't know whether this is actually a good idea. Is restasis preferable for long term use? The thing he told me that I'd never read or heard before is that restasis causes permanent changes if it works and you eventually taper down and stop taking it. Like it fixes you permanently. Is this right? Regarding BAK, I don't know what to think about it. I know people over at Dry Eye Talk forum are always concerned about it, but why would these companies continue to use it if it amounted to poison for the eyes? > One of the selling points of loteprednol is reduced penetration > compared to other steroids. They tell me that makes it least likely [quoted text clipped - 21 lines] > > initial month is no issue. > > -- -- > Regarding BAK, I don't know what to think about it. I know people over > at Dry Eye Talk forum are always concerned about it, but why would > these companies continue to use it if it amounted to poison for the > eyes? It's cheap, readily available, already FDA approved, and DOES do a nice job of killing bugs that can spoil/taint ophthalmic drops. I tried to petition the FDA to re-visit their approval of BAK. What they sent me amounted to a ~200 page application for review that needed to be filled out before they would look at it. They won. I threw it away. If you do the research (PubMed, for example), you'll find LOTS of studies that confirm my comments, though. It's evil. I would only use it short-term, and ONLY IF there were no alternative (eg, an antibiotic drop). |
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