starting stage [2:<6 months of age. i Geriatric Use No substantial differences in safety or efficacy relative to younger patients. a e h Common Adverse Effects Ophthalmic administration: Elevated IOP, a c e f g h posterior subcapsular cataract formation, a c e g h optic nerve damage, a c e f g h delayed wound healing. e f h Otic administration: Ear discomfort, ear pain, ear pruritus. i Dexamethasone Pharmacokinetics Absorption Bioavailability Corticosteroids are absorbed through the aqueous humor; because only low doses are given, little if any systemic absorption occurs after ophthalmic administration. d Distribution Extent Systemically absorbed corticosteroids are distributed into milk; not known whether topical corticosteroids could produce detectable levels in human milk. a e f g h i Stability Storage Ophthalmic Ointment Neomycin and polymyxin B sulfates and dexamethasone: 2 25 C. e Tobramycin and dexamethasone: 8 27 C. h Solution Dexamethasone sodium phosphate: 15 30 C. c Suspension Dexamethasone: Tight, light-resistant containers b at 8 27 C; a store upright. a Neomycin and polymyxin B sulfates and dexamethasone: 8 27 C. f Tobramycin and dexamethasone: Upright containers at 8 27 C. g Otic Suspension Ciprofloxacin and dexamethasone: 15 30 C; protect from light. i Do not freeze. i Actions Corticosteroids suppress the inflammatory response to mechanical, chemical, or immunologic agents. a c d e f g h Corticosteroids inhibit edema, fibrin deposition, capillary dilation, leukocyte and phagocyte migration; in addition, the drugs reduce capillary proliferation, fibroblast proliferation, deposition of collagen, and scar formation associated with inflammation. d Advice to Patients Importance of removing soft contact lenses prior to administering preparations containing benzalkonium chloride a g h and of delaying reinsertion of the lenses for 15 minutes after administration. c Importance of not wearing contact lenses if signs or symptoms of an eye infection occur. e Importance of learning and adhering to proper administration techniques to avoid contamination of the tip of the container. a e f i Importance of advising patients not to touch tip of dropper to eye or surrounding tissue. a c f g h i Importance of informing a clinician if another eye condition (e.g., trauma, surgery, infection) develops during ophthalmic therapy. c Advise patients to warm the ear suspension by holding the bottle in the hands for 1 2 minutes prior to administration. i Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses. a c e g h i Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. a c e g h i Importance of informing patients of other important precautionary information. (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Dexamethasone Routes Dosage Forms Strengths Brand Names Manufacturer Ophthalmic Suspension 0.1% Maxidex (with benzalkonium chloride; viscous) Alcon Ciprofloxacin and Dexamethasone Routes Dosage Forms Strengths Brand Names Manufacturer Otic Suspension Ciprofloxacin 0.3% and Dexamethasone 0.1% per mL Ciprodex (with benzalkonium chloride) Alcon * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Neomycin and Polymyxin B Sulfates and Dexamethasone Routes Dosage Forms Strengths Brand Names Manufacturer Ophthalmic Ointment Neomycin Sulfate 0.35% (of neomycin), Polymyxin B Sulfate 10,000 units (of polymyxin B) and Dexamethasone 0.1% per g* Maxitrol Alcon Neomycin and Polymyxin B Sulfates and Dexamethasone Bausch & Lomb, Falcon, Fougera Suspension Neomycin Sulfate 0.35% (of neomycin), Polymyxin B Sulfate 10,000 units (of polymyxin B) and Dexamethasone 0.1% per mL* Maxitrol (with benzalkonium chloride; viscous) Alcon Neomycin and Polymyxin B Sulfates and Dexamethasone Bausch & Lomb, Falcon Tobramycin and Dexamethasone Routes Dosage Forms Strengths Brand Names Manufacturer Ophthalmic Ointment 0.3% Tobramycin and Dexamethasone 0.1% per g TobraDex (with chlorobutanol) Alcon Suspension 0.3% Tobramycin and Dexamethasone 0.1% per mL TobraDex (with benzalkonium chloride) Alcon * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Dexamethasone Sodium Phosphate Routes Dosage Forms Strengths Brand Names Manufacturer Ophthalmic Solution 0.1% (of dexamethasone phosphate)* Dexamethasone Sodium Phosphate (with benzalkonium chloride) Falcon AHFS DI Essentials. Copyright 2017, Selected Revisions April 1, 2010. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. References a. Alcon Laboratories, Inc. Maxidex 0.1% (dexamethasone ophthalmic suspension) prescribing information. Fort Worth, TX; 2007 May. b. AHFS drug information 2008. McEvoy GK, ed. Dexamethasone. Bethesda, MD: American Society of Health-System Pharmacists; 2008: 2874-5. c. Falcon Pharmaceuticals. Dexamethasone sodium phosphate ophthalmic solution, USP prescribing information. Fort Worth, TX; 2007 Jul. d. AHFS drug information 2008. McEvoy GK, ed. EENT corticosteroids general statement. Bethesda, MD: American Society of Health-System Pharmacists; 2008: 2867-9. e. Alcon Laboratories, Inc. Maxitrol (neomycin and polymyxin B sulfates, and dexamethasone ophthalmic ointment) prescribing information. Fort Worth, TX; 2003 Oct. f. Alcon Laboratories, Inc. Maxitrol (neomycin and polymyxin B sulfates, and dexamethasone ophthalmic suspension) prescribing information. Fort Worth, TX; 2003 Aug. g. Alcon Laboratories, Inc. TobraDex (tobramycin and dexamethasone ophthalmic suspension) prescribing information. Fort Worth, TX; 2006 May. h. Alcon Laboratories, Inc. TobraDex (tobramycin and dexamethasone ophthalmic ointment) prescribing information. Fort Worth, TX; 2003 Oct. i. Alcon Laboratories, Inc. Ciprodex (ciprofloxacin 0.3% and dexamethasone 0.1% sterile otic suspension) prescribing information. Fort Worth, TX; 2003 Jul. Print this page> ] FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Recently Approved Lonhala Magnair Lonhala Magnair (glycopyrrolate) is a long-acting muscarinic antagonist (LAMA) bronchodilator for... Ozempic Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) analog administered once-weekly for the... 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