Neil & Kakinda... here's one for you

[Rebecca Petris]

Did you see Alcon's email newsblast about a BAK-free glaucoma med coming soon? If no see this link.

Wahoo. May this trend grow and thrive - as quickly as possible!!!!

- Whoops, just noticed that the web link didn't contain the title from the email, which was: "The World's First Zero-BAK Prostaglandin Analogue - The Countdown Begins"

[kakinda]

Alcon: coming to its senses

This is an important step by Alcon... a small progress from the usual non-sense to more sensible products...
BUT.... all chronic pathologies such as DE, ocular allergy, people suffering from frequent infections and/or ulcers, steroids dependent treaments, should have similarly a non-preserved option...
May I suggest Patanol for their next step because it can really be effective in treating inflammation and allergy but BAC ruins it all.
thanks for the info,
take care
K

[Rebecca Petris]

Sure, there is a long queue of products overdue for this. But, they have to crawl before they can walk.

[kakinda]

better but not good enough

Hi,
hopefully they'll start crawling forward and not backwards or side ways like crabs...
always finding an excuse for another preservative (polyquad) to finally admit what we all knew in the first place.

May i suggest that we all, take 2 minutes, to write to Alcon to congratulate them about taking this preservative issue seriously for glaucoma and unfortunately not that seriously for something like Patanol (allergy and inflammation) for instance:

http://www.alconinc.com/us/eo/comments/contactus.jhtml

I'm pretty sure I'm not the only interest in PF Patanol drops. Please forward me their replies if you can.

If they don't listen to us, their shareholders will... someday, because what they need is more and more to convince us and not ophthalmologists (we're the ones living with dry eye, we're the ones feeling the side-effects of their BAC)...so where the ones who will adopt the product or not. It's like every new eye drop with jewel or advanced mechanisms, and the like, they may fool us once... but they'll sure need to convince us (or our eyes) over the long term.

Once again this year i was forced to find a solution to keep on working during the high peak of the allergy season, took Patanol to survive a few days and then faced 15 days of ulcerations again...then I was forced to stop working.
I'm not managing the allergy at all but at least the ulcerations have stopped when I stopped using [O]Patanol.

it's "less worse" and certainly cheaper!

Take care
K

[kitty]

Hi,


If they don't listen to us, their shareholders will... someday, because what they need is more and more to convince us and not ophthalmologists (we're the ones living with dry eye, we're the ones feeling the side-effects of their BAC)...so where the ones who will adopt the product or not. It's like every new eye drop with jewel or advanced mechanisms, and the like, they may fool us once... but they'll sure need to convince us (or our eyes) over the long term.
K

It's also "us" who decides, at least in the U.S., what to spend our money on. I have to decide whether I want to pay the pharmacy co-pay to use a drug that will help my allergies vs. destroy my eyes. I too was forced into using Patanol, both for seasonal allergy and for allergy to Restasis. I stopped it as soon as I could, I just could not get through the days without it. Fortunately no ulcers happened as a result, but I am very afraid of the BAC/BAK. If patients don't want to pay the co-pay, or pay out of pocket, that will hit the manufacturers in their bottom line.

[Rebecca Petris]

Travatan-Z

I was just browsing through my new issue of Ophthalmology over a quick lunch. There were two gorgeous full page ads for Travatan-Z inside... with ZERO BAK oh so prominent in the ad. Yesssssssssssssssss.

(Yo, Pfizer, you listening? Yeah, you with the permanent full page Xalatan ad on the back cover - sure, you didn't mention BAK even once in the half page of small print on the adjacent page, but we all know it's in there.)

Let the competition roll. And please hurry up.

[neil0502]

Hopefully they'll start crawling forward and not backwards or side ways like crabs...
always finding an excuse for another preservative (polyquad) to finally admit what we all knew in the first place.

Remember how I said that we never hear the real story about the damage done by the LAST thing until THEY can use it to demonstrate an advantage offered by the NEWEST thing (that they're trying to sell us).

May i suggest that we all, take 2 minutes, to write to Alcon to congratulate them about taking this preservative issue seriously for glaucoma and unfortunately not that seriously for something like Patanol (allergy and inflammation) for instance:

http://www.alconinc.com/us/eo/comments/contactus.jhtml

Will do. Good idea. I'm going to include a comment that ALL ophthalmic drugs should be available as PF. Does anybody see any downside to that?? It doesn't mean "refrigeration required," but it may mean unit-dose packaging.

Thanks for highlighting this, Rebecca. Clearly, I'm a bit encouraged to see a measure of progress by Alcon.

[Rebecca Petris]

Does anybody see any downside to that??

Interestingly some might, in some drug categories... I am way behind on journals but I did notice that there have been some recent publications/studies talking about BAK enhancing efficacy of antibiotics. Personally if I've got an infection, I want something as effective as possible. The glaucoma meds have gotten the most attention because they have to be used long-term so their preservatives have the most potential for doing stuff like, uh, what happened to you .

[neil0502]

That's a valid point, Rebecca, and certainly one that I've raised in other posts.

The increase in efficacy that you're talking about comes from BAK's proven ability to increase the permeability of the cornea, potentially increasing the ability of the antimicrobial to penetrate deeper into the eye. Of course, since DES people already have excessively permeable corneas, this is certainly an adverse effect for us.

Because I just don't know whether or not the increased permeability caused by BAK really matters (where the infection really lives) in ophthalmic antimicrobial therapy, my personal (and biased!) approach would be to continue to raise the "I hate BAK" flag, allowing them to consider (and defend the case for) appropriate exceptions, while still encouraging them to pursue safer alternatives.

In the end, though, the permeability/drug delivery thing may well be a very valid exception for some classes of med.

[kakinda]

Rebecca,

I would seem more logical to use cationic emulsions or any other system to enhance substance (in this case antibiotic) penetration rather than enhancing possibly an ulcer to ensure penetration...of bacteria.
because by enhancing drug penetration, you may in the end also favour bacteria penetration and proliferation if the antibiotic isn't that effective.

Let's remind people why it ensures penetration: because it destroys some epithelial cells (epithelium is meant to be a barrier... nature isn't always wrong remember).

I am very much in favour of killing some bacteria but not at the cost of risking my cornea (It's like asking: who exactly was winning? just after a thermonuclear war!). Plus, there are other solutions (cationic, creams that stay longer, etc).

so beware of trying to be too effective... the best may be the ennemy of the good... an European saying.

Besides glaucoma and DE drops, allergy drops should also be preservative free since they require frequent use over long periods (remember some people suffer from allergy all year long, some six months...).

Take care
K

[neil0502]

Back to nature

It seems that there ARE potential replacements for BAK that will also enhance the drug delivery and penetration of "the right" ophthalmic drugs....

Click me!

Treatment of Experimental Bacterial Keratitis

Emilia Ghelardi,1* Arianna Tavanti,1 Paola Davini,1 Francesco Celandroni,1 Sara Salvetti,1 Eva Parisio,1 Enrico Boldrini,2 Sonia Senesi,1 and Mario Campa1
Dipartimento di Patologia Sperimentale, Biotecnologie Mediche, Infettivologia ed Epidemiologia, Universitą di Pisa,1 Farmigea S.p.A., Pisa, Italy2

Received 3 November 2003/ Returned for modification 5 February 2004/ Accepted 19 May 2004

Bacterial keratitis is a serious infectious ocular disease requiring prompt treatment to prevent frequent and severe visual disabilities. Standard treatment of bacterial keratitis includes topical administration of concentrated antibiotic solutions repeated at frequent intervals in order to reach sufficiently high drug levels in the corneal tissue to inhibit bacterial growth. However, this regimen has been associated with toxicity to the corneal epithelium and requires patient hospitalization. In the present study, a mucoadhesive polymer extracted from tamarind seeds was used for ocular delivery of 0.3% rufloxacin in the treatment of experimental Pseudomonas aeruginosa and Staphylococcus aureus keratitis in rabbits. The polysaccharide significantly increased the intra-aqueous penetration of rufloxacin in both infected and uninfected eyes. Rufloxacin delivered by the polysaccharide reduced P. aeruginosa and S. aureus in the cornea at a higher rate than that obtained by rufloxacin alone. In particular, use of the polysaccharide allowed a substantial reduction of S. aureus in the cornea to be achieved even when the time interval between drug administrations was extended. These results suggest that the tamarind seed polysaccharide prolongs the precorneal residence times of antibiotics and enhances drug accumulation in the cornea, probably by reducing the washout of topically administered drugs. The tamarind seed polysaccharide appears to be a promising candidate as a vehicle for the topical treatment of bacterial keratitis.
--

If I recall correctly, this tamarind seed is also one of the key components in the Visine Intensive drop....

[dianat]

Okay, can I digress and be a bimbo for a minute?

So, years ago did some Indian scientist get tamarind in his eye during his meal and realize that it "took the red out"?!

(I had Indian food for lunch. It was on my mind...)

[neil0502]

I can't really imagine you as a bimbo, but ... then again ... I just might be trying to curry favor....

[rimshot]

[dianat]

Neil,

I fully expected you to take a Punjab at me. You're such a darjeeling!

(another rim shot...if I even deserve one.)