Xibrom

[RDAC]

Wanted to make a mention - I have been using a great new nsaid that's been out in Japan for some time but only out for a year in the U.S. called Xibrom.

If you have used Acular - you should try this - much more powerful (only used twice a day) with less side effects (no burning and less bak than any other available nsaid).

http://www.istavision.com/products/products_xibrom.asp

Far less dangerous than a steroid and very effective.

[Rebecca Petris]

I happened to meet a regional sales manager for ISTA last week and had a look through some of their materials. I wasn't previously familiar with Xibrom but the data appeared awfully compelling. Much less burning than Acular (the leading NSAID) and greater efficacy. Sounded out a doc or two of my acquaintance and they had had very good experience with it.

ISTA are a small up-and-coming pharma with an interesting product lineup. One of their drugs in the pipeline is for dry eye (Ecabet Sodium).

[Danny_]

What's in this thing? Is it a drop to reduce inflamation?

[Rebecca Petris]

Yes it's a non-steroidal anti-inflammatory (NSAID), used mostly for post cataract surgery inflammation I believe. For details see this link.

[Vicki In Oregon]

Acular I think has no preservatives whereas this Xibrom has BAK and had I known I would not have taken it so long. I wish the dry eye expert had told me of this risk on my already dry eyes. He prescribed it for my dry eyes which is what makes no sense to me.

[Rebecca Petris]

Acular I think has no preservatives whereas this Xibrom has BAK and had I known I would not have taken it so long. I wish the dry eye expert had told me of this risk on my already dry eyes. He prescribed it for my dry eyes which is what makes no sense to me.

Acular is preserved with benzalkonium chloride. It is also available in a preservative free version. Xibrom is much newer and (as far as I'm aware) not yet available in preservative free.

I think you are overreacting and should discuss your concerns with your doctor.

[Vicki In Oregon]

I called my regular eye doctor and told him that the local expert gave me this and he thought it was pretty unusual. He also said that that is the guy whom they normally turn to for advice on dry eye patients. He said that Acular would have been better choice but preservative free. He said BAK is a very harsh detergent. Online you read about stuff being BAK free because BAK/BAC makes dry eyes worse and not just while using it. Not to mention Neils story and the links he provided regarding what BAK does. I dont know how much or how long one has to use it to have any amount of permanent damage. So long now I have been using only expensive preservative free drops so it frustrates me to have put in something in my eyes the last few weeks that contradicts this effort. If my eyes didn't hurt so much I would not be so worried. Tomorrow I go in for my upper control flow plugs and will ask for some of the tear tests to see how I do in relation to how i did before. Maybe he can look at my epithelial layer and tell if it is any worse than before. My understanding is that this cornea erosion dystrophy the local expert said i have affects the epilethilal tissue in addition to dry eyes alone so this whole thing just makes no sense to me. Hopefully tomorrow i will get some answers.

[RDAC]

More re Xibrom

See the web site (if you have not done so already); this use is a bit off-label, but it is the best pain reliever currently out by far. My eyes are dry primarily due to lack of mucous and not water and as such this helps a great deal. BAK is indeed a problem - however this drop has the lowest BAC concentration of any eye pain reliever drop (with preservatives).
Further my NYC doc who is quite well known in this field for dry eye work and studies has a number of patients using it. Dosing is twice daily but currently I only use it once daily.

If this helps you I would consider using it as I have done - there will be further studies of this drop in the coming year for our dry eye purpose. Related ISTA Pharmaceuticals is working themselves on a dry eye drop that I have hopes for - a mucosal secreotogue -

BAC is not good perhaps - but XIBROM is great - and as with all meds we have to weigh the good against the bad.

RDAC

[kakinda]

Hi,
BAK is not good for sure! Besides Neil's story, mine and a few others on this site, there is scientific evidence that one should not use BAK contaning drops frequently with normal eyes (let alone with DES, keratitis, dystrophy, ulceration!!!). If one has an erosion one should avoid abrasive substances even if low concentration (i have study on very low concentration stating that frequency is even more important)... it's common sense so maybe ask your doc before deciding anything.
But it's great to hear that your doc is aware that BAK is a very harsh detergent...
If only I had know that during the 90's ... and I'm sure Neil would say the same.
So sometimes you really have to use it (for instance, if you need an antibiotic - there are no PF antibiotics) but do it considering the pros and cons of using BAK (I guess only your doc is able to make that choice for you).
The 3 last important erosions I made were under BAK-containing drops... in had to use it cases.
The more you use it the more you are at-risk of getting some kind of sensitivity to BAK.
We really need to address this issue!
Keratos will work on specific BAK website soon... hopefully with the help of some of you.
Take care
K

[RDAC]

Agreed - BAK is not good but again weigh the two -

Folks – I agree BAK is a harsh preservative – the medical community has understood for some time its unintended effects with overuse. This is not solely with eye drop use but with nasal inhalants (where it can damage cilia) etc.

XIBROM has an excellent safely profile and with it an extremely low concentration of this preservative – this product is used by over 6 million Japanese – many of them using it ongoing for an off label purpose as we are discussing here. The idea as with any medication is to get the greatest helpful effect with the least negative side effects.

I would suggest considering this – as we do with all of our products: Omega 3 / GLA, humidifiers, eye drops – as simply one more addition to the arsenal.

Have your eyes checked bi monthly as I do – and use as limited as you can with the greatest effect.

[neil0502]

Your approach is sensible. I've recommended to a couple of people that ... IF you and your doc feel the risk:reward ratio is there ... at least have your tear film thoroughly evaluated a couple of times a month (+/-).

By the way ... there IS a preservative-free antibiotic ... at least in the States ... and at least in ointment form. It's what I was using to fly. It was NOT easy for the pharmacy to find, but ... with my help ... they managed.

It's called Ak-Poly-Bac:

http://www.akorn.com/catalog_product.php?product_id=24

http://www.akorn.com/documents/catal...478-238-35.pdf

Keywords: PF antibiotic, preservative-free antibiotic

[kakinda]

You're right Neil, as in France there is an ointment antibiotic formulation but no drops- that's what i meant - and that may be essential to ensure compatibility with other treatments, including sclerals...
Yes, keep your eyes under control as even NSAID are not always a good thing for DE...but then again there's
no easy choices with DE (just the better amongst the worse)...
with time one learns to make less bad choices
take care
K

[Vicki In Oregon]

Neil, have you been helped by the product you mentioned? It sounds like it is suppose to be equivalanet of what i used but i thought yours was anti biotic and mine anti inflammatory?

Thank you RDAC for posting this. By the way, my inbox is not full anymore.

Anyway, Neil had posted an article regarding studies doen on BAK and the amount of BAK in the Xibrom was just halfway between the most and least thye used on the test subjects and yet ALL had lowered tear scores after using it just a week. I used 3 weeks twice a day. Also, in another study he posted about using preservatives (not BAK but any) versus using non preserved artificial tears for 6 weeks, the end results showed much lowered tear scores on the various tests they do (tbut, shirmer) in the subjects using preservatives and just slightly lowered in those who did not use preservatives. Even though the non preservative was much much better, it worries me that there even was a negative change after just 6 weeks because we use these things for months and years. So even preservative free drops lower our bodies abiltiy to make its own tears it seems and that is scary to me. Makes me wonder about my plugs and how they make my body think it needs to produce even less tears when i am in constant pain. I did read somewhere and can maybe even find it where it said that plugs may do that, reduce your eyes ability to make even the few tears it does make. And yet I am going to try to get upper plugs again because the pain is too much. hopefully the control flow wont make me blurry like the others but again i worry about the long term affects of the things we do to try to help ourselves. because i cant function the way I am let alone with less and worse quality tears.

I think the opthamologist should at the very least discuss the positive and negatives of this product not just prescribe it because ultimately not all doctors are equally qualified and they all tell you something different so it is up to us to make informed decisions about what we put in our bodies. but we cannot make such a choice if we are not told about what we are prescribed.

[neil0502]

Neil, have you been helped by the product you mentioned? It sounds like it is suppose to be equivalanet of what i used but i thought yours was anti biotic and mine anti inflammatory?

My doc prescribed the PF antibiotic ointment as sort of a "last-ditch" attempt at easing the DES symptoms. Somewhere, I saw "delayed corneal healing" as a side effect, so I never used it regularly--maybe just a week or so at bedtime.

I DID, however, use it for my long flights over to Europe. I didn't see any downside for that sort of use.

[RDAC]

Since we're all talking here -

In my own experience Xibrom has actually increased tear quality / quantity. Perhaps this is due to same behavior as caused by Restasis - breaking the inflammation cycle etc.

Further – I have tried plugs twice and could not handle either time - they caused me a GREAT deal of eye pain. Seems for me plugs hold the cytokines – inflammatory mediators – to my eye when these are best off washed away – I caution folks to try collagen / temp. plugs first before ever attempting a more permanent option -

DES is an artful science indeed.

RDC