01/12/2019
Salaam colleagues ...
I want to raise an issue regarding the nasal & eye drops and their systemic effects (or side effects)
I went through many pieces of literature that the nasal and eyes drop drugs have an access to CNS (e.g olfactory mucosa in the nasal cavity), thereby can cause many CNS and systemic effects basically through their effects on the CNS..
So, we need to re-think that the nasal and eye drop less likely to have systemic actions.
The drugs those have receptors on CNS (e.g sympathomimetics (decongestants), parasympathomimetics, sympathoplegics, parasympathoplegics (old antihistamine)) are expected to cause systemic effects, and patients have to be counselled about that based on theirs disease conditions (CVDs, BPH, ... etc)
Herebelow, i will post some patient case reports that emphasize on this:
Case Report
From Eye Drops to ICU, a Case Report of Three Side Effects of Ophthalmic Timolol Maleate in the Same Patient
Abstract
Timolol Maleate (also called Timolol) is a nonselective beta-adrenergic blocker and a class II antiarrhythmic drug, which is used to treat intraocular hypertension. It has been reported to cause systemic side effects especially in elderly patients with other comorbidities. These side effects are due to systemic absorption of the drug and it is known that Timolol is measurable in the serum following ophthalmic use. Chances of life threatening side effects increase if these are coprescribed with other cardiodepressant drugs like calcium channel or systemic beta blockers. We report a case where an elderly patient was admitted with three side effects of Timolol and his condition required ICU admission with mechanical ventilation and temporary transvenous pacing. The case emphasizes the need of raising awareness among physicians of such medications about the potential side effects and drug interactions. A close liaison among patient’s physicians is suggested.
(Michael G. Lancina, Juan Wang, Geoffrey S. Williamson, and Hu Yang, “DenTimol as A Dendrimeric Timolol Analogue for Glaucoma Therapy: Synthesis and Preliminary Efficacy and Safety Assessment,” Molecular Pharmaceutics, 2018.
Changhua Mu, Meng Shi, Ping Liu, Lu Chen, and Gerard Marriott, “Daylight-Mediated, Passive, and Sustained Release of the Glaucoma Drug Timolol from a Contact Lens,” ACS Central Science, 2018
Systemic effects of fluticasone nasal spray: report of 2 cases.
Abstract
OBJECTIVE: To describe two clinical cases of systemic side effects from use of fluticasone nasal spray.
METHODS: A retrospective review of medical records of two patients using this drug was undertaken, and their clinical presentations and laboratory data are summarized.
RESULTS: Despite many clinical reports about the potential side effects from inhaled corticosteroids, no previously published clinical reports or studies have addressed such problems with the use of potent glucocorticoid nasal sprays. Two patients are described in whom different clinical problems developed after overuse of fluticasone nasal spray, a commonly advertised and prescribed drug. One patient was admitted to the hospital with symptoms of adrenal insufficiency. In the other patient, bone mineral density decreased substantially in 1 to 2 years despite preventive estrogen therapy. These patients had suppressed plasma or urinary cortisol, a low plasma adrenocorticotropic hormone (corticotropin) level, or an abnormal response to a cosyntropin stimulation test.
CONCLUSION: Patients should be clearly warned that the prescribed dosing for fluticasone nasal spray should be carefully followed because overuse may cause serious side effects.
Regards ...
