1. Name Of The Medicinal Product
Sofradex Ear/Eye Drops.
2. Qualitative And Quantitative Composition
Each bottle contains 0.5% w/v of Framycetin Sulphate Ph.Eur., Dexamethasone Sodium Metasulphobenzoate (equivalent to 0.050% w/v of Dexamethasone) and 0.005% w/v of Gramicidin USP.
3. Pharmaceutical Form
Sterile clear colourless ear/eye drops.
4. Clinical Particulars
4.1 Therapeutic Indications
In the Eye: For the short term treatment of steroid responsive conditions of the eye when prophylactic antibiotic treatment is also required, after excluding the presence of fungal and viral disease.
In the Ear: Otitis Externa.
4.2 Posology And Method Of Administration
DOSAGE
Adults (and the Elderly) and Children:
In the Eye: One or two drops applied to each affected eye up to six times daily or more frequently if required.
In the Ear: Two or three drops instilled into the ear three or four times daily.
ADMINISTRATION
Auricular and Ocular use.
4.3 Contraindications
Viral, fungal, tuberculous or purulent conditions of the eye. Use is contraindicated if glaucoma is present or herpetic keratitis (e.g. dendritic ulcer) is considered a possibility. Use of topical steroids in the latter condition can lead to extension of the ulcer and marked visual deterioration.
Otitis Externa should not be treated when the eardrum is perforated because of the risk of ototoxicity.
Hypersensitivity to the preparation.
4.4 Special Warnings And Precautions For Use
Topical corticosteroids should never be given for an undiagnosed red eye as inappropriate use is potentially blinding.
Treatment with corticosteroid/antibiotic combinations should not be continued for more than 7 days in the absence of any clinical improvement, since prolonged use may lead to occult extension of infections due to the masking effect of the steroid. Prolonged use may also lead to skin sensitisation and the emergence of resistant organisms.
Prolonged use may lead to the risk of adrenal suppression in infants.
Treatment with corticosteroid preparations should not be repeated or prolonged without regular review to exclude raised intraocular, pressure, cataract formation or unsuspected infections.
Aminoglycosides antibiotics may cause irreversible, partial or total deafness when given systemically or when applied topically to open wounds or damaged skin. This effect is dose related and is enhanced by renal or hepatic impairment. Although this effect has not been reported following ocular use, the possibility should be considered when high dose topical is given to small children or infants.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
None relevant to topical use
4.6 Pregnancy And Lactation
Safety for use in pregnancy and lactation has not been established. There is inadequate evidence of safety in human pregnancy. Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development including cleft palate and intrauterine growth retardation. There may therefore be a very small risk of such effects in the human foetus. There is a risk of foetal ototoxicity if aminoglycoside antibiotics preparations are administrated during pregnancy.
4.7 Effects On Ability To Drive And Use Machines
May cause transient blurring of vision on instillation. Warn patients not to drive or operate hazardous machinery unless vision is clear.
4.8 Undesirable Effects
Hypersensitivity reactions, usually of the delayed type, may occur leading to irritation, burning, stinging, itching and dermatitis.
Topical steroid use may result in increased intraocular pressure leading to optic nerve damage, reduced visual acuity and visual field defects.
Intensive or prolonged use of topical corticosteroids may lead to formation of posterior subcapsular cataracts.
In those diseases causing thinning of the cornea or sclera, corticosteroid therapy may result in the thinning of the globe leading to perforation.
4.9 Overdose
Long-term intensive topical use may lead to systemic effects.
Oral ingestion of the contents of one bottle (up to 10ml) is unlikely to lead to any serious adverse effects.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Framycetin Sulphate is an aminoglycoside antibiotic with a spectrum of activity similar to that of neomycin, this includes Staph. aureus and most clinically significant gram negative organisms.
Gramicidin is an antimicrobial cyclic polypeptide active in vitro against many gram positive bacteria. It is used for the local treatment of susceptible infections, sometimes in combination with other antimicrobial agents and frequently with a corticosteroid.
Dexamethasone is a synthetic glucocorticoid and has the general properties as other corticosteroids.
5.2 Pharmacokinetic Properties
Framycetin Sulphate absorption occurs from inflamed skin and wounds. Once absorbed it is rapidly excreted by the kidneys in active form. It has been reported to have a half life of 2-3 hours
Gramicidin has properties similar to those of Tyrothricin and is too toxic to be administered systemically.
Dexamethasone is readily absorbed from the gastro-intestinal tract. It has a biological half-life in plasma of about 190 minutes.
5.3 Preclinical Safety Data
Not applicable.
6. Pharmaceutical Particulars
6.1 List Of Excipients
The ear/eye drops contains Citric Acid BP, Sodium Citrate BP, Lithium Chloride, Phenylethyl Alcohol, Industrial Methylated Spirit BP, Polysorbate 80 BP, Purified Water BP.
6.2 Incompatibilities
None known.
6.3 Shelf Life
24 Months.
Discard contents 28 days after opening.
6.4 Special Precautions For Storage
Store below 25°C, do not refrigerate.
6.5 Nature And Contents Of Container
Glass bottle fitted with a special dropper attachment: Pack size of 8 or 10ml.
Plastic dropper bottle: Pack size of 10ml.
6.6 Special Precautions For Disposal And Other Handling
Not applicable.
7. Marketing Authorisation Holder
Sanofi-aventis
One Onslow Street
Guildford
Surrey
GU1 4YS
UK
8. Marketing Authorisation Number(S)
PL 04425/0210
9. Date Of First Authorisation/Renewal Of The Authorisation
4th June 2005
10. Date Of Revision Of The Text
December 2006
Legal Category
POM
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