Duotrav Alcon eye drops reduce internal pressure (2.5ml)

Dosage form Box X 2.5ml
Specifications Travoprost, Timolol
Ingredient Gleloma opened the original, glaucoma Glocom

Ingredient

Composition information	Content
Travoprost	0.04mg/ml
Timolol	5mg/ml

Uses

indications

Duotrav drugs are indicated in the following cases:

Reducing intraocular pressure in adult patients with open -angle glaucoma or glaucoma, those who do not fully respond to beta blockers or medications similar to prostaglandin.

Pharmacokic

Duotrav small eye solution contains two active ingredients: Travoprost and Timolol Maleatate. These two components reduce internal pressure with additional mechanisms of action and combination effect, which leads to better glaucoma than when using each single component (synergistic effect). 

Travoprost, a substance similar to Prostaglandin F2α, is a highly selective and highly -selected owner with a Prostaglandin FP receptor and reduces intraocular pressure by increasing aquatic escape through the Network of Conscious and Portuguese.

The reduction of glaucoma in humans begins within 2 hours after the eye is small and reaches the maximum effect within 12 hours. The significant reduction in internal pressure can be maintained for more than 24 hours after taking a single dose.

Timolol is an unsterious Adrenergic blocker, no intrinsic sympathetic activity, direct inhibition of myocardial muscle or membrane stability activity. The main mechanism of action of Timolol in the eye is associated with reducing the formation of aquaculture and slightly increasing the drainage.

In addition to reducing intraocular pressure, Travoprost also shows the effect of increasing blood flow at the end of the optic nerve based on data on rabbits after 7 days of eye small eyes (1.4 μg, 1 time/day).

On corneal cells cultured on people and after the eyes in the rabbit, the Duotrav eye small solution is stored with polyquidermiium-1 to minimize toxicity on the eye surface compared to the eye drops preserved with benzalkonium chloride.

pharmacokinetics

absorption:

Travoprost and Timolol are absorbed through the cornea. Travoprost is a precursor of isopropyl ester quickly hydrolyzed in the cornea into a free -active acid.

After the small solution of the Duotrav eye solution (using polyquidermium-1 preservatives) once a day for healthy objects for 5 days, the freelance acid dollar of Travoprost in plasma is below the quantitative limit of 0.010 ng/ml in most samples.

Observed that the amount of canvas can be quantified by free acid in some cases within an hour after taking the drug, in the range of 0.010–0,030 ng/ml. The average CMAX in the stable state of Timolol is 1.34 ng/ml and TMAX is about 0.69 hours after the drug once a day. Timolol has a sale time of about 4 hours.

Distribution:

Free acid Travoprost can be measured in aquaculture after a few hours in animal and plasma after 1 hour of medication. Timolol can be measured in humans after using Timolol and in plasma after 12 hours of medication.

Metabolism:

Metabolic is the main clearance mechanism for both Travoprost and free acid. The system of systemic metabolism for the free acid form of Travoprost is similar to the metabolic path of the endogenous prostaglandin f2α characterized by the reduction of double bonds 13-14, oxidation 15-hydroxyl into keton form and beta-oxyxt cutting part of carboxylic acid.

Timolol is metabolized mainly through CYP2D6 in two roads. A line that creates an ethanolamine side circuit on Thiadiazole and the second line creates an Ethanolic side circuit on the Morpholin nitrogen and a second -side circuit similar to a carbonyl group right next to the nitrogen. CYP2C19 has little role in Timolol metabolism.

Era:

Both Travoprost are free and timolol with metabolites are excreted mainly in urine. After taking Timolol oral, radioactive marks for volunteers, about 72% of the dose is excreted within 84 hours, with 66% excreted in urine and 6% in feces.

About 20% of the dose is excreted in a constant form in the urine, the rest is excreted in the form of metabolites. Due to the low concentration of Travoprost and quickly eliminate from plasma, it is impossible to determine the sale time. Timolol has a sale time of about 4 hours.

Before taking Duotrav Alcon eye drops reduce internal pressure (2.5ml)

How to use

eye drops.

Patients must remove the assurance ring right before the first use.

To avoid the infection into the small tip of the drug and the solution, be careful not to let the medications of the vial touch the eyelids, the area around the eyes or any surface. Close the lid of the vial when not in use.

Recommend patients to press the pipeline or close their eyes for 2 minutes after the drug, the absorption of systemic drugs will decrease. This will reduce the unwanted effects of the whole body and increase the effects on the spot.

If you are taking more than one eye drops, the drugs should be used at least 5 minutes apart. Eye ointment needs to be used final.

Dosage

used in adults, including the elderly (65 years or older):

The recommended dose is a drop in the conjunctiva bag of the eye once a day, in the morning or evening. Should drop the drug at the same time every day.

When replacing a glaucoma treatment with Duotrav eye solution, it should be stopped and started using Duotrav eye solution on the next day.

Patients with liver or kidney failure:

Almost no need to adjust the doses of small eye solution Duotrav.

Pediatric patients (under 18 years old):

Currently, it is not recommended to use Duotrav small eye solution for pediatric patients. The safety and effectiveness of the drug has not been determined in children and teenagers under 18 years old.

Elderly patients (over 65 years old):

There is no difference in safety and efficiency between the elderly and adults.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose? Timolol cannot be easily separated.

What to do when forgetting a dose? Do not put more than 1 drop/day due to evidence that the use of similar drugs prostaglandin can reduce the effect of lowering intraocular pressure.

Side Effects

When using Duotrav medicine, you may experience unwanted effects (ADR).

Common, ADR> 1/100

Eyes: Set of the eye, keratitis, blurred vision, dry eyes, eye pain, itchy eye, discomfort in the eyes, eye irritation.

Uncommon, 1/1000

Immune: Hypersensitivity.

nerve: dizziness, headache.

Eyes: keratitis, iritis, conjunctivitis, precursor inflammation, lash inflammation, fear of light, vision loss, eye strain, swelling of the eye, increasing tears, eyelid edema, eyelashes, eye allergies.

heart: Slow heart rate. circuit: increase/lower blood pressure.

Respiratory: Difficulty breathing.

skin: contact dermatitis, hair hair, skin hyperpigmentation (around the eyes or hyperpigmentation of the eyelid).

Rare, 1/10000

Mental: anxiety .

eyes: corneal slippery, vision impairment, eyelash collapse, conjunctival hemorrhage, scales, eyelashes grow upside down, double eyelashes. heart: arrhythmia, irregular heart rate. Respiratory: Hours, bronchospasm, cough, throat itching, throat pain, discomfort in the nose, upper respiratory cough syndrome. liver: Increased alanin aminotransferase, increased aspartat aminotransferase.

Skin: urticaria, melasma, hair loss.

musculoskeletal and connective tissue: headache.

Kidney - Ureter: Urine has abnormal colors.

Thirst, weak.

Not determined frequency

Mental: depression.

nerve: Cerebral vascular accident, paresthesia, fainting.

Eyes: Phu Hoang point, eyelid collapse, corneal disorders, deep groove, increased iris.

Heart: heart failure, tachycardia, chest pain, chest drum. circuit: peripheral edema.

Respiratory: asthma. Digestive: Dehydration.

DA: rash.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Duotrav drugs contraindicated in the following cases:

Hypersensitivity to active ingredients or any excipients of the drug.

Hypersensitivity to other beta blockers.

Respiratory disease reacts including bronchial asthma or a history of bronchial asthma, severe chronic obstructive pulmonary disease.

Sinus slow pace, sinus syndrome (including atrial sinus block), two or three atrial blocks, pronounced heart failure or cardiovisa.

Heavy allergic rhinitis.

corneal dystrophy.

Be cautious when using

like the eye medications used on the spot, Travoprost and Timolol are absorbed in the body. Because Timolol is a beta blocker, it is possible to have unwanted effects on the heart, lungs and other unwanted effects like beta blockers using systemic sugar.

Heart disorders:

In patients with cardiovascular diseases (coronary artery disease, prinzmetal angina, heart failure) and hypotension, the treatment of beta blockers should be carefully evaluated, consider treatment with other active ingredients. Patients with cardiovascular diseases should be monitored signs of worsening and unwanted effects.

circuit disorders:

Be cautious when treating drugs for patients with disturbance/severe peripheral circulatory disorders (severe form of Raynaud's disease or Raynaud's syndrome).

Respiratory disorders:

Respiratory reactions, including bronchodial spasms in patients with asthma, have been reported after taking some beta blockers.

Hypoglycemia/diabetes:

Be cautious when taking beta blockers for spontaneous hypoglycemia patients or unstable diabetes due to beta blockers can hide signs and symptoms of acute hypoglycemia.

hyperthyroidism:

Beta blockers can hide the signs of hyperthyroidism.

weak muscle:

Beta blockers have been reported can cause muscle weakness, shown in symptoms of myasthenia gravis (for example: Song, eyelid drooping, body weakness).

Skin exposure:

prostaglandin and similar drugs prostaglandin are biological active substances that can be absorbed through the skin. Pregnant or pregnant women should have appropriate preventive measures to avoid direct exposure to the drug. In case of contact with a significant portion of the amount of medicine in the vial, it is necessary to wash the area immediately exposed.

Other beta blockers:

Effects on intraocular pressure or Beta blockers can appear when using Duotrav for patients who are being treated with beta blockers. Should closely monitor the response of these patients. The use of two beta blockers on the spot is not recommended.

Other prostaglandin drugs:

The use of two on -site prostaglandin drugs is not recommended.

Hypersensitivity reaction:

When using beta blockers, patients with a history of allergies or hypersensitivity reactions to some allergens may react stronger with these allergens and may not respond to the common adrenaline dose used to treat hypersensitivity reactions.

Effect with the eye:

Travoprost can slowly change the eye color by increasing the number of melanin particles (pigment particles) in pigment cells. Before conducting treatment, the patient must be notified of the ability to permanently change the eye color.

Treatment of one eye can lead to permanent pigmentation. Long -term effects on pigment cells and any consequences are not known. The change in iris occurs slowly and may not be recognized for a few months to a few years.

The eye change is mainly observed in patients with mixed iris (for example: blue brown, gray brown, yellow brown and green brown). However, this phenomenon is also observed in brown eye patients.

Typically, the brown pigment around the pupil spreads concentrated towards the peripheral side of the sick eye, but the entire iris or part of the iris can turn brown. After stopping treatment, there is no observation of increasing brown iris.

Dark skin around the eye sockets and/or eyelids related to the use of Travoprost has been reported.

Travoprost may slowly change the eyelashes in the eye to receive treatment. These changes have been observed in about half of patients in clinical trials, including increasing length, thickness, pigmentation and/or the amount of eyelashes.

The mechanism of changing eyelashes and their long -term consequences are not known. In monkey studies, Travoprost has caused mild hypertrophy. However, this effect is not observed in clinical trials and is considered separate according to species.

Inexperienced use of Duotrav In case of inflammatory eye, new vein glaucoma, closed angle glaucoma, narrow -angle glauca or congenital glaucoma and only less experience in thyroid eye disease, open -angle glaucoma disease in patients with artificial lenses and glaoma pigmentation or glaucoma fake pools. Therefore, caution should be used in patients with intraocular inflammation as well as patients at risk of infection of irocyllitis/Ivanitis.

The point of the point has been reported while treating with the same drugs as prostaglandin f2α. Use carefully Duotrav in patients without lenses, patients with artificial lenses have torn post -room glass bags or room glass, or in patients who are at risk of royal throat.

Change the eye sockets and eyelashes, even the depth of the eyelid groove has been observed in the same drugs as prostaglandin.

Black Mac has been reported with aquaculture treatment (such as Timolol, Acetazolamide) after a reincarnation surgery.

surgical anesthesia:

Beta blockers can inhibit the body's beta -body -owned effect as Adrenaline. It is advisable to notify the anesthetist when the patient uses Duotrav.

corneal diseases:

Beta blockers can cause dry eyes. Caution when treating patients with corneal diseases.

Excipients:

The drug contains propylene glycol can cause skin irritation. The drug also contains 40 polyoxyethylene hydrogenated castor oil that can cause skin reactions.

The ability to drive and operate machinery

Duotrav does not have or negatively affect the ability to drive and operate machinery.

Pregnancy

Do not use drugs for women can be pregnant unless effective contraception.

No or limited data in the use of Duotrav or each individual component for pregnant women.

Travoprost has harmful pharmacological effects on pregnancy and/or fetus/infant.

Epidemiological studies do not show malformations but show the risk of developing pregnancy in the uterus when the mother uses oral beta blockers. In addition, the signs and symptoms of beta blockers (slow heart rate, hypotension, respiratory failure and hypoglycemia) have been seen in infants when beta blockers are used for mothers until birth.

Duotrav should not be used during pregnancy unless really necessary. However, if you take the drug during pregnancy to birth, babies should be carefully monitored during the first days of birth.

The period of breastfeeding

It is unknown whether Travoprost is excreted in breast milk or not. Animal studies have shown the excretion of Travoprost and the metabolites found in breast milk.

Timolol excrete in breast milk on the spot. Beta blockers are likely to cause serious unwanted effects to breastfeed. However, when the eye is small at the treatment dose, the amount of Timolol appears in breast milk is said to not cause clinical beta blockers in infants.

Do not recommend using Duotrav in nursing women.

Drug interaction

The effect of Beta Systemic Roholstered (reduced heart rate, depression) has been reported when combining the treatment of CYP2D6 inhibitors (such as Quinidine, Fluoxetine, Paroxetine) and Timolol.

can have a synergistic effect that leads to hypotension and/or a clear heartbeat slowly when using beta blocked eye solutions with oral clogging blockers, beta-adrenergic blockers, anti-arrhythmic drugs (including amiodarone), Digitalis heart glycoside, sympathetic drugs or Guanethidine.

Ability to grow blood pressure when stopping sudden clonidine when taking beta blockers.

Beta blockers may increase the hypoglycemic effect of diabetes treatment drugs because it can hide the signs and symptoms of hypoglycemia.

Beta blockers can reduce response to adrenaline, which is used in the treatment of anaphylaxis. It is necessary to be especially cautious for patients with a history of anaphylaxis allergy.

The pupil relaxes by simultaneous use of beta and adrenaline blockers (Epinephrine) sometimes reported.

Storage

Store drugs at a temperature not exceeding 30ºC.

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