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BNSSG Adult Joint Formulary

11.4 Corticosteroids and other anti–inflammatory preparations

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Last edited: 19-06-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

A preservative free option (or single unit dose drops) may be prescribed if available for all formulary products listed if clinically necessary, as an alternative option

Please ensure that all prescriptions for eye drops clearly state the number of drops, into which eye(s), and the frequency of administration

11.4.1 Corticosteroids

Recommended: (TLS Green)

Prednisolone 0.5% eye drops (brands include Predsol^®)

Prednisolone 1% eye drops (brands include Pred Forte^®)

Dexamethasone 0.1% eye drops (brands include Maxidex^®)

Alternatives: (TLS Blue)

Betamethasone 0.1% eye drops

Fluorometholone 0.1% eye drops

Specific indication:

Loteprednol 0.5% eye drops (TLS Amber Specialist recommended)

Treatment of uveitis in association with raised ocular pressure

Hydrocortisone sodium phosphate 3.35mg/mL eye drops (Softacort^®) (TLS Red)

For short-term treatment of mild non-infectious allergic or inflammatory conjunctival diseases for patients who are at increased risk of raised intraocular pressure and who require a preservative-free option.

Combined corticosteroid & antibacterial preparation

Recommended:

Dexamethasone 0.1% / Hypromellose 0.5% / Neomycin 0.35% / Polymyxin B sulphate 6000units/mL eye drops/ointment (Maxitrol^®) (TLS Green)

Do not prescribe Maxitrol® in combination with Ketorolac 0.5% eye drops for any patient.
Corneal melts reported due to combined use of Ketorolac and Maxitrol® eye preparations.
Be vigilant of any suspected / reported corneal melts associated with topical Maxitrol® and Ketorolac eye drops, refer for specialist advice and report them as an incident on Datix and using the MHRA yellow card.

Intravitreal corticosteroids

Dexamethasone intravitreal implant 700micrograms (Ozurdex^®) (TLS Red)

UHBW only for:

Macular oedema

NICE TA229 For the treatment of macular oedema caused by retinal vein occlusion (RVO)
NICE TA824 For the treatment of diabetic macular oedema

Uveitis

NICE TA460 dexamethasone and adalimumab for treating non-infectious uveitis

Fluocinolone acetonide intravitreal injection 190micrograms (Iluvien^®) (TLS Red)

NICE TA590 For the treatment of recurrent, non-infectious uveitis
NICE TA953 Fluocinolone acetonide intravitreal implant for treating chronic diabetic macular oedema. Note: concurrent treatment to both eyes is not recommended

11.4.2 DMARDs for ocular inflammation

Azathioprine (TLS Amber 1 month) (SCP Click here)

Methotrexate (TLS Amber 1 Month) (SCP Click here)

Mycophenolate (TLS Amber 3 Months) (SCP Click here)

11.4.3 Other anti-inflammatory preparations

Recommended: (TLS Green)

Sodium cromoglicate 2% eye drops

Suitable for self care

Alternatives:

Olopatadine 1mg/mL eye drops (TLS Green)

Ketotifen eye drops (TLS Green)

Third line - Use when olopatadine not available or a preservative free option required

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