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BNSSG Adult Joint Formulary

11.4 Corticosteroids and other anti–inflammatory preparations

Last edited: 13-05-2024


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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