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Preservatives in glaucoma medication

Preservatives continue to be in widespread use in ophthalmic medications due to the convenience they provide, regulatory requirements and the higher cost of alternatives. Benzalkonium chloride (BAK) remains the most commonly used preservative but there is a trend towards the use of preservative-free...

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Autores principales: Steven, David W, Alaghband, Pouya, Lim, Kin Sheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241623/
https://www.ncbi.nlm.nih.gov/pubmed/29973365
http://dx.doi.org/10.1136/bjophthalmol-2017-311544
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author Steven, David W
Alaghband, Pouya
Lim, Kin Sheng
author_facet Steven, David W
Alaghband, Pouya
Lim, Kin Sheng
author_sort Steven, David W
collection PubMed
description Preservatives continue to be in widespread use in ophthalmic medications due to the convenience they provide, regulatory requirements and the higher cost of alternatives. Benzalkonium chloride (BAK) remains the most commonly used preservative but there is a trend towards the use of preservative-free (PF) drops for glaucoma, although at a higher price. An extensive body of literature explores BAK toxicity on ocular structures in animal and laboratory studies (in vitro and in vivo). Non-randomised controlled studies have provided some supporting evidence of its toxicity in patients, especially in those with pre-existing ocular surface disease (OSD) or on multiple medications. However, there have been very few randomised controlled trials that compare the same medication with and without BAK preservative. Several of these trials have never been published in any peer reviewed journals. Notwithstanding, those that have been published, have not demonstrated any clear benefits of the BAK-free formulations. Short duration and exclusion of those with OSD are limitations of these studies. There is a lack of evidence of clinically significant harm from a small number of BAK preserved drops in patients without OSD. This means that generally more expensive PF glaucoma medications should only be recommended for those on poly pharmacy or those with OSD but are not necessarily required for all patients.
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spelling pubmed-62416232018-11-27 Preservatives in glaucoma medication Steven, David W Alaghband, Pouya Lim, Kin Sheng Br J Ophthalmol Review Preservatives continue to be in widespread use in ophthalmic medications due to the convenience they provide, regulatory requirements and the higher cost of alternatives. Benzalkonium chloride (BAK) remains the most commonly used preservative but there is a trend towards the use of preservative-free (PF) drops for glaucoma, although at a higher price. An extensive body of literature explores BAK toxicity on ocular structures in animal and laboratory studies (in vitro and in vivo). Non-randomised controlled studies have provided some supporting evidence of its toxicity in patients, especially in those with pre-existing ocular surface disease (OSD) or on multiple medications. However, there have been very few randomised controlled trials that compare the same medication with and without BAK preservative. Several of these trials have never been published in any peer reviewed journals. Notwithstanding, those that have been published, have not demonstrated any clear benefits of the BAK-free formulations. Short duration and exclusion of those with OSD are limitations of these studies. There is a lack of evidence of clinically significant harm from a small number of BAK preserved drops in patients without OSD. This means that generally more expensive PF glaucoma medications should only be recommended for those on poly pharmacy or those with OSD but are not necessarily required for all patients. BMJ Publishing Group 2018-11 2018-07-04 /pmc/articles/PMC6241623/ /pubmed/29973365 http://dx.doi.org/10.1136/bjophthalmol-2017-311544 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Review
Steven, David W
Alaghband, Pouya
Lim, Kin Sheng
Preservatives in glaucoma medication
title Preservatives in glaucoma medication
title_full Preservatives in glaucoma medication
title_fullStr Preservatives in glaucoma medication
title_full_unstemmed Preservatives in glaucoma medication
title_short Preservatives in glaucoma medication
title_sort preservatives in glaucoma medication
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6241623/
https://www.ncbi.nlm.nih.gov/pubmed/29973365
http://dx.doi.org/10.1136/bjophthalmol-2017-311544
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