Pred Forte

Pred Forte (prednisolone acetate ophthalmic suspension) 1% is a high-potency corticosteroid formulation specifically engineered for the management of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. Its micronized suspension ensures optimal drug delivery and bioavailability at the site of inflammation, making it a cornerstone in ophthalmic therapeutic regimens. This medication is distinguished by its rapid onset of action and proven efficacy in reducing edema, fibrin deposition, capillary dilation, and leukocyte migration. It is a critical tool for ophthalmologists and optometrists in preserving ocular integrity and visual function by curtailing destructive inflammatory cascades.

Features

• Active Ingredient: Prednisolone Acetate 1.0% (10 mg/mL)
• Pharmacologic Class: Corticosteroid
• Formulation: Sterile, preserved (benzalkonium chloride 0.01%), micronized ophthalmic suspension
• pH: Adjusted to be compatible with the ocular surface (approximately 5.0-5.4)
• Viscosity Agent: Hydroxypropyl Methylcellulose for improved residence time
• Availability: 5 mL, 10 mL, and 15 mL dropper bottles
• Preservative: Benzalkonium Chloride (0.01%)
• Inactive Ingredients: Purified Water, Glycerin, Sodium Phosphate, Edetate Disodium

Benefits

• Rapid and Potent Anti-inflammatory Action: Effectively suppresses the inflammatory response by inhibiting multiple inflammatory mediators, leading to a swift reduction in pain, photophobia, redness, and swelling.
• Superior Ocular Penetration: The unique micronized particle size allows for enhanced corneal penetration, ensuring therapeutic drug levels are reached in the anterior chamber.
• Preservation of Ocular Structures: By controlling severe inflammation, it helps prevent sight-threatening complications such as synechiae formation, corneal scarring, and glaucoma secondary to uveitis.
• Improved Patient Comfort and Compliance: The suspension formulation is well-tolerated by most patients, and the dosing frequency, while potentially high initially, is typically tapered, aiding in long-term treatment adherence.
• Versatility in Treatment: Indicated for a wide spectrum of anterior segment inflammatory conditions, from post-operative care to autoimmune-related uveitis.

Common use

Pred Forte is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe. Its primary use cases include the management of acute anterior uveitis (iritis and iridocyclitis), certain forms of keratitis (such as superficial punctate keratitis, herpes zoster keratitis, and allergic corneal marginal ulcers), and inflammatory conditions of the conjunctiva like allergic conjunctivitis. It is also extensively used prophylactically and therapeutically in the post-operative period following ocular surgery (e.g., cataract extraction, corneal transplant, glaucoma filtering surgery) to minimize inflammation and improve surgical outcomes. Its use is critical in conditions where the inflammatory process poses an immediate threat to visual acuity or ocular anatomy.

Dosage and direction

Dosage must be individualized based on the severity of the inflammatory condition and the patient’s response. Shake the bottle vigorously for 10-15 seconds before each use to ensure a homogeneous suspension.

• For mild to moderate inflammation: Instill 1 to 2 drops into the conjunctival sac of the affected eye(s) two to four times daily.
• For severe inflammation: The initial dosing may be 1 to 2 drops every hour during waking hours until a clinical response is observed, followed by a gradual tapering of frequency over days or weeks as inflammation subsides.
• Post-operative care: A typical regimen is 1 to 2 drops two to four times daily, beginning 24 hours post-surgery and continuing through the first two weeks, with subsequent tapering based on clinical assessment.
• Important Administration Technique: To minimize systemic absorption, apply gentle pressure to the lacrimal sac (nasolacrimal occlusion) for 1-2 minutes immediately after instillation. Do not allow the dropper tip to touch any surface, including the eye, to avoid contamination.

Precautions

• Prolonged Use: Extended use (greater than two weeks) may increase the risk of elevated intraocular pressure (IOP), which can lead to glaucomatous damage and optic nerve atrophy. Regular monitoring of IOP is mandatory.
• Corticosteroid Response: Some patients may be “steroid responders,” experiencing a significant rise in IOP after only a few weeks of use. These patients require very close supervision.
• Infection Risk: Corticosteroids may suppress the host immune response, potentially enhancing the establishment of secondary ocular infections (bacterial, fungal, or viral). They may also mask the signs of active infection.
• Corneal Integrity: Use with extreme caution, and only under close supervision, in patients with corneal thinning or ulceration, as perforation has been known to occur with the use of topical steroids.
• Cataract Formation: Posterior subcapsular cataract formation has been reported with prolonged use of corticosteroid preparations.
• Contact Lenses: The preservative benzalkonium chloride may be absorbed by soft contact lenses. Patients should be instructed to remove lenses prior to application and wait at least 15 minutes before reinsertion.

Contraindications

Pred Forte is contraindicated in the following scenarios:

• Most viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella.
• Mycobacterial infection of the eye.
• Fungal diseases of the ocular structures.
• Known hypersensitivity to any component of the formulation (prednisolone acetate, benzalkonium chloride, etc.).

Possible side effect

A range of adverse reactions has been associated with topical ocular corticosteroids. The most common and significant include:

• Increased Intraocular Pressure (IOP): This is the most frequent serious side effect, with the magnitude of rise depending on the individual, drug potency, and dosing frequency.
• Cataracts: Prolonged use may lead to the development of posterior subcapsular cataracts.
• Delayed Wound Healing: Corticosteroids inhibit fibroblast proliferation and collagen synthesis.
• Secondary Ocular Infections: Due to suppression of host immune mechanisms and the potential to mask signs of an ongoing infection.
• Ocular Discomfort: Transient burning, stinging, or blurring of vision immediately upon instillation.
• Other less common reactions: Mydriasis, ptosis, conjunctival hyperemia, and punctate keratopathy.

Drug interaction

Formal drug interaction studies have not been conducted with Pred Forte. However, the potential for interactions exists.

• Other Topical Ophthalmic Agents: If more than one topical ophthalmic drug is being used, the drugs should be administered at least 5 to 10 minutes apart. Ointments should be administered last.
• Systemic Corticosteroids: Concurrent use with systemic corticosteroids could potentially lead to additive systemic corticosteroid effects, though this is less likely with topical administration and proper nasolacrimal occlusion.

Missed dose

If a dose is missed, it should be instilled as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. The patient should not instill a double dose to make up for the missed one. Maintaining a consistent schedule is important for controlling inflammation, so patients should be counseled on adherence.

Overdose

Acute overdose with topical ocular administration is unlikely to cause life-threatening systemic effects due to minimal absorption. However, excessive topical application could theoretically lead to increased systemic side effects associated with corticosteroids (e.g., hyperglycemia, adrenal suppression). The eye(s) may be irrigated with lukewarm water to remove excess medication. Treatment should be symptomatic and supportive. In case of accidental ingestion, seek medical attention or contact a Poison Control center.

Storage

• Store at controlled room temperature 20°C to 25°C (68°F to 77°F).
• Protect from light and freezing.
• Keep the bottle tightly closed when not in use.
• Discard the medication (and any remaining suspension) 28 days after the bottle is first opened. Write the discard date on the bottle label upon opening to ensure patient safety and drug efficacy.

Disclaimer

This information is for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your ophthalmologist, physician, or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content is provided on an “as is” basis.

Reviews

• Clinical Consensus: Pred Forte is widely regarded by ophthalmologists as the gold-standard topical steroid for managing significant anterior segment inflammation. Its efficacy in rapidly controlling post-operative inflammation and acute uveitic episodes is well-documented in clinical literature.
• Practitioner Feedback: Eye care professionals consistently report predictable and potent anti-inflammatory results. The need for vigilant IOP monitoring is universally emphasized in professional discussions and peer reviews.
• Patient Experience: Patient-reported outcomes often note a rapid decrease in symptoms like pain, redness, and light sensitivity. Common complaints relate to the temporary blurring of vision upon instillation and the challenge of a frequent dosing schedule during the initial treatment phase. The importance of strict adherence to the tapering schedule is a frequent point of discussion in patient support forums, as premature discontinuation can lead to rebound inflammation.