Trifluridine ophthalmic dosing, indications, interactions, adverse effects, and more

Sections

Sections trifluridine ophthalmic
Dosing & Uses
Adverse Effects
Warnings
Pregnancy
Pharmacology
Administration
Images
Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ophthalmic solution

1% (generic)

Herpes Simplex Virus

Indicated for the treatment of primary keratoconjunctivitis and recurrent epithelial keratitis due to herpes simplex virus, types 1 and 2

1 gtt onto cornea q2hr while awake until reepithelialization (not to exceed 9 gtt/day), THEN

1 gtt q4hr (minimum 5 gtt/day) x7 days

Not to exceed treatment beyond 21 days

Off-label Uses

CDC recommends use for smallpox or monkeypox viral ophthalmic infections

Dosage Forms & Strengths

ophthalmic solution

1% (generic)

Herpes Simplex Virus

Indicated for the treatment of primary keratoconjunctivitis and recurrent epithelial keratitis due to herpes simplex virus, types 1 and 2

<6 years: Safety and efficacy not established

≥6 years

1 gtt onto cornea q2hr while awake until reepithelialization (not to exceed 9 gtt/day), THEN
1 gtt q4hr (minimum 5 gtt/day) x7 days
Not to exceed treatment beyond 21 days

Off-label Uses

CDC recommends use for smallpox or monkeypox viral ophthalmic infections

1-10%

Transient burning/stinging

Palpebral edema

Frequency Not Defined

Superficial punctate keratopathy

Epithelial keratopathy

Stromal edema

Keratitis sicca

Hyperemia

Increased IOP

Hypersensitivity reactions

Contraindications

Hypersensitivity

Cautions

Cosnider other Tx if no improvement after 7 days or incomplete reepithelialization after 14 days

Use >21 days should be avoided because of potential ocular toxicity

Inactive against bacteria, fungi & Chlamydia

Pregnancy & Lactation

Pregnancy Category: C

Lactation: unlikely to be distributed into breast milk; use caution

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Appears to involve inhibition of viral replication; trifluridine, instead of thymidine, is incorporated into viral DNA during replication which results in the formation of defective proteins and an increased mutation rate

Reversibly inhibits thymidylate synthetase, an enzyme required for DNA synthesis

Pharmacokinetics

Absorption: penetrates cornea & can be detected in the aqueous humor; no systemic

Metabolites: 5-carboxy-2'-deoxyuridine

Ocular Administration

For ophthalmic use only

Avoid touching tip of applicator to eye or other surfaces

Wash hands before and after instillation

Storage

Refrigerate at 2-8ºC (36-46ºF)

Images

Pricing & Images are not currently available for this monograph.

Patient Handout

TRIFLURIDINE DROPS - OPHTHALMIC

(try-FLEWR-ih-deen)

COMMON BRAND NAME(S): Viroptic

USES: This medication is used to treat herpes infection of the eye. Herpes is a virus that lives in the body quietly until an outbreak is triggered. Trifluridine is not a cure for the infection, but treatment of an outbreak can speed up the healing of the sores/swelling in the eye and lower the risk of complications (such as vision loss).

HOW TO USE: To apply eye drops, wash your hands first. To avoid contamination, do not touch the dropper tip or let it touch your eye or any other surface.Tilt your head back, look up, and pull down the lower eyelid to make a pouch. Hold the dropper directly over your eye and place 1 drop into the pouch as directed by your doctor. Look down and gently close your eyes for 1 to 2 minutes. Place one finger at the corner of your eye (near the nose) and press gently. This will prevent the medication from draining out. Try not to blink and do not rub your eye. Repeat these steps for your other eye if so directed.Do not rinse the dropper. Replace the dropper cap after each use.Use this medication as directed by your doctor, usually every 2 hours while awake until the eye has healed. Do not use more than 9 drops into the eye in a 24-hour period. After healing, use this medication for another 7 days, usually every 4 hours while awake (at least 5 drops per day).If you are using another kind of eye medication (such as drops or ointments), wait at least 5 to 10 minutes before applying other medications. Use eye drops before eye ointments to allow the drops to enter the eye.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day. Continue using it for the full time prescribed. Stopping the medication too early may result in a return of the infection.Do not use this medication more often or use longer than prescribed because doing so may increase the risk of side effects. This medication should not be used for more than 21 days at a time.Tell your doctor if your condition worsens, does not improve after 7 days, or does not completely heal after 14 days.

SIDE EFFECTS: Temporary mild burning, stinging, and irritation may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: swelling eyelids, eye pain/redness, feeling as if something is in the eye, vision changes.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before using trifluridine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: other eye problems (such as glaucoma).After you apply this drug, your vision may become temporarily blurred. Do not drive, use machinery, or do any activity that requires clear vision until you can do it safely.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Lab and/or medical tests (such as eye exam) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store in the refrigerator away from light. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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