From the Guidelines
The principle behind combining corticosteroids with other medications in ophthalmic eye drops is to enhance anti-inflammatory efficacy while minimizing steroid-induced side effects, such as increased intraocular pressure and cataract formation, by allowing for a lower steroid dose and shorter treatment duration [ 1 ].
Key Considerations
- Reduced Side Effects: Combining corticosteroids with other medications, like non-steroidal anti-inflammatory drugs (NSAIDs) or antihistamines, can reduce the risk of steroid-related complications [ 1 ].
- Enhanced Efficacy: Dual-action agents, which possess both antihistamine and mast cell stabilizer activities, have been shown to be more effective in preventing or treating ocular itching than other ocular agents [ 1 ].
- Lower Steroid Dose: The use of modified steroids, such as loteprednol etabonate, can reduce the risk of increased intraocular pressure compared to other ocular corticosteroids [ 1 ].
Common Combinations
- Corticosteroid and NSAID: A combination of a corticosteroid, such as loteprednol etabonate, and an NSAID, like ketorolac, can provide effective relief of ocular allergy symptoms while minimizing steroid-induced side effects [ 1 ].
- Corticosteroid and Antihistamine: Combining a corticosteroid with an antihistamine, such as azelastine or epinastine, can provide additional relief of ocular allergy symptoms, including itching and redness [ 1 ].
From the Research
Principle Behind Combining Corticosteroids with Other Medications
The principle behind combining corticosteroids (steroids) with other medications in ophthalmic eye drops is to enhance the therapeutic efficacy and minimize the potential side effects associated with corticosteroid use alone. This approach is based on the concept of synergism, where the combination of two or more drugs produces a greater effect than the sum of their individual effects.
Rationale for Combination Therapy
- The use of corticosteroids alone can lead to increased intraocular pressure (IOP), which is a significant concern in patients with glaucoma or those at risk of developing glaucoma 2, 3, 4.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ketorolac tromethamine can provide good control of intraocular inflammation without the risk of steroidal IOP increase 2, 4.
- The combination of corticosteroids with NSAIDs or other medications can provide a more comprehensive approach to managing postoperative inflammation and preventing infection 5, 6.
- The selection of medications for combination therapy depends on the specific clinical scenario, patient factors, and the potential benefits and risks associated with each medication.
Benefits of Combination Therapy
- Enhanced therapeutic efficacy: Combination therapy can provide better control of inflammation and prevention of infection compared to monotherapy 5, 6.
- Reduced risk of side effects: The use of lower doses of corticosteroids in combination with other medications can minimize the risk of increased IOP and other side effects associated with corticosteroid use alone 3, 6.
- Improved patient comfort: Combination therapy can provide better symptom control and improved patient comfort compared to monotherapy 2.