A fixed-dose combination ophthalmic solution containing a non-steroidal anti-inflammatory drug (NSAID) and a fourth-generation fluoroquinolone antibiotic. It is designed for the management of post-operative ocular inflammation and prevention/treatment of associated bacterial infections following cataract surgery. This combination leverages the anti-inflammatory and analgesic action of Ketorolac with the broad-spectrum bactericidal action of Moxifloxacin.
Adult: One drop instilled into the conjunctival sac of the affected eye(s) 4 times daily, starting 24 hours post-surgery. Duration: Typically 2 weeks, or as directed by the ophthalmologist.
Note: 1. Wash hands. 2. Tilt head back. 3. Gently pull lower eyelid to form a pouch. 4. Instill one drop without touching the dropper tip to eye or any surface. 5. Close eyes gently for 1-2 minutes, applying gentle pressure to the nasolacrimal duct (inner corner of eye) to minimize systemic absorption. 6. Wait at least 5 minutes before instilling any other ophthalmic medication.
The combination exerts a dual action: Ketorolac inhibits the cyclooxygenase (COX) enzymes, primarily COX-1 and COX-2, thereby reducing the synthesis of prostaglandins (mediators of pain, inflammation, and miosis). Moxifloxacin inhibits bacterial DNA gyrase (Topoisomerase II) and topoisomerase IV, enzymes critical for DNA replication, transcription, and repair, leading to rapid bacterial cell death.
Pregnancy: Category C (US FDA). Ketorolac: Avoid in late pregnancy (risk of premature closure of ductus arteriosus). Moxifloxacin: Animal studies show cartilage damage in immature animals. Use only if potential benefit justifies potential fetal risk. Consult ophthalmologist and obstetrician.
Driving: May cause transient blurred vision immediately after instillation. Patients should not drive or operate machinery until vision clears.
| Oral Anticoagulants (Warfarin, Acenocoumarol) | Increased risk of ocular and systemic bleeding due to additive antiplatelet effect of Ketorolac. | Major |
| Other Systemic NSAIDs (e.g., Aspirin, Ibuprofen, Diclofenac) | Increased risk of GI ulceration/bleeding and renal toxicity. Additive antiplatelet effect. | Major |
| Corticosteroids (Oral or Topical) | Increased risk of corneal melting, delayed healing, and elevated IOP. Also increased risk of GI ulceration. | Major |
| Antiplatelet drugs (Clopidogrel, Ticagrelor) | Increased bleeding risk. | Moderate |
| Antihypertensives (ACE inhibitors, ARBs, Diuretics) | NSAID may reduce antihypertensive efficacy and worsen renal function. | Moderate |
| Methotrexate | Increased risk of methotrexate toxicity. | Major |
| Probenecid | May increase systemic levels of Ketorolac. | Moderate |
| Cation-containing products (Zinc, Iron, Calcium, Antacids) | May chelate Moxifloxacin if administered systemically, reducing absorption. Not relevant for topical ocular use. | Minor |
Same composition (Ketorolac (0.5% w/v) + Moxifloxacin (0.5% w/v)), different brands: