A sterile, topical ophthalmic suspension/ointment combining a broad-spectrum fluoroquinolone antibiotic (Ciprofloxacin) with a potent corticosteroid (Dexamethasone). It is primarily indicated for steroid-responsive inflammatory ocular conditions where a risk of bacterial infection exists or where such infection is present. This combination provides anti-inflammatory, anti-allergic, and antibacterial actions, making it a mainstay for treating external ocular infections with significant inflammation.
Adult: Ophthalmic Suspension: Instill 1 or 2 drops into the conjunctival sac(s) every 4 to 6 hours. In severe disease, drops may be used hourly and tapered. Ophthalmic Ointment: Apply a 1 cm ribbon into the conjunctival sac 3 to 4 times daily.
Note: 1. Wash hands before use. 2. Shake the suspension well before use. 3. Tilt head back, pull lower eyelid down to form a pouch. 4. Instill drops/apply ointment without touching the tip to eye or any surface. 5. Close eyes gently for 1-2 minutes. Apply gentle pressure to the nasolacrimal duct (inner corner of eye) for 1 minute to minimize systemic absorption. 6. Wait at least 5-10 minutes before instilling any other ophthalmic medication.
The combination exerts a dual mechanism: Ciprofloxacin inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, leading to rapid bactericidal activity. Dexamethasone binds to cytoplasmic glucocorticoid receptors, inducing synthesis of anti-inflammatory proteins (lipocortins) and inhibiting the synthesis of pro-inflammatory mediators (prostaglandins, leukotrienes). This suppresses inflammation, capillary dilation, edema, and scar tissue formation.
Pregnancy: Category C (US FDA). Dexamethasone may be teratogenic in animal studies. Ciprofloxacin causes arthropathy in immature animals. Use only if the potential benefit justifies the potential risk to the fetus. Avoid prolonged use.
Driving: May cause temporary blurred vision after application. Patients should not drive or operate machinery until vision clears.
| Other topical ophthalmic NSAIDs (e.g., Ketorolac, Nepafenac) | Increased risk of corneal healing impairment and ulceration. | Major |
| Systemic corticosteroids (e.g., Prednisolone) | Additive systemic steroid effects, increasing risk of hyperglycemia, adrenal suppression. | Moderate |
| Oral anticoagulants (e.g., Warfarin) | Potential increased anticoagulant effect (theoretical risk from minimal systemic absorption). | Minor |
| Theophylline | Ciprofloxacin may inhibit metabolism, increasing theophylline levels (risk from systemic absorption). | Minor |
Same composition (Ciprofloxacin (0.3% w/v) + Dexamethasone (0.1% w/v)), different brands: