Difluprednate is a corticosteroid that is used as a topical ophthalmic solution for the treatment of inflammatory ocular conditions.

Difluprednate Uses:

• Inflammation and pain:

  • It is used to treat inflammation and pain after ocular surgery.

• Uveitis:

  • It is indicated for the treatment of endogenous anterior uveitis.

Difluprednate Dose in Adults:

Difluprednate Dose in the treatment of endogenous anterior uveitis:

• Instill one drop into the conjunctival sac of the affected eye four times a day for fourteen days.
• Gradually taper the dose as clinically indicated.

Difluprednate dose in the treatment of inflammation and pain associated with ocular surgery:

• Instill one drop in the conjunctival sac of the affected eye four times a day beginning 24 hours after surgery
• Continue treatment for 2 weeks, then reduce the dose to twice daily for one week
• Gradually taper the dose based on the clinical response.

Difluprednate Dose in Childrens:

Difluprednate dose in the treatment of endogenous anterior uveitis in children older than 2 years of age: 

• Instill one drop into the conjunctival sac of the affected eye four times a day for 14 days
• Taper the dose gradually as clinically indicated.

Difluprednate dose in the treatment of Inflammation associated with ocular surgery:

• Instill one drop in the conjunctival sac of the affected eye four times a day beginning 24 hours after surgery.
• Continue the treatment for 2 weeks, then reduce the dose to twice daily for one week
• Taper the dose gradually based on the clinical response.

Pregnancy Risk Factor C

• Studies on animal reproduction have shown that fetal health can be adverse.
• Ocular administration can result in minimal systemic absorption.

Use of difluprednate while breastfeeding

• It is unknown if the drug will be excreted into breastmilk.
• Corticosteroids are excreted in breastmilk when given systemically.
• However, ocular administration is less effective and should be avoided by breastfeeding mothers.

Difluprednate Dose in Kidney disease:

Dosage instructions in patients with kidney disease have not been provided by the manufacturer, however, systemic absorption is limited and adjustments in the dose are not necessary.

Difluprednate Dose in Liver disease:

Dosage instructions in patients with liver disease have not been provided by the manufacturer, however, systemic absorption is limited and adjustments in the dose is not necessary.

Common Side Effects of Difluprednate:

• Ophthalmic:

  • Anterior chamber inflammation
  • Blepharitis Cataract (secondary)
  • Conjunctival edema
  • Corneal edema
  • Eye pain
  • Ocular hyperemia (ciliary, conjunctival, limbal)
  • Photophobia

Less Common Side Effects of Difluprednate:

• Central nervous system:

  • Headache

• Ophthalmic:

  • Blurred Vision
  • Decreased Visual Acuity
  • Dry Eye Syndrome
  • Eye Irritation
  • Increased Intraocular Pressure
  • Iridocyclitis
  • Iritis
  • Ophthalmic Inflammation (Postoperative)
  • Punctate Keratitis
  • Uveitis

Contraindications to Difluprednate:

• Patients with hypersensitivity reactions to any component of the drug or the drug are advised not to use it.
• In cases of acute, untreated bacterial infections of your eyes, it should be avoided.
• It is not recommended in
  • Acute viral infections of the eyes (including varicella infections, herpes simplex, and vaccinia)
  • Fungal infection of the eyes
  • Mycobacterial ocular infection of the eyes.

Warnings and precautions

• Cataracts

  • If used for a long time, corticosteroids can cause posterior subcapsular cataracts.
  • It can delay the healing process and increase the likelihood of bleb formation in patients who have had cataract surgery.

• Corneal perforation

  • Topical steroids can cause corneal perforation when used in conditions that cause corneal thinning.

• Infections are exacerbated

  • Corticosteroids can exacerbate underlying infections.
  • Patients with a history or conjunctival infection should not use it.
  • It is also not recommended for mycobacterial and ocular fungal infections.
  • If symptoms persist after treatment is initiated, the patient should be evaluated every 2 days.

• Glaucoma:

  • Patients with elevated intraocular pressure or glaucoma should not use it.
  • The intraocular pressure can rise and cause optic nerve damage by prolonged use of glucocorticoids.
  • Patients who have been taking the drug for more than ten days, as well as those who experience visual pain, blurring or defects in their visual acuity or field of vision, should have intraocular pressure checked. Treatment may be stopped.

• Immunosuppression:

  • It can mask an existing infection, and make the eyes more susceptible to new infections.
  • Consider the possibility of fungal infection if the patient suffers from persistent corneal ulcerations after prolonged use.
  • Assess and treat accordingly.

Monitoring parameters:

Monitor the intraocular pressure. Periodically examine the lenses (with prolonged use of greater than 28 days)

How to administer Difluprednate?

• It is administered as an ophthalmic solution into the eyes.
• When administering the solution, wash hands before using the dropper and avoid touching the tip of the dropper.
• Contact lenses should be removed before instilling the drops and should not be reinserted within 10 minutes of the difluprednate eye drops. In surgical patients, avoid instilling drops from the same bottle in both the eyes.

Mechanism of action of Difluprednate:

• It is a corticosteroid and can be used topically as drops or a solution to reduce inflammation. 
• It decreases scar formation and edema by inhibiting capillary dilation.
• It penetrates cells easily and stimulates the production lipocortins, which modulate prostaglandins' and leukotrienes' activity.

Absorption

• Systemic exposure to activemetabolite can be negligible when applied topically in the eyes.

Metabolism:

• It is deacetylated to an active metabolite. (DFB).

International Brands of Difluprednate:

• Durezol
• Diflupred
• Diflustero
• Dipred
• Epitopic
• Neopred
• Predasin
• Ribeca

Difluprednate Brands Names in Pakistan:

No Brands Available in Pakistan.