Loteprednol (Lotemax) is a corticosteroid that is used to treat allergic and inflammatory conditions of the eyes (allergic conjunctivitis and inflammation of the eyes after ocular surgery)

Loteprednol Uses

• Ophthalmic inflammatory conditions (0.5% suspension):

  • Works well on eye-related inflammatory conditions.

• Postoperative inflammation/pain (0.38% gel; 0.5% suspension/ ointment/ gel; 1% suspension):

  • Reduces symptoms that develop after ocular surgery.

• Seasonal allergic conjunctivitis (0.2% suspension):

  • Transiently improves allergic conjunctivitis.

Loteprednol (Lotemax) Dose in Adults:

Loteprednol (Lotemax) Dose in the treatment of Ophthalmic inflammatory conditions:

• Ophthalmic:

  • 0.5% suspension:

    • Give 1 to 2 drops up to 4 times per day into the conjunctival sac. The initial dose may be increased by up to 1 drop every hour. Slowly reduce the dose after chronic use. Evaluate on 48-hourly-basis in case of no response.

Loteprednol (Lotemax) Dose in the treatment of Postoperative ophthalmic inflammation/pain:

• Ophthalmic:

  • 38% gel:

    • Apply 1 drop into the conjunctival sac of the affected eye(s) 3 times daily. To be initiated a day after surgery and continued for the next 14 days.

  • 5% ointment:

    • Apply ~ / inch ribbon into the conjunctival sac of the affected eye(s) up to 4 times a day initiating on postoperative day 1 and continued for the next 14 days.

  • 5% gel, 0.5% suspension:

    • 1 to 2 drops can be given up to 4 times a day. To be initiated a day after surgery and then continued for up to 14 days.

  • 1% suspension:

    • Instill 1 to 2 drops into the affected eye(s) twice a day initiating 24 hours after surgery and continuing throughout the first 2 weeks of the postoperative period.

Loteprednol (Lotemax) Dose in the treatment of Seasonal allergic conjunctivitis:

• Ophthalmic:

  • 0.2% suspension:

    • Instill 1 drop into the affected eye(s) 4 times a day.

Loteprednol (Lotemax) Dose in Childrens:

Loteprednol (Lotemax) Dose in the Postoperative inflammation and pain:

• Infants, Children, and Adolescents:

  • Ophthalmic:

    • 0.5% gel (Lotemax):

      • 1 to 2 drops can be given upto 4 times a day. To be initiated 24 hours after surgery and then continued for upto 14 days.

Loteprednol (Lotemax) Pregnancy Category: C

• The benefits must be balanced against the potential risks of pregnancy. If necessary, a minimal amount of the drug should be administered with puncta occlusion.

Use during breastfeeding:

• Breast milk contains systemic corticosteroids.
• It is unknown how much systemic absorption occurs after topical application.
• When loteprednol is to be given to lactating mothers, it is best to exercise caution.

Dose in Kidney Disease:

Dosage adjustments are not recommended by the manufacturer.

Dose in Liver disease:

Dosage adjustments are not recommended by the manufacturer.

Common Side Effects of Loteprednol (Lotemax):

• Central Nervous System:

  • Foreign Body Sensation Of Eye
  • Headache

• Endocrine & Metabolic:

  • Chemosis

• Local:

  • Application Site Burning

• Ophthalmic:

  • Anterior Chamber Inflammation
  • Blurred Vision
  • Epiphora
  • Eye Discharge
  • Eye Pruritus
  • Injected Sclera
  • Photophobia
  • Visual Disturbance
  • Xerophthalmia

• Respiratory:

  • Pharyngitis
  • Rhinitis

Less Common Side Effects Of Loteprednol (Lotemax):

• Dermatologic:

  • Erythema Of Eyelid

• Ophthalmic:

  • Conjunctival Hyperemia
  • Corneal Edema
  • Eye Pain
  • Conjunctivitis
  • Corneal Changes
  • Eye Discomfort
  • Eye Irritation
  • Keratoconjunctivitis
  • Uveitis
  • Increased Intraocular Pressure
  • Posterior Capsule Opacification

• Miscellaneous:

  • Papilla

Contraindications to Loteprednol (Lotemax):

• Hypersensitivity to loteprednol and other corticosteroids as well as any component of the formulation
• Untreated ocular infections (bacterial, viral and fungal)

Warnings and precautions

• Cataracts

  • There is a risk of developing posterior subcapsular or glaucoma formation.
  • The development of blebs after cataract surgery can cause complications and impair healing.

• Corneal thinning

  • It may cause a decrease in the thickness of the cornea and sclera.
  • Long-term use can increase the risk of perforation.

• Glaucoma:

  • Glaucoma risk and its complications
  • Glaucoma patients should be cautious. Patients receiving treatment for more than 10 days must monitor their IOP.

• Immunosuppression:

  • Continuous use can lead to secondary ocular infections, including fungal infections.
  • Potential to reduce or exacerbate acute purulent ocular infection.
  • Patients with corneal ulcerations that are not healing should be evaluated for fungal infection

• Systemic absorption

  • Research has shown that topical ophthalmic steroids are absorbed systemically. This could result in a decrease in body steroid production.

• Herpes simplex

  • Ocular herpes Simplex should not be treated with corticosteroids as they can worsen the condition.
  • Patients with a history or herpes simplex should be treated with extreme caution.

Loteprednol: Drug Interaction

Monitoring parameters:

• Intraocular pressure (if >10 days of treatment);
• Signs and symptoms of infection

How to administer Loteprednol (Lotemax)?

• For topical ophthalmic use only; minimize contamination by avoiding contact of dropper tip with eye or other surfaces.
• Contact lenses should not be worn when using ophthalmic gel, ointment, or suspension.
• However, contact lenses may be reinserted 15 minutes following administration.

Mechanism of action of Loteprednol (Lotemax):

• Corticosteroids have anti-inflammatory properties, which reduce edema and capillary dilation as well as leukocyte migration and scar formation. 
• Loteprednol easily crosses cell membranes, and via lipocortins alters prostaglandins & leukotrienes.

The beginning of action

• Symptoms of seasonal allergic conjunctivitis can be reduced within two hours of the instillation.

Absorption:

• Plasma levels of loteprednol (and its metabolite) were below the level of quantitation (1.ng/mL).

Distribution

• It penetrates the cornea the most easily, followed closely by the iris/ciliary and the aqueous humor.

Metabolism

• Inactivating metabolism is done by corneal esterases. Loteprednol is rapidly metabolized once the glucocorticoid receptor has been activated. This minimizes adverse effects.

International Brand Names of Loteprednol:

• Alrex
• Inveltys
• Lotemax
• Lotemax SM
• Disolot
• Lacrison
• Lopred
• Loteflam
• Lotemax
• Lotenol
• Lotep
• Lotepred
• Loteprol
• Loterex
• Lotesoft
• Oftal
• Oftol Forte
• Olopred

Loteprednol Brand Names in Pakistan: