Categorization of Marketed Artificial Tear Formulations Based on Their Ingredients: A Rational Approach for Their Use

Dry eye disease is a common ocular condition affecting millions of people worldwide. Artificial tears are the first line therapy for the management of dry eye disease. Artificial tear formulations contain a variety of active ingredients, biologically active excipients, and preservatives. Many of these formulations are also available as preservative-free. This study was conducted to inspect artificial tear formulations currently marketed in the United States for their active ingredients, biologically relevant excipients, and preservatives. The marketed artificial tears were examined at various US retail pharmacy chains and using the manufacturers’ website to compile information about active ingredients, inactive ingredients, and preservatives. The currently marketed artificial tears can be grouped into four categories based on their active ingredients. The artificial tears also contain biologically active chemicals listed as inactive ingredients, which have osmoprotectant, humectant, and tear film lipid layer or mucous layer mimicking properties. Most artificial tears contain vanishing type preservatives such as purite or sodium perborate and safer quaternary compound polyquaternium-1. The majority of these artificial tear formulations are also available as preservative-free single dose unit. The study provides a formulary of artificial tears based on active ingredients, biologically active excipients, and the preservative-free option. The formulary should assist healthcare providers in making a stepwise and rational selection of appropriate artificial tears for patients suffering from dry eye disease

CYP2C9 Polymorphism and Use of Oral Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for management of inflammation and pain, but they can cause gastrointestinal, cardiovascular, and renal adverse effects. Genetic variations in CYP450 enzymes affect their metabolic activity, thus impacting the hepatic clearance, elimination half-life, and risk of adverse effects of drugs metabolized by that CYP. Celecoxib, ibuprofen, flurbiprofen, meloxicam, and piroxicam are significantly metabolized by CYP2C9. The Clinical Pharmacogenetic Implementation Consortium has published evidence-based recommendations on CYP2C9 polymorphism–based safe usage of NSAIDs. As pharmacogenetics becomes more common, pharmacists will play a critical role in optimizing drug regimens based on pharmacogenetic test results