Unibrom

Indications

• Postoperative inflammation following cataract surgery
• Control of anterior segment inflammation when corticosteroids are contraindicated

Dosage

Children: For pediatric patients, dosage information should be obtained from the BNF for Children, as it is not provided in the general BNF.

Adults: For adult patients, the specific dosing regimen should be consulted from the product literature, as it may vary based on the formulation and clinical context.

Mechanism of action

Bromfenac exerts its effects by blocking the synthesis of prostaglandins through the inhibition of cyclooxygenase (COX) enzymes 1 and 2. Prostaglandins are known to mediate intraocular inflammation, leading to disruptions in the blood-aqueous humor barrier, vasodilation, increased vascular permeability, and leukocytosis. By inhibiting these processes, Bromfenac helps reduce inflammation and associated symptoms in the eye.

Pharmacodynamics

As a topical NSAID, Bromfenac demonstrates potent anti-inflammatory activity. It is designed for ophthalmic use, providing localized effects with reduced systemic exposure. This targeted action allows for effective management of ocular inflammation with a lower risk of systemic side effects typically seen with oral NSAIDs.

Pharmacokinetics

Bromfenac is administered topically as an eye drop formulation, leading to rapid absorption in the ocular tissues. The drug is characterized by high protein binding and undergoes metabolism primarily in the liver. The elimination half-life and specific pharmacokinetic parameters can vary based on individual patient factors and the formulation used. Generally, the pharmacokinetics of topical ophthalmic drugs like Bromfenac result in minimal systemic absorption, which is beneficial for reducing systemic side effects.

Contra-indications

• History of hypersensitivity to aspirin
• History of hypersensitivity to any other NSAID
• Patients with asthma, angioedema, urticaria, or rhinitis precipitated by NSAIDs

Adverse effects

• Eye discomfort
• Oedema
• Dry eye
• Headache
• Eye infection
• Eye inflammation
• Paraesthesia
• Vision blurred
• Retinal inflammation
• Hypersensitivity reactions
• Asthma exacerbation
• Dyspnoea
• Rhinitis
• Vision disorders

Interactions

• Other NSAIDs may increase the risk of adverse effects
• Caution is advised when used with anticoagulants due to potential increased bleeding risk

Precautions

• May mask symptoms of infection
• Use with caution in patients with a history of asthma or respiratory conditions
• Monitor for signs of ocular inflammation or infection

Pregnancy

Safety in pregnancy has not been established. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether bromfenac is excreted in human milk. Caution is advised; use only if necessary.

Storage

Store at room temperature, protect from light, and keep out of reach of children. Once opened, use within 28 days.

Formulations

• Bromfenac ophthalmic solution 900 micrograms/ml
• Yellox (Bausch & Lomb UK Ltd) eye drops, 5 ml

Mechanism of action

The mechanism of its action is thought to be due to its ability to block prostaglandin synthesis by inhibiting cyclooxygenase 1 and 2. Prostaglandins have been shown in many animal models to be mediators of certain kinds of intraocular inflammation. In studies performed in animal eyes, prostaglandins have been shown to produce disruption of the blood-aqueous humor barrier, vasodilation, increased vascular permeability, leukocytosis, and increased intraocular pressure.

Pharmacodynamics

Bromfenac ophthalmic solution is a sterile, topical, nonsteroidal anti-inflammatory drug (NSAID) for ophthalmic use.