Allergan Ltd

EXOCIN (Ofloxacin) 0.3% w/v Eye Drops Solution

For full list of excipients, see section 6.1

Eye drops, solution

Clear, pale to light yellow-green solution, practically free from visible particles.

EXOCIN is indicated for the topical treatment of external ocular infections (such as conjunctivitis and keratoconjunctivitis) caused by ofloxacin-sensitive organisms.

Adults only: One to two drops in the affected eye(s) three or four times daily. The length of treatment should not exceed 10 days without an ophthalmic review.

EXOCIN is contraindicated in patients sensitive to ofloxacin or similar quinolone drugs.

EXOCIN is not recommended for use in children or adolescents before epiphyseal closures.

EXOCIN should not be used during pregnancy or in women at risk of pregnancy, nor during lactation.

EXOCIN is not for injection.

Serious and occasionally fatal hypersensitivity (anaphylactic/anaphylactoid) reactions, some following the first dose, have been reported in patients receiving systemic quinolones, including ofloxacin. Some reactions were accompanied by cardiovascular collapse, loss of consciousness, angioedema (including laryngeal, pharyngeal or facial edema), airway obstruction, dyspnea, urticaria, and itching.

If an allergic reaction to ofloxacin occurs, discontinue the drug. Use EXOCIN with caution in patients who have exhibited sensitivities to other quinolones antibacterial agents.

When using EXOCIN eye drops the risk of rhinopharyngeal passage which can contribute to the occurrence and the diffusion of bacterial resistance should be considered. As with other anti-infectives, prolonged use may result in overgrowth of non-susceptible organisms. If infection worsens, or if clinical improvement is not noted within a reasonable period, discontinue use and institute alternative therapy.

Stevens-Johnson syndrome has been reported in patients receiving topical ophthalmic ofloxacin, however, a causal relationship has not been established.

Data are very limited to establish efficacy and safety of ofloxacin eye drops 0.3% in the treatment of conjunctivitis in neonates.

The use of ofloxacin eye drops in neonates with ophthalmia neonatorum caused by Neisseria gonorrhoeae or Chlamydia trachomatis is not recommended as it has not been evaluated in such patients. Neonates with ophthalmia neonatorum should receive appropriate treatment for their condition, e.g. systemic treatment in cases caused by Chlamydia trachomatis or Neisseria gonorrhoeae.

Use in the elderly: No comparative data are available with topical dosing in elderly versus other groups.

The following precautions are relevant for the systemic absorption of oxoquinolone antibacterial agents. However, the plasma levels of ofloxacin following absorption from topically applied EXOCIN eye drops are minimal.

Persons with latent or actual defects in glucose-6-phosphate dehydrogenase activity may be prone to haemolytic reactions with systemically absorbed oxoquinolone antibacterial agents.

Patients with pre-existent significant renal or hepatic disorders should be carefully monitored to detect any deterioration in function. Dosage reduction may be required.

EXOCIN should be administered with caution to persons with existent central nervous system disorders, epilepsy, hepatic or renal insufficiency, or severe dehydration. Photosensitivity reactions may be induced. Evidence of CNS irritability has been reported particularly in the elderly, leading occasionally to psychosis.

Clinical and non-clinical publications have reported the occurrence of corneal perforation in patients with pre-existing corneal epithelial defect or corneal ulcer, when treated with topical fluoroquinolone antibiotics. However, significant confounding factors were involved in many of these reports, including advanced age, presence of large ulcers, concomitant ocular conditions (e.g. severe dry eye), systemic inflammatory diseases (e.g. rheumatoid arthritis), and concomitant use of ocular steroids or non-steroidal anti-inflammatory drugs. Nevertheless, it is necessary to advise caution regarding the risk of corneal perforation when using product to treat patients with corneal epithelial defects or corneal ulcers.

Corneal precipitates have been reported during treatment with topical ophthalmic ofloxacin. However, a causal relationship has not been established.

Long-term, high-dose use of other fluoroquinolones in experimental animals has caused lenticular opacities. However, this effect has not been reported in human patients, nor has it been noted following topical ophthalmic treatment with ofloxacin for up to six months in animal studies including studies in monkeys.

Caution should be taken when using fluoroquinolones, including EXOCIN, in patients with known risk factors for prolongation of the QT interval such as, for example:

- Congenital long QT syndrome

- Concomitant use of drugs that are known to prolong the QT interval (e.g. Class IA and III anti-arrhythmics, tricyclic antidepressants, macrolides, antipsychotics)

- Uncorrected electrolyte imbalance (e.g. hypokalaemia, hypomagnesaemia)

- Elderly

- Cardiac disease (e.g. heart failure, myocardial infarction, bradycardia)

(see section 4.2 elderly, section 4.5, section 4.8, section 4.9)

EXOCIN contains the preservative benzalkonium chloride which may cause ocular irritation and discolour soft contact lenses.

Use of contact lenses is not recommended in patients receiving treatment for an eye infection.

It has been shown that the systemic administration of some quinolones inhibits the metabolic clearance of caffeine and theophylline. Drug interaction studies conducted with systemic ofloxacin have demonstrated that metabolic clearance of caffeine and theophylline are not significantly affected by ofloxacin.

Although there have been reports of an increased prevalence of CNS toxicity with systemic dosing of fluoroquinolones when used concomitantly with systemic nonsteroidal anti-inflammatory drugs (NSAIDs), this has not been reported with the concomitant systemic use of NSAIDs and ofloxacin.

Mineral antacids used simultaneously may effect systemic absorption. Concomitant use of systemic quinolones with some phenylproprionic acid derived non-steroidal anti-inflammatory drugs may lead to toxicity possibly because of renal effects.

A study of concurrent administration with a coumarin anticoagulant showed no interaction.

EXOCIN, like other fluoroquinolones, should be used with caution in patients receiving drugs known to prolong the QT interval (e.g. Class IA and III anti-arrhythmics, tricyclic antidepressants, macrolides, antipsychotics) (see section 4.4)

Use in pregnancy: There have been no adequate and well-controlled studies performed in pregnant women. Since systemic quinolones have been shown to cause arthropathy in immature animals, it is recommended that EXOCIN not be used in pregnant women.

Use during lactation: Because ofloxacin and other quinolones taken systemically are excreted in breast milk and there is potential for harm to nursing infants, EXOCIN should not be used during lactation.

No studies on the effects on the ability to drive and use machines have been performed.

Transient blurring of vision may occur on instillation of eye drops. Do not drive or operate hazardous machinery unless vision is clear.

General

Serious reactions after use of systemic ofloxacin are rare and most symptoms are reversible. Since a small amount of ofloxacin is systemically absorbed after topical administration, adverse events reported with systemic use could possibly occur.

Frequency categories: Very common (1/10); common (1/100 to <1/10); uncommon (1/1,000 to 1/100); rare (1/10,000 to 1/1,000); very rare (1/10,000), not known (cannot be estimated from the available data).

No case of overdose has been reported.

In the event of a topical overdose, flush the eye with water.

In the event of an overdose, symptomatic treatment should be implemented. ECG monitoring should be undertaken, because of the possibility of QT interval prolongation.

Pharmacotherapeutic group: Ophthalmologicals, anti-infectives, quinolones

ATC code: S 01 AX 11

Ofloxacin is a synthetic fluorinated 4-quinolone, having fast acting, broad spectrum bactericidal activity against certain aerobic gram-positive and gram-negative bacteria.

Ofloxacin has been shown to be active against most strains of the following organisms both in vitro and clinically in ophthalmic infections. Clinical trial evidence of the efficacy of EXOCIN against S. pneumoniae was based on a limited number of isolates.

Gram-negative bacteria: Acinetobacter calcoaceticus var. anitratum and A. calcoaceticus var. lwoffi; Enterobacter sp. including E. cloacea, Haemophilus sp. including H. influenza and H. aegyptius; Klebsiella sp. including K. pneumoniae; Moraxella sp; Morganella morganii; proteus sp. including P. mirabilis; Pseudomonas sp. including P. aeruginosa, P. cepacia, and P. fluoroscens; and Serrata sp. including S. marcescens.

Gram-positive bacteria: Bacillus sp; Corynebacterium sp; Micrococcus sp; Staphylococcus sp. including S. aureus and S. epidermidis; Streptococcus sp. including S. pneumoniae (see above), S. viridans and beta-haemolytic Streptococcus.

Ofloxacin appears to have more than one mechanism contributing to its bactericidal action. The primary mechanism of action is believed to be the inhibition of bactericidal DNA gyrase, the enzyme responsible for inserting negative supercoils into bacterial DNA. This inhibition causes the rapid death of bacteria by stopping DNA replication, which apparently induces a cellular response leading to further damage to bacterial DNA and preventing normal gene expression. In addition, ofloxacin possesses an additional bactericidal mechanism which is independent of protein and DNA synthesis. Therefore it is bactericidal in both the replicating and non-replicating stages of growth. Mammalian cells are not inhibited by the quinolones.

After ophthalmic instillation as an eyedrop, ofloxacin is well absorbed and distributed to all parts of the eye.

In a healthy volunteer study, mean tear film concentrations of ofloxacin measured four hours after topical dosing (9.2 mcg/ml were higher than the 2 mcg/ml) minimum concentration of ofloxacin necessary to inhibit 90% of most ocular bacterial strains (MIC₉₀) in vitro.

Systemically absorbed ofloxacin is widely distributed and undergoes rapid elimination from the body. It is mainly excreted unchanged in the urine.

The maximal serum concentration observed after ophthalmic doses to man (approx. 1.9 ng/ml) was at least two thousand fold lower than that after an oral 300 mg dose (approx. 4625 ng/ml).

Ofloxacin is not subject to degradation by beta-lactamase enzymes nor is it modified by enzymes such as aminoglycoside adenylases or phosphorylases, or chloramphenicol acetyltransferase.

Systemic toxicity studies have been conducted in a number of animals species at acute, subacute and chronic levels using a variety of experimental animals. The choices were consistent with general practices in drug investigation. Reproduction studies including fertility and teratogenicity have also been carried out. Together these have established the safety of the drug.

The profile of ofloxacin compares favourably with those of other wide-spectrum antimicrobial agents. The much lower dosages used ophthalmically result in less drug absorption and far fewer adverse events are expected with this mode of administration.

The main effects noted have been primarily gastrointestinal complaints with some central nervous effects. However, the most notable effect has been the action of ofloxacin on articular cartilage in immature animals and in this respect the product is not recommended during pregnancy.

Benzalkonium chloride

Sodium chloride

Sodium hydroxide (for pH adjustment)

Hydrochloric acid (for pH adjustment)

Purified water

Not applicable.

2 years, unopened.

Discard unused contents 28 days after opening the bottle.

Do not store above 25°C.

Low density polyethylene (LDPE) bottle with LDPE tip and medium or high impact polystyrene cap. Contains 5 ml in a 10 ml bottle.

No special requirements.

Any unused product or waste material should be disposed of in accordance with local requirements.

Allergan Pharmaceuticals Ireland

Castlebar Road

Westport

Co. Mayo

Ireland

PA 148/49/1

Date of first authorisation: 10^th June 1991

Date of last renewal: 10^th June 2006

07 June 2011