Download - Anti Viral Drugs in Ophthalmology
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Dr. Ankit M. PunjabiDOMS (Final Year), Dept of Ophthalmology,
KIMS Hospital, BangaloreKarnataka, INDIA
Email: [email protected]
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1. Smallest living unit2. Nutrition from host3. Difficult to Rx4. Difficult to diagnose
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DNA Viruses1. Herpes group HSV & HZV CMV2. Adeno viruses3. Variola & Vaccinia4. Molluscum contagiosum5. HPV
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RNA Viruses1. Picorna viruses2. Measles3. Mumps4. Rubella
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1. Adsorption2. Entry3. Uncoating4. Transcription5. Virus component synthesis
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Ist Generation drugs
1. Idoxuridine2. Vidarabine3. Trifluorothymidine4. Cytarabine
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2nd Generation Drugs1. Acyclovir2. Bromo vinyl deoxyuridine3. Interferons4. Famiclovir5. Vabaciclovir6. Foscarnet7. Ganciclovir
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8. Zidovudine9. Sorvudine
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Thymidine analogue Activated by cellular & viral kinase Incorporation into viral genome Faulty virus synthesis
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TOXICITY1. SPK2. Indolent ulceration3. Delayed epithelial healing4. Stromal opacification5. Chemosis6. Hyperaemia7. Follicles
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8. Eyelid edema9. Meibomian gland plugging10. Punctal occlusion
DOSE 0.1% e/d and 0.5% e/o
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1. Idurin 0.1%2. Ridinox 0.1%3. Toxil 0.1%
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Acute and Recurrent Herpetic keratoconjuctivitis
KeratitisPurine nucleoside analoguePhosphorylation by host kinases
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Chain terminator for new viral DNA
Doesnot require viral thymidine kinase
Not effective against RNA viruses
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Side effects1. Irritation2. SPK3. Pain 4. Photophobia5. Punctal occlusion6. Secondary glaucoma7. Corneal vascularisation
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Fluorinated pyrimidine Thymidine analogue Phosphorylated to active form More conc. In infected cells Drug of choice for HSV Keratitis Water and lipid soluble Drug of choice for HSV
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Side Effects1. Burning & Stingy sensation2. Hyperaemia3. Keratitis sicca4. Delayed wound healing5. Raised IOP
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DOSE
1% Solution 6 – 9 times till epithelium heals then, 1 drop 4 times/day for week
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Acyclic nucleoside analogue of Guanosine Selective for herpes infected cells Thymidine kinase & DNA polymerase Chain termination Oral, Topical, Intravenous administration
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DOSE1. Topical – 3% Ointment2. Systemic – 1g/ 24 hr for 10 days 200mg, 400mg, 800mg Tablets3. Intravenous 5 mg/ kg 8 hrly for 5 – 10 days
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INDICATIONS1. Primary HSV2. Infectious epithelial keratitis3. HSV iritis & blepharitis4. Risk of recurrence of infectious ds.5. Post PK for HSV6. ARN7. Immunosuppressed patients
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SIDE EFFECTS1. SPK2. Burning sensation3. GIT disturbances, nausea, diziness4. Renal dysfunction5. Iv rashes, fall in BP
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1. Acivir2. Cyclovir3. Ocuvir4. Syslovir5. Virucid6. Zovirax ophthalmic oint.
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Guanine analogue Structurally related to acyclovir CMV retinitis
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INDICATIONS1. CMV Retinitis2. Prevention in immunosuppresed patients
C/I Hyperesensitivity to acyclovir or
ganciclovir
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DOSE1. CMV retinitis Induction regime 5mg/kg every 12 hrs for 14-21 days Maintenance regime 5 mg/kg/hr once daily/ week or 6 mg/kg once daily 5 days /week
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Oral, for maintenance only 1000 mg 3 times daily or 500 mg 6 times daily every 3 hrs.
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Prevention 5 mg/Kg every 12 hrs for 7 –14 days Then, 5 mg/kg once daily / week or 6 mg/Kg once daily 5 days / week
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Ganciclovir intravitreal implant1. Rx of CMV retinitis2. 4.5 mg of drug3. Released over 6 – 8 months4. Stored at 15 – 30 * C
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1. Glycoproteins2. Host cell in response to viral infection3. Broad antiviral, Immunomodulator & Anti-proliferative4. Three types
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INDICATIONS1. Herpes Zoster2. AIDS related Kaposi’s sarcoma
DOSE 30 – 400 million/ml once or twice a day for
2 weeks
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Adverse effects1. Fever, chills, Myalgia2. Bonemarrow depression3. Neurotoxicity4. Hypersenstivity
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Tri-sodium salt of phosphoformic acid Inhibits viral DNA replication Acyclovir and Ganciclovir resistant Renal excretion
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DOSE
60 mg/Kg every 8 hrs for 2 –3 weeks Maintenance 90 – 120 Mg/Kg over 2 hrs once daily
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1. Bromovinyl deoxyuridine2. HPMPC