FML Liquifilm is indicated for corticosteroid responsive inflammation of the palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe.

Posology

 Paediatric population

 The safety and efficacy in children aged 2 years or less has not been established. No  data are available.

 

 Elderly population

No overall differences in safety or effectiveness have been observed between elderly and younger patients.

 

Method of administration:

FML Liquifilm is for topical ophthalmic use only. Shake FML Liquifilm suspension well before use.

Topically as drops into the conjunctival sac.

1-2 drops instilled into the conjunctival sac 2-4 times daily.  During the first 24 to 48 hours of treatment, the dose may be safely increased to 2 drops at one hour intervals. 

The treatment should not be withdrawn too early.

In chronic conditions, withdrawal of treatment should be carried out by gradually decreasing the frequency of applications (see section 4.4).

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. FML Liquifilm is contraindicated in active viral diseases of the cornea and conjunctiva, including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, as well as mycobacterial and untreated bacterial infection of the eye and fungal diseases of ocular structures.

Eye drops containing corticosteroids should not be used for longer than a week except under an eye specialist’s careful surveillance combined with regular measurement of intraocular pressure.

Prolonged use of corticosteroids may result in elevated intraocular pressure (IOP) with possible development of glaucoma and infrequent damage to the optic nerve, defects in visual acuity and fields of vision, posterior subcapsular cataract formation, and delayed wound healing. Prolonged use may also suppress the host immune response and thus increase the hazard of secondary ocular infections. Steroids should be used with caution in the presence of glaucoma. Intraocular pressure should be checked frequently.

Acute untreated infection of the eye may be masked or activity enhanced by the presence of steroid medication.

Use of intraocular steroids may prolong the course and may exacerbate the severity of many viral infections on the eye (including herpes simplex). Use of a corticosteroid medication in the treatment of the patients with a history of herpes simplex keratitis requires great caution. Frequent slit lamp microscopy is recommended, in severe cases once a day.

To prevent eye injury or contamination, care should be taken to avoid touching the applicator tip to the eye or to any other surface. The use of the bottle by more than one person may spread infection.

FML Liquifilm contains benzalkonium chloride which is irritant to the eye and could cause discoloration of soft contact lenses.  Avoid contact with soft contact lenses.  Remove contact lenses before FML is used and wait for at least 15 minutes before reinsertion.

Concomitant ocular medication should be administered 5 minutes prior to the instillation of FML Liquifilm.

No interaction studies have been performed.

Co-treatment with CYP3A inhibitors, including cobicistat-containing products, is expected to increase the risk of systemic side-effects. The combination should be avoided unless the benefit outweighs the increased risk of systemic corticosteroid side-effects, in which case patients should be monitored for systemic corticosteroid side-effects.

 

Pregnancy

There are no or limited amount of data from the use of fluorometholone in  pregnant women. Studies in animals have shown reproductive toxicity.

FML Liquifilm is not recommended during pregnancy.

 

Lactation

It is unknown whether fluorometholone is excreted in human milk. FML Liquifilm should not be used during breast-feeding.

FML Liquifilm has no influence on the ability to drive and use machines. However, instillation of any eye drop could result in transient blurring of vision.  If this occurs, the patient should wait for the blurring to subside before driving or operating machinery.

Class effects:

 Although systemic effects are extremely uncommon, there have been rare  occurrences of systemic hypercorticoidism after use of topical steroids.

The following undesirable effects have been reported since FML Liquifilm was  marketed.

 

Frequency:

Common: affecting >1/100 and <1/10 patients

Not known: the incidence cannot be determined from available information.

 

Immune system disorders

Not known: Hypersensitivity

 

Eye disorders

Not known: Eye irritation, conjunctival/ ocular hyperaemia, eye pain, visual disturbance, foreign body sensation, eyelid oedema, blurred vision, eye discharge, eye pruritis, lacrimation increased, eye oedema/eye swelling, mydriasis, cataract (including subcapsular)*, ulcerative keratitis, ocular infection (including bacterial, fungal*, and viral* infections), visual field defect, punctate keratitis

 

Gastrointestinal disorders

Not known: Dysgeusia

 

Skin and subcutaneous tissue disorders

Not known: Rash

 

Investigations

Common: Intraocular pressure increased

 

See section 4.4 for further information

 

Adverse reactions reported in phosphate containing eye drops

Cases of corneal calcification have been reported very rarely in association with the use of phosphate containing eye drops in some patients with significantly damaged corneas.

 

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via:

The national pharmacovigilance center and drug safety center (NPC):

·       Fax:  +966-11-205-7662

·       Call NPC at  +966-11-20382222, Exts: 2353-2356-2317-2354-2334-2340

·       Toll free phone: 8002490000

·       E-mail: npc.drug@sfda.gov.sa

·       Website: www.sfda.gov.sa/npc

Overdosage by the topical ophthalmic route will not ordinarily cause acute problems. 

If accidental overdosage occurs in the eye, the eye should be flushed with water or normal saline.  If accidentally ingested, the patient should drink fluids to dilute.

Pharmacotherapeutic group: Corticosteroids, plain

ATC code: S01BA07

Fluorometholone is a synthetic corticosteroid (glucocorticoid), a derivative of desoxyprednisolone. It is a member of the group of universally known steroids used for the treatment of eye inflammation.

Glucocorticoids bind to cytoplasmic receptors and control the synthesis of infection mediators thus damping inflammatory reactions (swelling, fibrin deposition, capillary dilatation, phagocyte migration) and also capillary proliferation, collagen deposition and scarring.

Although topical corticosteroid treatment often increases intraocular pressure both in normal eyes and in the eyes of a patient with increased intraocular pressure, fluorometholone increases intraocular pressure less than, for example, dexamethasone. A study showed that fluorometholone after six weeks’ treatment increased intraocular pressure statistically significantly less than dexamethasone (mean change dexamethasone: 9 mmHg, mean change fluorometholone: 3 mmHg).

When tritium-labelled 0.1 % fluorometholone suspension was administered locally, the peak concentration of the radioactive substance in aqueous humour was achieved 30 minutes after administration. A rapidly forming metabolite occurred at high concentrations both in aqueous humour and corneal extracts, which shows that fluorometholone is metabolised to a certain extent while penetrating the cornea and aqueous humour.

Effects in non-clinical studies were observed only at exposures considered sufficiently in excess of the maximum human exposure indicating little relevance to clinical use.

Polyvinyl alcohol

Benzalkonium chloride

Disodium edetate

Sodium chloride

Sodium phosphate dibasic heptahydrate

Sodium phosphate monobasic monohydrate

Polysorbate 80

Sodium hydroxide (for pH adjustment)

Purified water

Not applicable.

Unopened: 3 years. Once opened: discard after 28 days.

Do not store above 25°C.  Do not refrigerate or freeze.

Discard any unused content 28 days after opening the bottle.

Shake well before using.

A bottle and an applicator tip of low density polyethylene (LDPE).  A screw cap of high impact polystyrene (HIPS).

The bottle contains 5 ml or 10 ml of suspension.

Not all pack sizes may be marketed.

Keep bottle tightly closed when not in use.

No special requirements.

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