MILITARY PHARMACY AND MEDICINE

© Military Pharmacy and Medicine • 2012 • 4 • 38 – 503) Drugs that inhibit COX-2 with a selectivitythat is >50 times higher compared to COX-1,e.g. refecoxib (Vioxx, withdrawn frommarket).4) Drugs that are weak inhibitors of both COXisoforms: 5-aminosalicylic acid (known asmesalazine or mesalamine), sodium salicylate,sulfosalazine.The active substances listed above in italics areavailable in both non-ophthalmic and ophthalmicproducts. With regard to the first, i.e.structural classification, of note is the fact thatophthalmic NSAIDs are listed in two groups:acetic acid derivatives, or, more precisely, heteroaryl— and/or phenylacetic acid derivatives(most of the listed compounds, including indomethacinthat contains indole moiety) and arylpropionicacid derivatives (flurbiprofen assodium salt dihydrate). With regard to the secondclassification, based on the effects againstCOX-1 and COX-2, all ophthalmic preparations are inGroup 1, encompassing inhi-bitors of bothisoenzymes, with preference towards COX-1.Ophthalmic NSAIDsCompared to all available NSAIDs, ophthalmicpreparations are a small group of products — currently,only six such products are available atPolish market (according tothe latest ophthalmic drugsguide-book: Pharmindex-Okulistyka [Ophthalmology]2012): Indocollyre containsindomethacin, Dicloabak, Difadol0,1% and Naclof containthe same active substance —diclofenac, while the other twoophthalmic drugs, Nevanacand Yellox contain nepafenacand bromfenac, respectively.Review articlemore [10-12]. In the past, one other compound,fenoprofen, was tested in ophthalmic preclinicaland clinical trials; however, these did not lead tothe drug being registered.Table 1 presents ophthalmic NSAIDs currentlyavailable in Poland, as well as other compoundsof this class available elsewhere in the world.Indomethacin was the first member of the familyof ophthalmic NSAIDs, introduced in the early1980s — it was widely used in ophthalmologicalpractice (and is still available in the Europeanmarket), but it has never been registered by FDAto be sold within the US. Another non-steroidalcompounds included flurbiprofen, suprofen, diclofenacand ketorolac; the therapeutic potentialof these compounds in ophthalmology wasdescribed by Abelson and Sloan in 1994 [13]. Atthat time, the first two of these drugs were usedmostly for prevention of miosis during ocularprocedures, diclofenac was used in the treatmentof post-operative inflammation followingcataract removal, and ketorolac was used totreat itching occurring in the course of seasonalallergic conjunctivitis (SAC). Another ophthalmicNSAIDs contained fenacs — nepafenac andTable 1: Ophthalmic NSAIDs currently available in Polandand other compounds of this class availableelsewhere in the world.Other ophthalmic preparationsare available outsidePoland, including Acular,Acular-LS, Acular-PF, andAcuvail (all containing ketorolac),as well as Ocufen andOcuflur containing flu-rbiprofen;the suprofen—containingproduct Profenal is not usedas a medicinal product any38 http://military.isl-journals.com