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sulfacetamide sodium solution/ drops
ISOPTO CETAMIDE® (sulfacetamide sodium ophthalmic solution USP) 15% and CETAMIDE™ (sulfacetamide sodium ophthalmic ointment, USP) 10% are sterile topical antibacterial agents for ophthalmic use. The active ingredient is represented by the following structural formula:
Chemical name: N-Sulfanilylacetamide monosodium salt monohydrate.
Each mL of solution contains: Active: Sulfacetamide sodium 15% (150 mg/mL). Preservative: Methylparaben 0.05%, Propylparaben 0.01%. Vehicle: 0.5% Hydroxyporpyl Methylcellulose 2910 (viscosity type, 4000 cps). Inactive: Sodium Thiosulfate 0.3%, Dibasic Sodium Phosphate and/or Monobasic Sodium Phosphate (to adjust pH), Purified Water.
pH range between 7.0 and 7.8 DM-02
Each gram of ointment contains: Active: Sulfacetamide Sodium 10% (100 mg). Preservatives: Methylparaben 0.05%, Propylparaben 0.01%. Inactive: White Petrolatum, Anhydrous Liquid Lanolin, Mineral Oil. DM-00
The sulfonamides are bacteriostatic agents and the spectrum of activity is similar for all. Sulfonamides inhibit bacterial synthesis of dihydrofolic acid by preventing the condensation of the pteridine with aminobenzoic acid through competitive inhibition of the enzyme dihydropteroate synthetase. Resistant strains have altered dihydropteroate synthetase with reduced affinity for sulfonamides or produce increased quantities of aminobenzoic acid.
Topically applied sulfonamides are considered active against susceptible strains of the following common bacterial eye pathogens: Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus (viridans group), Haemophilus influenzae, Klebsiella species, and Enterobacter species.
Topically applied sulfonamides do not provide adequate coverage against Neisseria species, Serratia marcescens and Pseudomonas aeruginosa. A significant percentage of Staphylococcal isolates are completely resistant to sulfa drugs.
INDICATIONS AND USAGE
For the treatment of conjunctivitis and other superficial ocular infections due to susceptible microorganisms and as an adjunctive in systemic sulfonamide therapy of trachoma: Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus (viridans group), Haemophilus influenzae, Klebsiella species, and Enterobacter species.
For the treatment of conjunctivitis and other superficial ocular infections due to susceptible microorganisms. Topically applied sulfonamides do not provide adequate coverage against Neisseria species, Serratia marcescens and Pseudomonas aeruginosa. A significant percentage of staphylococcal isolates are completely resistant to sulfa drugs.
FOR TOPICAL EYE USE ONLY – NOT FOR INJECTION. FATALITIES HAVE OCCURRED, ALTHOUGH RARELY, DUE TO SEVERE REACTIONS TO SULFONAMIDES INCLUDING STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, FULMINANT HEPATIC NECROSIS, AGRANULOCYTOSIS, APLASTIC ANEMIA AND OTHER BLOOD DYSCRASIAS. Sensitizations may recur when a sulfonamide is readministered, irrespective of the route of administration. Sensitivity reactions have been reported in individuals with no prior history of sulfonamide hypersensitivity. At the first sign of hypersensitivity, skin rash or other serious reaction, discontinue use of this preparation.
Prolonged use of topical anti-bacterial agents may give rise to overgrowth of nonsusceptible organisms including fungi. Bacterial resistance to sulfonamides may also develop. Ophthalmic ointments may retard corneal wound healing. The effectiveness of sulfonamides may be reduced by the para-aminobenzoic acid present in purulent exudates. Sensitization may recur when a sulfonamide is readministered irrespective of the route of administration, and cross-sensitivity between different sulfonamides may occur. At the first sign of hypersensitivity, increase in purulent discharge, or aggravation of inflammation or pain, the patient should discontinue use of the medication and consult a physician (see WARNINGS).
Information for Patients
To avoid contamination, do not touch tip of container to eye, eyelid or any surface.
Carcinogenesis, Mutagenesis, Impairment of Fertility
No studies have been conducted in animals or in humans to evaluate the possibility of these effects with ocularly administered sulfacetamide. Rats appear to be especially susceptible to the goitrogenic effects of sulfonamides, and long-term oral administration of sulfonamides has resulted in thyroid malignancies in these animals.
Pregnancy Category C. Animal reproduction studies have not been conducted with sulfonamide ophthalmic preparations. Kernicterus may occur in the newborn as a result of treatment of a pregnant woman at term with orally administered sulfonamides. This product should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus.
Systemically administered sulfonamides are capable of producing kernicterus in infants of lactating women. Because of the potential for the development of kernicterus in neonates, a decision should be made whether to discontinue nursing or discontinue the drug taking into account the importance of the drug to the mother.
Bacterial and fungal corneal ulcers have developed during treatment with sulfonamide ophthalmic preparations. The most frequently reported reactions are local irritation, stinging and burning. Less commonly reported reactions include non-specific conjunctivitis, conjunctival hyperemia, secondary infections and allergic reactions. Fatalities have occurred, although rarely, due to severe reactions to sulfonamides including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias (see WARNINGS).
DOSAGE AND ADMINISTRATION
For conjunctivitis and other superficial ocular infections:
Solution: Instill one or two drops into the conjunctival sac(s) of the affected eye(s) every two to three hours initially. Dosages may be tapered by increasing the time interval between doses as the condition responds. The usual duration of treatment is seven to ten days.
Ointment: Apply a small amount (approximately one-half inch ribbon) into the conjunctival sac(s) of the affected eye(s) every three to four hours and at bedtime. Dosages may be tapered by increasing the time interval between doses as the condition responds. The ointment may be used as adjunct to the solution. The usual duration of treatment is seven to ten days.
How to apply CETAMIDE™ Ointment:
Solution in 5mL and 15mL plastic DROP-TAINER® Dispensers. Ointment in 3.5g ophthalmic tubes:
5 mL solution - NDC 0998-0522-05
15 mL solution - NDC 0998-0522-15
3.5 g ointment - NDC 0065-0526-35
Solution – Store at 8° - 24°C (46° - 75°F). Protect from light. Do not use if solution is discolored (dark brown). Sulfonamide solutions, on long standing, will darken in color and should be discarded.
Ointment – Store at 8° - 27°C (46°-80°F).
CAUTION: Federal (USA) law prohibits dispensing without prescription.
Rev: January 1995
ALCON LABORATORIES, INC.
Fort Worth, TX 76134 USA
Printed in USA
Revised: 11/2006 Alcon
Reproduced with permission of U.S. National Library of Medicine
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