PATIENT COMPLIANCE WITH USE OF TOPICAL OPHTHALMIC CORTICOSTEROID SUSPENSIONS

We surveyed the compliance of 100 patients with the instructions on the label of a bottle of 1.0% prednisolone acetate ophthalmic suspension. Of these patients, 63 did not shake the bottle, as directed on the label. Of the 37 subjects who did shake the bottle, 18 (48.6%) did so one to ten times, 28 (75.7%) shook it one to 15 times, and only one patient shook the bottle as many as 32 times. We determined the concentration of corticosteroid in four commonly available preparations of ophthalmic corticosteroid suspension after shaking separate, unused bottles of each drug up to 40 times. The preparations tested were 1.0% prednisolone acetate (Pred Forte and Econopred Plus), 0.1% dexamethasone (Maxidex), and 2.5% hydrocortisone acetate (Hydrocortone). The percent of maximum concentration of each of these preparations was 29% or less after no shakes, 53% or less after ten shakes, and 61% or less after 15 shakes. After shaking the bottle as many as 40 times, only Hydrocortone reached its maximum attainable concentration. Almost two thirds of the subjects in this study, those who did not shake the bottle, would have delivered to an eye less than one third of the maximum concentration of any of the medications tested. Almost half of the patients who did shake the bottle (bottle shaken one to ten times) would have delivered half or less of the maximum concentration of any of the four drugs. Three-fourths of the patients who shook the bottle (bottle shaken one to 15 times) would have delivered less than two thirds of the maximum concentration of any of the four medications. © 1979.