Particle size and drug interactions of injectable corticosteroids used in ophthalmic practice.
OBJECTIVE
The aim of this study is to compare the particle sizes of commercially available corticosteroids for intralesional injection to manufacturers' specifications and to evaluate changes in size when mixed with other steroids and other commonly used solutions.


METHODS
The particle sizes of dexamethasone sodium phosphate, methylprednisolone acetate, triamcinolone acetonide, and betamethasone sodium phosphate and beta-methasone acetate were measured with the Coulter counter. Each steroid was mixed with each of the others, lidocaine, and lidocaine with epinephrine, then measured immediately and after 1 hour to determine the effect on particle size.


RESULTS
All steroids showed accurate manufacturer specifications. Dexamethasone showed an increase in particle size when mixed with lidocaine alone, immediately and after 1 hour. Triamcinolone showed an increase in particle size only after 1 hour after mixture with lidocaine alone. Triamcinolone, dexamethasone, and methylprednisolone particles increased in size when mixed with lidocaine and epinephrine. Dexamethasone and triamcinolone showed an additional increase in size when allowed to sit for 1 hour after mixture with lidocaine and epinephrine. Mixing steroids caused no increase in particle size.


CONCLUSIONS
Because an increase in the number of particles greater than 20 microns in a solution also increases the likelihood of vascular occlusion, the authors urge care in the mixing of these drugs, especially with lidocaine and epinephrine. If mixture is necessary, the authors recommend that injection take place immediately subsequent.
Francis
B A
BA
Tulane University, Department of Ophthalmology, New Orleans.
Chang
E L
EL
Haik
B G
BG
D000779:Anesthetics, Local / Q000737:chemistry; D001623:Betamethasone / Q000031:analogs & derivatives / Q000737:chemistry; D003907:Dexamethasone / Q000031:analogs & derivatives / Q000737:chemistry; D004347:Drug Interactions; D004837:Epinephrine / Q000737:chemistry; D005938:Glucocorticoids / Q000737:chemistry*; D015552:Injections, Intralesional; D008012:Lidocaine / Q000737:chemistry; D008775:Methylprednisolone / Q000031:analogs & derivatives / Q000737:chemistry; D000077555:Methylprednisolone Acetate; D009184:Mydriatics / Q000737:chemistry; D009883:Ophthalmic Solutions / Q000737:chemistry; D010316:Particle Size; D011364:Professional Practice; D014222:Triamcinolone Acetonide / Q000737:chemistry
D000779:Anesthetics, Local; D005938:Glucocorticoids; D009184:Mydriatics; D009883:Ophthalmic Solutions; C004180:dexamethasone 21-phosphate; D000077555:Methylprednisolone Acetate; C028994:betamethasone sodium phosphate; D003907:Dexamethasone; D001623:Betamethasone; D008012:Lidocaine; D014222:Triamcinolone Acetonide; D008775:Methylprednisolone; D004837:Epinephrine