Dicortineff – composition, action, indications, dosage, side effects

Proven content

Dicortineff is a suspension drug used in ophthalmology and ENT. It is a combined preparation used in the treatment of inflammation of the eyeball and conjunctiva, as well as in the case of otitis externa and middle ear. The drug is available on prescription in stationary pharmacies. What are the indications and contraindications for the use of Dicortineff drops? How does this preparation work? Can its use cause side effects in a patient? How much does a pack of this drug cost?

Dicortineff – drug characteristics

Dicortineff is a combination drug in the form of a suspension, intended for topical use. The composition of this preparation includes two antibiotics – neomycin and gramicidin and a glucocorticosteroid – fludrocortisone.

The drug has antibacterial, anti-inflammatory and anti-allergic properties. First of all, it relieves the symptoms of eye or ear disease, i.e. it reduces itching, burning and swelling. This drug is available in stationary pharmacies only with a prescription.

Dicortineff is a white to off-white suspension which may form sediment on the bottom after prolonged standing. After light shaking, the mixture becomes uniform. The medicine is contained in a 5 ml polyethylene bottle with a dropper and a tamper-evident screw cap. The bottle is packed in a cardboard box.

The entity responsible for the production and distribution of Dicortineff is Warszawskie Zakłady Farmaceutyczne Polfa SA Polfa Warszawa SA is one of the largest Polish pharmaceutical companies, established in 1824 as the Institute of Artificial Mineral Waters. In 2003, the company was transformed into a sole-shareholder company of the State Treasury, and from 2004 to 2012 it was part of Polski Holding Farmaceutyczny SA On April 19, 2012, as a result of privatization, Polfa Warszawa joined the Polpharma Group. The portfolio of Polfa in Warsaw includes over 140 different drugs that are distributed throughout the country and exported to dozens of countries around the world. The most popular product of this pharmaceutical company is ACARD.

Which pharmaceutical companies are appreciated by Poles? Check: Customer satisfaction from Polish pharmaceutical companies: which is the most convincing?

Dicortineff – composition and action of the drug

Dicortineff is a combined preparation, which means that several ingredients are active substances. Dicortineff contains 3 active substances and they are:

1. that’s gram – is a peptide antibiotic with an ionophore effect. It is a highly toxic compound that causes haemolysis in the body, i.e. the breakdown of red blood cells. Therefore, it can only be used topically – on the skin, in the ears or in the eyes, because then it is not absorbed into the bloodstream. The mechanism of action of gramicidin is based on the drug binding to the bacterial cell membrane and discharging the normal ion concentration gradient inside and outside the cell. This causes the death of the bacterial cell. Bacteria and some pathogenic fungi are sensitive to gramicidin; 
2. neomycyna – is an aminoglycoside antibiotic with a bactericidal effect on gram-negative bacteria, especially bacilli (except Haemophilus), mycobacteria tuberculosis and S. aureus. It has no effect on Pseudomonas aeruginosa. Neomycin works by interfering with the biosynthesis of proteins in a bacterial cell. This antibiotic binds to the 30S ribosome subunit, which leads to mRNA misreading during the translation process, resulting in the synthesis of abnormal proteins and the death of the bacterial cell. The bactericidal effect depends on the concentration of the antibiotic in the focus of the infection. Neomycin is not used parenterally because it is a highly toxic compound;
3. fludrokortyzon – is a synthetic fluorinated corticosteroid with strong anti-inflammatory, anti-allergic, anti-itching, anti-edema and mineralocorticotropic properties. The mechanism of action of fludrocortisone is to reduce the permeability of the capillaries, thereby reducing the swelling. In addition, fludrocortisone has a strong mineralocorticotropic effect – it works about 100 times stronger than hydrocortisone. Topically applied to the conjunctival sac, it inhibits the formation of exudate in the course of inflammatory processes in the anterior segment of the eyeball.

To sum up, the combined action of 2 antibiotics provides the preparation with a broad spectrum of antibacterial activity. 1 ml of suspension contains 2500 IU of neomycin, 25 IU of gramicidin and 1 mg of fludrocortisone.

The other substances in Dicortineff are trolamine, dilute hydrochloric acid (for pH adjustment), benzalkonium chloride solution, sodium chloride, ethanol 96% and purified water.

If you want to learn more about the properties and uses of neomycin read on: Neomycin – use, contraindications

Dicortineff – indications for the use of the drug

Dicortineff in the form of a suspension is a drug used in ophthalmology and ENT. In ophthalmic treatment, Dicortineff is used in cases of inflammation:

1. eyeball;
2. uveal;
3. conjunctiva;
4. the edges of the eyelids.

If the drug is used in ENT treatment, the indications are:

1. inflammation of the outer and middle ear; 
2. ear inflammation after surgery;
3. post-traumatic conditions of the external auditory canal. 

What could be the causes of eye pain? Check: Eye pain. Diseases that are manifested by pain in the eyeball

Dicortineff – contraindications to use

Dicortineff, despite its effectiveness in treating inflammation of the eye or ear, cannot be used by every patient struggling with this type of ailments.

Contraindications to the use of Dicortineff are:

1. hypersensitivity to the active substances or other aminoglycoside antibiotics, or to any of the excipients;
2. viral, tuberculous or fungal infections of the eye or ear;
3. diseases associated with defects in the corneal epithelium, if the medicine is to be used in the eye;
4. glaucoma, if the medicine is to be used in the eye;
5. perforation of the ear drum, if the medicine is to be used in the ear.

If the above circumstances apply to you, you should not use Dicortineff drops. If you are unsure, consult your doctor or pharmacist before taking Dicortineff.

How to choose the most effective eye drops? Read: Eye drops – types. What to look for when choosing? [WE EXPLAIN]

Dicortineff – precautions

Before and during the use of Dicortineff, follow the precautions included in the package leaflet.

Precautions to keep in mind include:

1. Talk to your doctor or pharmacist before using Dicortineff.
2. special care should be taken when using the drug in patients with suspected perforation (rupture) of the eardrum, as the drug entering the middle ear may cause burning pain and even damage to the auditory nerve;
3. during long-term use of Dicortineff, bacterial and fungal superinfections may occur, and in predisposed persons there may be an increase in intraocular pressure, and even a steroid cataract;
4. Hypersensitivity to topical aminoglycosides may occur in some patients, including cross-sensitivity to other aminoglycosides. If symptoms of hypersensitivity occur, discontinue use of the drug;
5. patients using eye medications containing neomycin sulfate should consult their doctor if eye pain, redness, swelling or irritation worsens or persists;
6. serious side effects including neurotoxicity, ototoxicity and nephrotoxicity may occur in patients receiving neomycin systemically or topically on open wounds or damaged skin. Caution should be exercised with the concomitant use of a systemic aminoglycoside antibiotic;
7. long-term administration of ophthalmic steroids may cause ocular hypertension and / or glaucoma, with damage to the optic nerve, decreased visual acuity and visual field defects, and posterior subcapsular cataracts;
8. in the absence of the effects of the use of Dicortineff drops, treatment with a drug consisting of a corticosteroid and an antibiotic should not last more than 7 days;
9. In diseases which reduce the thickness of the cornea and sclera, perforation may occur as a result of topical application of corticosteroids. Corticosteroids may reduce resistance to infection, promote the development of bacterial, viral or fungal infections, and mask clinical signs of infection, as well as mask the diagnosis of antibiotic ineffectiveness or reduce hypersensitivity reactions to Dicortineff;
10. if you experience blurred vision or other visual disturbances, contact your doctor;
11. the expiry date after first opening the bottle is 4 weeks;
12. the medicine should not be used after the expiry date which is stated on the carton. The expiry date refers to the last day of that month;
13. this medicine should not be disposed of via wastewater or household waste. It’s best to ask your pharmacist how to dispose of medicines you no longer use.

What should you know about proper drug storage? Check: Medications that are stored wrongly are poisonous

Dicortineff – dosage and method of use

Always use Dicortineff exactly as described in the package leaflet or as directed by your doctor or pharmacist.

Before using the drug, the bottle should be shaken so that the suspension is evenly mixed. As a rule, Dicortineff drugs should be used up to 2 days after the symptoms disappear, but not longer than 7 days.

When applying the drug to the eye, 1-2 drops are instilled into the conjunctival sac 2 to 5 times a day.

When applying the medicine, the tip of the dropper should not be touched as this may contaminate the contents of the bottle.

To use your eye drops correctly, please follow the steps below:

1. wash your hands thoroughly before putting the drug into your eyes;
2. unscrew the cap on the bottle;
3. tilt your head back and pull the lower eyelid down to form a pocket between the eyelid and the eyeball;
4. invert the bottle and gently press the side with your thumb or forefinger until one drop of the medicine is dispensed into the eye. Do not touch the eye or eyelids with the dropper tip;
5. if a drop missed your eye, use another drop;
6. after using Dicortineff, apply gentle pressure to the inner corner of the eye for about 2 minutes. This will help to stop the medicine from being absorbed into your body;
7. The dropper is designed to measure drops accurately, so do not enlarge the dropper hole;
8. after instillation, the bottle should be closed. 

In the case of applying the drug to the ear, 2-4 drops are instilled into the ear canal on the dressing 2-4 times a day.

To use your ear drops correctly, please follow the steps below:

1. wash your hands thoroughly before using the drug;
2. unscrew the cap on the bottle;
3. lie on your side with the treated ear facing up;
4. gently pull the earlobe (lower part of the auricle) away from the neck;
5. invert the bottle and gently press with your thumb or forefinger on the side until 2-4 drops of the medicine are squeezed into the treated ear;
6. after instillation, remain lying down for about 15 minutes, so that the drops can run down the ear canal;
7. wipe excess drops with a clean tissue;
8. after instillation, the bottle should be closed.

When using Dicortineff, it is also worth using the help of another person, because it makes the application of the drug much easier. Also, be careful not to let water get into the previously injected ear.

How to choose the most effective ear drops? Read on: Ear drops – types and action. Is using ear drops safe?

Dicortineff – improper use of the drug

Taking more than the recommended dose of the drug or missing the indicated dose during the day is considered inappropriate use of Dicortineff.

As it turns out, an overdose after administration into the conjunctival sac, as well as after accidental oral ingestion, due to the low content of the active substance, is unlikely. Accidental drinking of the suspension does not cause serious side effects. However, it is advisable to administer fluids to dilute the ingested medication.

If a dose is missed, a double dose should not be taken to make up for it.

How to take medication correctly? Check: How to take medications effectively?

Dicortineff – side effects

Dicortineff, like any other drug, may cause side effects in patients. It is important to report any suspected adverse reactions after authorization of the medicinal product so that the benefit / risk balance of the medicinal product can be monitored.

The frequency classification of adverse body reactions (ADRs) is based on the following principles: very common (≥1 / 10), common (≥1 / 100 to <1/10), uncommon (≥1 / 1 to <000/1), rare (≥ 100 / 1 to <10 / 000), very rare (<1 / 1), not known (cannot be estimated from the available data).

Rare side effects that may occur after using Dicortineff drops are nonspecific conjunctivitis or allergic reactions.

However, with an unknown frequency, the following may occur:

1. itching or burning of the conjunctiva, blurred vision;
2. hypersensitivity reactions, usually of the delayed type, leading to irritation, burning, stinging, itching and dermatitis. Contact your doctor if you experience these symptoms. 

What are the symptoms of conjunctivitis and how to treat it? Check: Conjunctivitis – types. What is the treatment of conjunctivitis? [WE EXPLAIN]

Dicortineff – interaction with other drugs

Before starting treatment with Dicortineff, please inform your doctor or pharmacist about all the medicines you are taking or have taken recently. You should also inform what medications the patient plans to take in the near future.

Although the literature describes interactions of individual components of the drug, i.e. neomycin, gramicidin and fludrocortisone, with various types of compounds, this applies to other forms of the drug – administered orally or intravenously.

When using Dicortineff in the form of a suspension for the eyes and ears, small amounts of the active substances contained in the drug may penetrate into the systemic circulation. This can happen during prolonged instillation of the suspension. In such cases, there is a potential for interactions with muscle relaxants and anticoagulants. If absorbed into the systemic circulation, fludrocortisone reduces the effect of antidiabetic drugs.

Some drugs can increase the effect of Dicortineff and your doctor may want to closely monitor you when you are taking such drugs, including some HIV drugs: ritonavir, cobicistat.

Which drugs should never be combined with each other? Check: Dangerous interactions

Dicortineff and pregnancy and breastfeeding

The use of any medications or dietary supplements during pregnancy requires consultation with the attending physician. If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking Dicortineff.

Dicortineff is not recommended for use in pregnant women. Conversely, the decision whether to discontinue breast-feeding or to discontinue treatment with Dicortineff taking into account the benefit of breast-feeding for the child and the benefit of use of the product for a nursing woman should be made with the physician.

What is worth knowing about proper supplementation during pregnancy? Check: Conscious choices. Diet and supplementation in pregnancy

Dicortineff — cena

The price of the drug Dicortineff may differ depending on the city in which the preparation will be purchased or the pharmacy chosen by the patient. You should pay about PLN 20-25 for a package of Dicortineff.

What are the most common eye infections? Check: The four most common eye infections that cannot be underestimated