Dexycu Drug Information
Generic name: DEXAMETHASONE
Corticosteroid [EPC]
Uses of Dexycu
(dexamethasone intraocular suspension) 9% is indicated for the treatment of postoperative inflammation. DEXYCU is a corticosteroid indicated for the treatment of postoperative inflammation.
Dosage & Administration of Dexycu
Step 1. Prepare a sterile field. Remove the components of the administration kit from their respective pouches:
| | Step 2. Withdraw the syringe plunger approximately 1 inch. Place the syringe ring on the plunger (slit facing the plunger). Apply slight downward pressure until the syringe ring "snaps" into place. | Step 3. Place the 18-gauge needle firmly on the syringe. Remove the cap from the needle. Depress the plunger completely and then withdraw the plunger to fill the syringe with air. | Step 4. | Step 5. Remove the blue plastic flip-cap from the vial and wipe the top of rubber stopper with an alcohol pad. Invert the vial. | Step 6. Insert the needle into the vial and inject the air into the vial. Making sure the needle tip is immersed in the drug material pooled in the neck of the inverted vial, fill the syringe by slowly withdrawing the plunger approximately 0.2 mL. Remove the needle from the vial and discard the unused portion in the vial. | Step 7. Remove the needle from the syringe. Firmly place the cannula on the syringe and remove the plastic cap. Hold the syringe vertically with the cannula pointing up. Depress the plunger to expel air bubbles from syringe. | Step 8. Affix the syringe guide over the syringe ring on the plunger. | Step 9. Depress the plunger until the syringe guide/ring mechanism comes gently into contact with the flange of the syringe. Lightly tap/flick the barrel of the syringe to remove any excess drug from the tip of the cannula. Do not wipe or touch the tip of the cannula to remove excess drug. | Step 10. Remove the syringe guide, leaving the syringe ring in place. | Step 11. In a single slow motion, inject 0.005 mL of the drug material behind the iris in the inferior portion of the posterior chamber. If the sphere of administered drug after intraocular injection appears to be larger than 2 mm in diameter, excess drug material may be removed by irrigation and aspiration in the sterile surgical setting PLEASE NOTE: Some drug material will remain in the syringe after the injection—this is necessary for accurate dosing. Discard unused portion remaining in the syringe after administration. | |
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Side Effects of Dexycu
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The following adverse events rates are derived from three clinical trials in which 339 patients received the 517 microgram dose of DEXYCU. The most commonly reported adverse reactions occurred in 5-15% of subjects and included increases in intraocular pressure, corneal edema and iritis. Other ocular adverse reactions occurring in 1-5% of subjects included, corneal endothelial cell loss, blepharitis, eye pain, cystoid macular edema, dry eye, ocular inflammation, posterior capsule opacification, blurred vision, reduced visual acuity, vitreous floaters, foreign body sensation, photophobia, and vitreous detachment.
Warnings & Cautions for Dexycu
Increase in Intraocular Pressure Prolonged use of corticosteroids including
DEXYCU may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Steroids should be used with caution in the presence of glaucoma.
Delayed Healing
The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation. In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of corticosteroids.
Exacerbation of Infection
The use of DEXYCU, as with other ophthalmic corticosteroids, is not recommended in the presence of most active viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal disease of ocular structures. Employment of a corticosteroid medication in the treatment of patients with a history of herpes simplex requires caution. Use of ocular steroids may prolong the course and may exacerbate the severity of many viral infections of the eye (including herpes simplex). Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application.
Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. Fungal culture should be taken when appropriate. Prolonged use of corticosteroids may suppress the host response and thus increase the hazard of secondary ocular infections.
In acute purulent conditions, steroids may mask infection or enhance existing infection.
Cataract Progression
The use of corticosteroids in phakic individuals may promote the development of posterior subcapsular cataracts.
Pregnancy Safety for Dexycu
Pregnancy Risk Summary There are no adequate and well-controlled studies of DEXYCU (dexamethasone intraocular suspension) 9% in pregnant women. Topical ocular administration of dexamethasone in mice and rabbits during the period of organogenesis produced cleft palate and embryofetal death in mice and malformations of abdominal wall/intestines and kidneys in rabbits at doses 7 and 5 times higher than the injected recommended human ophthalmic dose (RHOD) of DEXYCU (517 micrograms dexamethasone), respectively . In the US general population the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Data Animal Data Topical ocular administration of 0.15% dexamethasone (0.75 mg/kg/day) on gestational days 10 to 13 produced embryofetal lethality and a high incidence of cleft palate in mice.
A dose of 0.75 mg/kg/day in the mouse is approximately 7-times the injected RHOD of DEXYCU, on a mg/m 2 basis. In rabbits, topical ocular administration of 0.1% dexamethasone throughout organogenesis (0.20 mg/kg/day on gestational day 6, followed by 0.13 mg/kg/day on gestational days 7 – 18) produced intestinal anomalies, intestinal aplasia, gastroschisis and hypoplastic kidneys. A dose of 0.13 mg/kg/day in the rabbit is approximately 5-times the injected RHOD of DEXYCU, on a mg/m 2 basis.
A no-observed-adverse-effect-level (NOAEL) was not identified in the mouse or rabbit studies.
Pediatric Use of Dexycu
Pediatric Use Safety and effectiveness of DEXYCU in pediatric patients have not been established.
Clinical Studies of Dexycu
Clinical efficacy was evaluated in a randomized, double-masked, placebo-controlled trial (NCT02006888) in which subjects received either DEXYCU or placebo (vehicle). A dose of 5 microliters of DEXYCU (equivalent to 517 micrograms of dexamethasone), a dose equivalent to 342 micrograms of dexamethasone or vehicle was administered by the physician at the end of the surgical procedure. The primary efficacy endpoint for the study was the proportion of patients with anterior chamber cell clearing (i.e., cell score=0) on postoperative day (POD) 8. The presence of anterior cells was assessed using a slit lamp binocular microscope up to 30 days post treatment. The percentage of patients with anterior chamber clearing at Day 8 was 20% in the placebo group, and 57%, and 60% in the 342 and 517 microgram treatment groups, respectively (Table 1). The percentage of subjects receiving rescue medication of ocular steroid or NSAID was significantly lower at Day 3, 8, 15 and 30 in the 342 and 517 microgram treatment groups compared to placebo (Table 2). Table 1: Proportion of subjects with clearing of the anterior chamber cells by visit Treatments Difference and 97.5% CI Visits Placebo N=80 DEX342 N=158 DEX517 N=156 DEX342 vs Placebo DEX517 vs Placebo Subjects who received rescue medication were treated as failure.
Day 1 7 (9%) 17 (11%) 24 (15%) 2% (-7%, 11%) 7% (-3%, 16%) Day 3 13 (16%) 60 (38%) 44 (28%) 22% (9%, 34%) 12% (0%, 24%) Day 8 16 (20%) 90 (57%) 94 (60%) 37% (24%, 50%) 40% (27%, 54%) Day 15 21 (26%) 83 (52%) 91 (58%) 26% (12%, 40%) 32% (18%, 46%) Day 30 28 (35%) 113 (72%) 103 (66%) 36% (22%, 51%) 31% (16%, 46%) Table 2: Proportion of subjects receiving rescue medications Visits Number (Percent) of Patients Receiving Rescue Medication, and 95% CI Placebo N=80 DEX342 N=158 DEX517 N=156 Subjects who received an ocular corticosteroid or NSAID in study eye. Day 1 10 (13%); 6%, 22% 9 (6%); 3%, 10% 10 (6%); 3%, 12% Day 3 30 (38%); 27%, 49% 9 (6%); 3%, 10% 16 (10%); 6%,16% Day 8 40 (50%); 39%, 61% 12 (8%); 4%, 13% 16 (10%); 6%,16% Day 15 43 (54%); 42%, 65% 22 (14%); 9%, 20% 26 (17%); 11%, 24% Day 30 43 (54%); 42%, 65% 25 (16%); 10%, 22% 31 (20%); 14%, 27%
Drug information sourced from the FDA. This content is for informational purposes only and does not constitute medical advice. Consult a healthcare professional before making any medication decisions.
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