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L. M. Amico, F. A. Bucci, Jr., L. D. Waterbury; Aqueous Penetration of Ketorolac 0.4% Compared With Bromfenac 0.09% in Cataract Patients: Peak and Trough Drug Concentrations. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3929.
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To compare the aqueous penetration of ketorolac tromethamine 0.4% (Acular LS) and bromfenac 0.09% (Xibrom) at peak and trough time points in patients scheduled for phacoemulsification.
Sixty two phacoemulsification patients were randomized to receive ketorolac 0.4% (n=30) or bromfenac 0.09% (n=32). On label dosing of ketorolac 0.4% QID and bromfenac 0.09% BID was given 3 days prior to surgery. On the day of surgery each patient received 4 additional doses 90 minutes prior to surgery. Thirty two additional patients were randomized and analyzed (ketorolac 0.4%, n=16/bromfenac 0.09%, n=16) for on label trough drug levels. Aqueous samples were collected on label 12 hours after a single dose of bromfenac and 6 hours after a single dose of ketorolac. Trough patients received no pulse dosing prior to surgery. Following collection of 0.15cc of aqueous trough with a 30 gage needle through peripheral clear cornea, samples were stored at T-60°C prior to analysis. Drug concentrations were analyzed by liquid chromatography tandem mass spectrometry using positive turbo-ionspray ionization and multiple reaction monitoring mode for quantification.
Aqueous concentrations were significantly higher for ketorolac than bromfenac at both the peak and trough drug effect. At peak, mean concentrations were 772.5 ± 537.0 ng/mL for ketorolac and 39.5 ± 32.4 ng/mL for bromfenac (P<.001). At trough, mean concentrations were 130.5 ± 159.4 ng/mL for ketorolac and 6.2 ± 3.1 ng/mL for bromfenac (P=.004).
In cataract patients just prior to phacoemulsification, ketorolac achieved significantly greater concentrations in the aqueous than did bromfenac at both peak and trough.
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