Maxitrol

Package leaflet: Information for the patient

Warning! Keep this leaflet, information on the immediate packaging is in a foreign language.
Maxitrol (Maxidrol), (1 mg + 3500 i.u. + 6000 i.u.)/g, ointment for the eyes
Dexamethasonum + Neomycini sulfas + Polymyxini B sulfas
Maxitrol and Maxidrol are different trade names for the same medicinal product.
Please read the following information carefully before using this medicine, as it contains
important information for the patient.

• Keep this leaflet for future reference.
• If you have any questions, consult your doctor, pharmacist, or nurse.
• This medicine has been prescribed for a specific individual. Do not pass it on to others. It may harm someone else, even if their symptoms are the same.
• If you experience any adverse reactions, including any not listed in this leaflet, inform your doctor, pharmacist, or nurse. See section 4.

Table of contents:

1. What Maxitrol is and what it is used for
2. Important information before using Maxitrol
3. How to use Maxitrol
4. Possible side effects
5. How to store Maxitrol
6. Contents of the pack and other information

1. What Maxitrol is and what it is used for

Maxitrol is used to treat inflammatory eye diseases that may be associated with infection.
Eye inflammation may be caused by infection, other penetrating agents, or eye injury.
Maxitrol is a combination medicine containing antibacterial agents and a corticosteroid.
Corticosteroids (in this case, dexamethasone) are used to prevent and reduce eye inflammation. The antibacterial agents in this medicine (in this case, neomycin sulfate and polymyxin B sulfate) are active against most pathogenic bacteria causing eye infections.

2. Important information before using Maxitrol

When not to use Maxitrol:

• if the patient is allergic to neomycin sulfate, polymyxin B sulfate, dexamethasone, or to any of the other ingredients of this medicine (listed in section 6),
• if the patient has
• herpes simplex keratitis, vaccinia, varicella (chickenpox), or any other viral eye infection
• fungal eye infection
• untreated parasitic eye infections
• tuberculous eye infection
• untreated purulent eye infections

Warnings and precautions:
For ocular use only

• Some patients may develop hypersensitivity to topically applied aminoglycoside antibiotics such as neomycin. If symptoms of hypersensitivity occur, discontinue use of the medicine and contact a doctor immediately (see section 4). Hypersensitivity reactions may manifest as local itching or redness of the skin, severe allergic reactions (anaphylactic reactions), or severe skin reactions. Such skin reactions may also occur during treatment with other topical or systemic antibiotics from the same class (aminoglycosides).
• In addition, topical use of neomycin may cause redness, irritation, and a sensation of skin discomfort.
• Patients who have experienced hypersensitivity reactions to topical neomycin may also be hypersensitive to other antibiotics.
• If the patient is using other antibiotics during treatment with Maxitrol, medical advice should be sought, as concomitant use of Maxitrol with other antibiotics may lead to serious adverse effects.
• In patients using corticosteroids in the eye for prolonged periods, the following may occur:  increased intraocular pressure. Intraocular pressure should be monitored regularly during treatment with this medicine. This is particularly important in paediatric patients, as corticosteroid-induced elevation in intraocular pressure may be greater and occur earlier in children than in adults. Consult a doctor, especially in the case of children. The risk of elevated intraocular pressure and/or cataract is also higher in predisposed patients (e.g. diabetic patients).  development of drug-induced Cushing's syndrome due to systemic absorption of the medicine. Seek medical advice if the patient develops swelling and weight gain, particularly noticeable in the trunk and face, as these are usually the first signs of a condition called Cushing's syndrome. Adrenal suppression may occur following discontinuation of prolonged or intensive treatment with Maxitrol. Consult a doctor before deciding to stop treatment. This risk is particularly significant in children and in patients treated with ritonavir or cobicistat.
• If signs of eye infection appear or worsen, contact a doctor immediately. Patients using Maxitrol may have reduced resistance to eye infections, including antibiotic-resistant bacterial and fungal infections.
• In patients using corticosteroids and non-steroidal anti-inflammatory drugs simultaneously, impaired healing of ocular surface damage may occur.
• If the patient has diseases leading to thinning of the cornea or sclera, they should inform the doctor.
• Wearing contact lenses is not recommended during treatment of eye inflammation or infection.

If the patient experiences blurred vision or other visual disturbances, they should contact a
doctor.
If the patient has glaucoma, treatment duration should be limited to two weeks unless otherwise
advised by a doctor.
The medicine should be used for as long as directed by the doctor. If symptoms worsen or do not
improve, consult a doctor.
Children
The safety and efficacy of Maxitrol in children have not been established; therefore, use in this age group is not recommended.
Maxitrol and other medicines
Tell your doctor or pharmacist about all medicines the patient is currently using or has recently used, as well as any medicines the patient plans to use, including those available without a prescription.
Particularly inform the doctor if the patient is taking:
topically acting non-steroidal anti-inflammatory drugs. Concurrent topical use of a steroid medicine and a non-steroidal anti-inflammatory drug may lead to impaired healing of eye injuries;
ritonavir or cobicistat, as they may increase blood levels of dexamethasone.
If the patient is using other eye drops or ointments simultaneously, at least 5 minutes should be left between the administration of each medicine. Ophthalmic ointments should be applied last.
Pregnancy, breastfeeding, and fertility
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or is planning to become pregnant, she should consult a doctor or pharmacist before using this medicine.
This medicine is not recommended during pregnancy or breastfeeding.
Driving and using machines
Maxitrol has no or negligible effect on the ability to drive and operate machinery.
Vision may be blurred for a short time after instillation of Maxitrol. Do not drive or operate machinery until this symptom has resolved.
Maxitrol contains methyl parahydroxybenzoate (E 218) and propyl parahydroxybenzoate (E 216),
which may cause allergic reactions (including delayed-type reactions).
The medicine contains lanolin, which may cause local skin reactions (e.g. contact dermatitis).

3. How to use Maxitrol

Maxitrol should always be used exactly as directed by the doctor. If in doubt, consult a doctor or pharmacist.
Maxitrol is intended exclusively for ophthalmic use; each package of the medicine should be used by only one patient.
If the patient is using other eye drops or ointments at the same time, at least a 5-minute interval should be maintained between the administration of each medication. Ophthalmic ointments should be applied last.

Recommended dosage
Typically, a small amount of ointment (a strip approximately 1.5 cm long) should be instilled into the conjunctival sac of the affected eye(s) 3 or 4 times daily. The duration of treatment will be determined by the doctor. Do not discontinue treatment prematurely.

1 2

1. Prepare the Maxitrol tube and a mirror.
2. Wash your hands.
3. Unscrew the cap from the tube.
4. Hold the tube in your hand, gripping it between your thumb and index finger.
5. Tilt your head backward. Gently pull down the lower eyelid with a clean finger to form a "pocket" between the eyelid and the eyeball. The ointment strip should be placed into this pocket (Figure 1).
6. Bring the tip of the tube close to the eye; a mirror may be used to assist.
7. Do not let the tip of the tube touch the eye, eyelids, surrounding areas, or any other surfaces. Failure to follow this instruction may result in contamination of the ointment.
8. Gently squeeze the tube to extrude a strip of ointment (Figure 2).
9. After applying Maxitrol, release the lower eyelid and blink several times to help spread the ointment over the entire surface of the eye. Gently close the eyelids for a few seconds; this helps reduce systemic absorption of the drug.
10. If treatment of both eyes is necessary, repeat the above steps for the second eye.
11. Immediately after use, recap the tube tightly.
12. Only one tube of the medicine should be used at any one time.

If the ointment is accidentally expressed outside the eye, repeat the procedure to correctly apply the ointment into the eye.

Use of more than the recommended dose of Maxitrol
In case of overdose, excess ointment can be rinsed from the eye with lukewarm water. Do not use the ointment again until the next scheduled dose.

Missed dose
If a dose is missed, take the next scheduled dose as planned. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not use a double dose to make up for a missed dose.

If you have any further questions about the use of this medicine, consult your doctor or pharmacist.

4. Possible adverse reactions

Like all medicines, this medicine can cause adverse reactions, although not everyone experiences them.
If the patient develops allergic reactions, including rash, swelling of the face, lips, tongue
and (or) throat, which may cause difficulty breathing or swallowing, or other
severe adverse reactions occur, treatment with Maxitrol should be discontinued and immediate
contact should be made with a doctor or the nearest hospital Emergency Department.
The following adverse reactions have been observed during treatment with Maxitrol:
Not common ( may occur in less than 1 out of 100 patients ): corneal inflammation,
increased intraocular pressure, eye itching, sensation of eye discomfort, eye irritation.
Frequency unknown ( frequency cannot be determined from available data ):
hypersensitivity, headache, ulcerative keratitis, blurred vision, photophobia, pupil dilation,
eyelid drooping, eye pain, eye swelling, sensation of a foreign body in the eye, eye hyperemia,
excessive tearing, severe skin reactions (Stevens-Johnson syndrome), blurred vision, excessive
body hair growth (especially in women), muscle weakness and loss of muscle mass, purple skin striae,
increased blood pressure, irregular menstruation or absence of menstruation, changes in protein and calcium levels in the body, growth suppression in children and adolescents, and swelling and weight gain, particularly noticeable on the trunk and face (a condition known as Cushing's syndrome) (see section 2 "Warnings and precautions").
Reporting of adverse reactions
If any adverse reactions occur, including any not listed in this leaflet, inform your doctor, pharmacist, or nurse. Adverse reactions can be reported directly to the Department for Monitoring of Adverse Drug Reactions
of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products
Al. Jerozolimskie 181C,
02-222 Warsaw,
Phone: +48 22 4921301
Fax: +48 22 4921309
Website: https://smz.ezdrowie.gov.pl
Adverse reactions can also be reported to the marketing authorization holder or parallel importer.
Reporting adverse reactions helps provide more information on the safety of this medicine.
If any of the symptoms worsen or if any other adverse reactions not listed in this leaflet occur, inform your doctor.

5. How to store Maxitrol medicine

To avoid contamination, discard the tube with any remaining medicine 15 days after first opening the tube.
Please record the date of first opening below.
Date of first opening:
Keep the medicine out of the sight and reach of children.
Do not store above 30°C.
Do not use this medicine after the expiry date stated on the packaging after: EXP.
The expiry date refers to the last day of the stated month.
Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Contents of the pack and other information

What Maxitrol contains
The active substances are:
Dexamethasone 1 mg/g
Neomycin sulfate 3500 I.U./g
Polymyxin B sulfate 6000 I.U./g
The other components are:
Methyl parahydroxybenzoate (E 218), propyl parahydroxybenzoate (E 216), lanolin, white
petrolatum.

What the medicine looks like and contents of the pack
Maxitrol is a greasy, semi-transparent or opaque, white or slightly yellowish, homogeneous,
lump-free ointment.
It is available in an internally epoxy lacquered aluminium tube with an applicator made of HDPE or a HDPE/LDPE mixture and an HDPE cap, packed in a cardboard box containing 3.5 g of ointment.

Marketing Authorisation Holder in France, the country of export:
Novartis Pharma S.A.S.
8-10, rue Henri Sainte-Claire Deville
92500 Rueil-Malmaison
France

Manufacturer:
Novartis Pharma GmbH
Roonstrasse 25
90429 Nuremberg
Germany

Parallel Importer:
Polypharm S.A.
ul. Barska 33
02-315 Warsaw
Poland

Repackaged by:
CEFEA Sp. z o.o. Sp. komandytowa
ul. Działkowa 56
02-234 Warsaw
Poland

Marketing Authorisation Number in France, the country of export: 319 835-6 34009 319 835 6 9
Parallel Import Authorisation Number: 284/24