PRED FORTE®

(prednisolone acetate ophthalmic suspension, USP) 1%

sterile

DESCRIPTION

PRED FORTE® (prednisolone acetate ophthalmic suspension, USP) 1% is a sterile, topical anti-
inflammatory agent for ophthalmic use. Its chemical name is 11ß,17, 21-Trihydroxypregna-1,4-
diene-3, 20-dione 21-acetate and it has the following structure:

prednisolone acetate

Each mL of PRED FORTE® contains:

Active: prednisolone acetate (microfine suspension) 1%
Inactives: benzalkonium chloride as preservative; boric acid; edetate disodium; hypromellose;
polysorbate 80; purified water; sodium bisulfite; sodium chloride; and sodium citrate.
The pH during its shelf life ranges from 5.0 - 6.0.

CLINICAL PHARMACOLOGY

Prednisolone acetate is a glucocorticoid that, on the basis of weight, has 3 to 5 times the anti-
inflammatory potency of hydrocortisone. Glucocorticoids inhibit the edema, fibrin deposition,
capillary dilation, and phagocytic migration of the acute inflammatory response, as well as
capillary proliferation, deposition of collagen, and scar formation.

INDICATIONS AND USAGE

PRED FORTE® is indicated for the treatment of steroid-responsive inflammation of the

palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe.

CONTRAINDICATIONS

PRED FORTE® suspension is contraindicated in acute untreated purulent ocular infections, in

most 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 diseases of ocular structures.

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 PRED FORTE® suspension is also contraindicated in individuals with known or suspected
hypersensitivity to any of the ingredients of this preparation and to other corticosteroids.

WARNINGS

Prolonged use of corticosteroids may result in posterior subcapsular cataract formation and may
increase intraocular pressure in susceptible individuals, resulting in glaucoma with damage to the
optic nerve, defects in visual acuity and fields of vision. Prolonged use may also suppress the
host immune response and thus increase the hazard of secondary ocular infections.

If this product is used for 10 days or longer, intraocular pressure should be routinely monitored
even though it may be difficult in children and uncooperative patients. Steroids should be used
with caution in the presence of glaucoma. Intraocular pressure should be checked frequently.

Various ocular diseases and long-term use of topical corticosteroids have been known to cause
corneal and scleral thinning. Use of topical corticosteroids in the presence of thin corneal or
scleral tissue may lead to perforation.

Acute purulent infections of the eye may be masked or activity enhanced by the presence of
corticosteroid medication.

The use of steroids after cataract surgery may delay healing and increase the incidence of bleb
formation.

Use of ocular steroids may prolong the course and may exacerbate the severity of many viral
infections of the eye (including herpes simplex). Employment of a corticosteroid medication in
the treatment of patients with a history of herpes simplex requires great caution; frequent slit
lamp microscopy is recommended.

PRED FORTE® suspension contains sodium bisulfite, a sulfite that may cause allergic-type
reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic
episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general
population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic
than in non-asthmatic people.

PRECAUTIONS

General
The initial prescription and renewal of the medication order beyond 20 milliliters of PRED
FORTE® suspension should be made by a physician only after examination of the patient with
the aid of magnification, such as slit lamp biomicroscopy, and, where appropriate, fluorescein
staining. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.

As fungal infections of the cornea are particularly prone to develop coincidentally with long-
term local corticosteroid applications, fungal invasion should be suspected in any persistent
corneal ulceration where a corticosteroid has been used or is in use. Fungal cultures should be
taken when appropriate.

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 Information for Patients
Advise patients that if eye inflammation or pain persists longer than 48 hours or becomes
aggravated, they should consult a physician.

Advise patients that to prevent eye injury or contamination, care should be taken to avoid
touching the bottle tip to eyelids or to any other surface. The use of this bottle by more than one
person may spread infection. Keep bottle tightly closed when not in use. Keep out of the reach of
children.

Advise patients that PRED FORTE® suspension contains benzalkonium chloride, which may be
absorbed by soft contact lenses. Contact lenses should be removed prior to application of PRED
FORTE® and may be reinserted 15 minutes following its administration.

Carcinogenesis, Mutagenesis, Impairment of Fertility

No studies have been conducted in animals or in humans to evaluate the potential of these
effects.

Pregnancy
Prednisolone has been shown to be teratogenic in mice when given in doses 1-10 times the
human dose. Dexamethasone, hydrocortisone, and prednisolone were ocularly applied to both
eyes of pregnant mice five times per day on days 10 through 13 of gestation. A significant
increase in the incidence of cleft palate was observed in the fetuses of the treated mice. There are
no adequate well-controlled studies in pregnant women. Prednisolone should be used during
pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers
It is not known whether topical ophthalmic administration of corticosteroids could result in
sufficient systemic absorption to produce detectable quantities in breast milk. Systemically
administered corticosteroids appear in human milk and could suppress growth, interfere with
endogenous corticosteroid production, or cause other untoward effects. Because of the potential
for serious adverse reactions in nursing infants from prednisolone, a decision should be made
whether to discontinue nursing or to discontinue the drug, taking into account the importance of
the drug to the mother.

Pediatric Use
The safety and effectiveness in pediatric patients have been established. Use in pediatric patients
is supported by evidence from adequate and well-controlled studies of prednisolone acetate
ophthalmic suspension in adults with additional data in pediatric patients.

Geriatric Use
No overall differences in safety or effectiveness have been observed between elderly and
younger patients.

ADVERSE REACTIONS
The following adverse reactions have been identified during use of PRED FORTE®. Because
reactions are reported voluntarily from a population of uncertain size, it is not always possible to

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 reliably
estimate their frequency or establish a causal relationship to drug exposure.

Adverse reactions include elevation of intraocular pressure (IOP) with possible development of
glaucoma and infrequent optic nerve damage, posterior subcapsular cataract formation, and
delayed wound healing.

The development of secondary ocular infection (bacterial, fungal, and viral) has occurred. Fungal
and viral infections of the cornea are particularly prone to develop coincidentally with long-term
applications of steroids. The possibility of fungal invasion should be considered in any persistent
corneal ulceration where steroid treatment has been used (see PRECAUTIONS).

Other adverse reactions reported with the use of prednisolone acetate ophthalmic suspension
include: allergic reactions; dysgeusia; foreign body sensation; headache; pruritus; rash; transient
burning and stinging upon instillation and other minor symptoms of ocular irritation; urticaria;
and visual disturbance (blurry vision).

Keratitis, conjunctivitis, corneal ulcers, mydriasis, conjunctival hyperemia, loss of

accommodation and ptosis have occasionally been reported following local use of
corticosteroids. Corticosteroid-containing preparations have also been reported to cause acute
anterior uveitis and perforation of the globe.

OVERDOSAGE

Overdosage will not ordinarily cause acute problems. If accidentally ingested, drink fluids to
dilute.

DOSAGE AND ADMINISTRATION

Shake well before using. Instill one to two drops into the conjunctival sac two to four times
daily. During the initial 24 to 48 hours, the dosing frequency may be increased if necessary. Care
should be taken not to discontinue therapy prematurely.

If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated (see
PRECAUTIONS).

HOW SUPPLIED

PRED FORTE® (prednisolone acetate ophthalmic suspension, USP) 1% is supplied sterile in

opaque white LDPE plastic bottles with droppers with white high impact polystyrene (HIPS)
caps as follows:

1 mL in 5 mL bottle - NDC 11980-180-01

5 mL in 10 mL bottle - NDC 11980-180-05
10 mL in 15 mL bottle - NDC 11980-180-10
15 mL in 15 mL bottle - NDC 11980-180-15

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 Storage: Store at up to 25°C (77°F). Protect from freezing. Store in an upright position.

Revised: MM/YYYY

© 2017 Allergan. All rights reserved.

Irvine, CA 92612, U.S.A.
All trademarks are the property of their respective owners.
Made in the U.S.A.

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