CHCs containing EE may inhibit the metabolism of other compounds (., cyclosporine, prednisolone, theophylline, tizanidine, and voriconazole) and increase their plasma concentrations. CHCs have been shown to decrease plasma concentrations of acetaminophen, clofibric acid, morphine, salicylic acid, and temazepam. Significant decrease in plasma concentration of lamotrigine has been shown, likely due to induction of lamotrigine glucuronidation. This may reduce seizure control; therefore, dosage adjustments of lamotrigine may be necessary.
Although evidence for the use of topical antibiotics in an uncomplicated corneal abrasion is lacking, they are usually prescribed with the rationale of preventing superinfection. 4 , 16 , 17 Topical antibiotics are indicated for corneal abrasions caused by contact lens use, foreign bodies, or a history of trauma with infectious or vegetative matter, because there is a higher risk of secondary bacterial keratitis in these cases. 18 For uncomplicated abrasions, options include erythromycin % ophthalmic ointment, polymyxin B/trimethoprim (Polytrim) ophthalmic solution, and sulfacetamide 10% ophthalmic ointment or solution ( Table 2 ) . Topical antibiotics are generally dosed four times a day and continued until the patient is asymptomatic for 24 hours. Ointments are thought to provide better lubrication than solutions, resulting in increased comfort and healing. Preparations containing neomycin should be avoided because of the frequency of contact hypersensitivity. Combination preparations with a topical steroid are contraindicated because topical steroids increase susceptibility to infection and may delay healing. 19
Given how NSAIDs and steroids work in the body, a combination of anti-inflammatory doses of NSAIDs and corticosteroids is almost always contraindicated and should generally be avoided. This nasty mix can induce gastrointestinal bleeding and/or alter oxygen delivery to the uniquely important organs like the liver and/or kidneys. There are several alternatives for pain management in patients, and consultation with a board-certified veterinary surgeon, sports medicine and rehabilitation specialist, and/or critical care specialist may be invaluable to help ensure pets receive the best possible healthcare.