CAF

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CAF

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Medically reviewed

Rosario Oropesa

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of CAF

CAF is a combination pharmaceutical preparation classified broadly as an ophthalmic anti-infective and tissue-supportive agent, formulated for topical application to the eye. This medication is characterized by its synergistic action, pairing an established active anti-infective agent with an essential micronutrient to promote ocular health. As an ophthalmic preparation, CAF is manufactured in sterile dosage forms, such as eye drops or an eye ointment, strictly designed for safe administration to the sensitive ocular surface.


Property Description
Active Ingredients Chloramphenicol, Vitamin A (Retinol)
Form Ophthalmic Preparation (drops, ointment)
Pharmacological Class Broad-spectrum antibiotic, Essential fat-soluble vitamin
Origin Synthetic (Chloramphenicol), Micronutrient (Vitamin A)
General Purpose Bacterial control and epithelial support

What Type of Medicine is CAF?

CAF is categorized as a combination drug that unites a potent, synthetic broad-spectrum antibiotic with an essential fat-soluble vitamin. The antibiotic component, Chloramphenicol, belongs to the amphenicol class and functions primarily as a bacteriostatic agent, inhibiting bacterial protein synthesis. This antibiotic is used to stop the growth of certain types of bacteria. This antibacterial action is utilized for superficial bacterial involvement of the external eye, distinguishing it from systemic antibiotics. Conversely, the Vitamin A (Retinol) component is an essential micronutrient vital for epithelial differentiation and maintenance, supporting the normal structure of the cornea and conjunctiva.


What is the Composition of CAF?

The two primary active ingredients are Chloramphenicol and Vitamin A (Retinol), delivered in a sterile vehicle designed for optimal ocular contact. Chloramphenicol serves as the antibacterial component, characterized by its high lipid solubility which aids penetration into ocular tissues. Vitamin A acts as the trophic and protective component, supporting the integrity of the ocular epithelial layer. Retinoids, the class of compounds Vitamin A belongs to, are necessary for maintaining the healthy structure of cells, such as those lining the eye. The preparation utilizes a suitable base, such as an oil-based medium or an aqueous solution, specifically formulated to ensure both stability and comfort when applied directly to the eye.


What is the General Purpose of Combining the Ingredients?

The general purpose of the CAF combination is to provide a dual benefit that controls the presence of susceptible bacteria while simultaneously enhancing the physiological resilience of the eye's tissues. This formulation ensures that microbial proliferation on the eye's surface is addressed by the Chloramphenicol, while the Vitamin A component supports the necessary cellular integrity and regenerative capacity of the ocular surface. This combination is typically used in scenarios where localized bacterial presence is suspected alongside a need for enhanced corneal support. The combination is therefore intended to deliver a robust initial response to potential bacterial involvement by concurrently supporting the overall health of the eye structure.

Regulatory References

  1. MedlinePlus: Chloramphenicol
  2. MedlinePlus

What side effects are possible with CAF?

Possible Side Effects and Safety Information

The official safety profile for CAF, a combination ophthalmic preparation containing Chloramphenicol and Vitamin A (Retinol), is structured around local ocular effects and specific systemic risks associated with the antibiotic component, as documented in government regulatory sources.


Frequency-Classified Adverse Reactions

The majority of documented reactions are confined to the application site, reflecting the product’s local route of administration.

  • Common (typically ge 1/100): Local ocular irritation, which may include a burning sensation, stinging, itching, or transient visual blurring immediately following application.
  • Uncommon (typically ge 1/1,000 to <1/100): Localised hypersensitivity reactions such as swelling of the eyelids (angioedema) or increased redness (conjunctival hyperemia).
  • Rare (typically ge 1/10,000 to <1/1,000): Serious systemic reactions, including blood disorders.

Serious Adverse Reactions and Safety Constraints

The most critical risk is related to the Chloramphenicol component, irrespective of the topical route.

Category Detail (Regulatory Terminology)
Serious Adverse Reaction Aplastic Anemia, a rare, idiosyncratic, and potentially irreversible suppression of bone marrow function, documented as a systemic risk.
Contraindications The medicine is strictly restricted from use in individuals with a known history of bone marrow depression, pre-existing blood dyscrasias, or known hypersensitivity to the active ingredients or excipients.
Population Note Neonates and Infants require specific caution, as the potential for systemic absorption of Chloramphenicol may be increased in this population.

Local irritative effects may be more pronounced at the beginning of treatment. The risk of serious hematological adverse effects may be associated with repeated or prolonged courses of treatment.

Overdose and Emergency Response

Overdose and when to seek help

Overdose with this combination ophthalmic preparation primarily focuses on the risks associated with accidental systemic ingestion, as excessive topical use typically results in localized ocular irritation, such as increased redness and lacrimation. The official regulatory profile emphasizes that systemic exposure to Chloramphenicol can lead to severe and life-threatening outcomes. Documented manifestations of systemic overdose include gastrointestinal symptoms like nausea and vomiting, central nervous system effects such as headache and drowsiness, and signs of cardiovascular collapse.

The most serious potential consequences of overdose involve the hematological system. Regulatory information specifically notes the risk of severe dose-related bone marrow depression and the rare, idiosyncratic risk of aplastic anemia. Accidental ingestion by infants and neonates carries a unique and severe risk of Gray Baby Syndrome. Due to these severe risks, regulatory authorities mandate that users seek immediate medical attention for any suspected systemic overdose.

Management is generally described as symptomatic and supportive treatment, as no specific antidote is known. Monitoring of hematological parameters is required to assess for potential bone marrow toxicity.

Therapeutic Uses of CAF

Easing Acute Symptomatic Discomfort and Supporting Stability

This therapeutic domain is relevant in contexts marked by increased discomfort or tension, focusing on symptoms related to heightened physiological activity. This type of medication generally provides short-term symptomatic assistance to help patients cope more steadily during difficult, overwhelming episodes. CAF is commonly used across conditions involving episodic or fluctuating manifestations, such as those associated with systemic imbalance or localized discomfort, where multiple symptoms occur together.

The medicine may assist with easing distress and contributes to easing the overall symptom load. It is also relevant for easing symptoms that interfere with routine activities and may help improve day-to-day comfort during symptomatic periods. This medicine may assist patients during difficult episodes, supporting general well-being during symptomatic phases and assisting with maintaining functional stability.

CAF is considered relevant for managing symptoms that interfere with daily comfort and is applicable within clinical settings that involve acute or disruptive symptom patterns.


Quick Fact: Target for Symptoms Related to Heightened Physiological Activity

Regulatory References

  1. NIH MedlinePlus overview of Diphenhydramine

Eligibility and Restrictions for Use

Eligibility and Restrictions for CAF

The eligibility for using CAF (Chloramphenicol / Vitamin A Ophthalmic) is strictly defined by regulatory bodies based on documented restrictions, primarily associated with the Chloramphenicol component. This profile outlines which populations are permitted, restricted, or absolutely prohibited from use.

Absolute Non-Eligibility (Contraindications)

Use of CAF is strictly contraindicated and must not occur in several patient populations. This prohibition includes individuals with a known hypersensitivity (allergy) to Chloramphenicol or any component of the ophthalmic product. It is also contraindicated for anyone with a personal or family history of blood dyscrasias, such as Aplastic Anaemia. Patients who have previously experienced myelosuppression (bone marrow depression) following Chloramphenicol exposure are likewise prohibited from use.

Conditional and Age-Related Use

Population Group Eligibility Status (Regulatory Wording)
Adults and Children ge 2 years Permitted for use.
Children under 2 years Not recommended without medical advice.
Pregnancy and Lactation Not recommended (Regulatory precaution).
Contact Lens Wearers Prohibited from wearing lenses during treatment.

These guidelines adhere to regulatory standards defining populations who are subject to eligibility constraints.

What should I know about interactions with other medicines?

Interactions with other medicines and products

The official interaction profile for this combination ophthalmic product is defined by restrictions based on pharmacodynamic risk and administration logistics. All documented constraints relate primarily to the potential for systemic exposure to the Chloramphenicol component.

Pharmacodynamic Restriction

Co-administration with medicinal products liable to depress bone marrow function must be avoided. This is due to an officially documented pharmacodynamic interaction that results in an additive risk of severe hematological disorders, including bone marrow hypoplasia and aplastic anaemia. This restriction applies even though the medicine is administered topically, based on the potential for systemic absorption.

Timing and Administration Constraints

An official procedural constraint requires the establishment of a necessary time interval between administrations when CAF is co-administered with other topical ophthalmic preparations, such as eye drops or eye ointments. This separation ensures optimal contact of each product with the ocular surface.

Metabolic and Substance Interactions

Regulatory documentation for this ophthalmic preparation does not formally list specific metabolic (CYP-mediated), drug transporter, food, alcohol, or herbal product interactions. The interaction profile focuses strictly on the potential for additive pharmacodynamic effects and local administration rules.

Mechanism of Action

How CAF Works: A Dual Pharmacodynamic Mechanism

CAF utilizes two primary, complementary mechanistic domains to influence localized biological processes at the ocular surface.

Targeted Inhibition of Bacterial Protein Synthesis

This domain focuses on the Chloramphenicol component, which acts as an inhibitor by binding directly to the bacterial 50S ribosomal subunit. This binding arrests the protein synthesis pathway at the elongation stage, leading to a physiological effect of microbial growth arrest (bacteriostasis) and local suppression of bacterial proliferation.


Transcriptional Modulation of Epithelial Structure

This domain centers on Vitamin A (Retinol), which modulates the Epithelial Differentiation and Maintenance Pathway by activating nuclear receptors (RAR/RXR) that function as transcription factors. This mechanism supports the synthesis of key structural proteins, leading to the physiological effect of modulating epithelial structure and facilitating barrier maintenance.


Mechanistic Complementarity

The drug's overall effect profile is shaped by the synergy of these mechanisms: the inhibition of bacterial growth modifies the local bacterial activity, while the transcriptional support mechanism promotes maintenance of the host's epithelial barrier function, contributing to the regulation of localized biological processes.

Dosage and Administration Information

How to Use CAF (Caffeine Citrate) — Administration Guidelines

The administration and dosing rules for the prescription product Caffeine Citrate are specific and technical. Use must strictly adhere to a healthcare provider's direction and is typically confined to a specific patient population, such as premature infants.


Administration scope

Classification Specification
Route of administration Intravenous (IV) infusion or Oral (via feeding tube)
Dosing schedule Administered as a single loading dose followed by daily maintenance doses
Timing in relation to meals Oral dosing is typically unaffected by formula feeding
Preparation requirements Vials are for single use only; any unused portion must be discarded. The dose must be measured accurately with an appropriate syringe
Age-group administration rules Indicated for infants between 28 and <33 weeks gestational age; use in infants with impaired renal or hepatic function requires monitoring and dose adjustment
Missed-dose rules Not specifically detailed in the step sequence; do not increase dose without consultation
Special procedural conditions Serum concentrations of caffeine should be monitored in certain populations (e.g., those with impaired hepatic or renal function, or prior theophylline exposure)

Instruction classifications (high-level)

  • Administration method type: Intravenous / Oral
  • Frequency pattern: Daily
  • Basis: Established clinical parameters
  • Use-context constraints: Strictly limited to specific gestational age and clinical condition (apnea of prematurity)

Resulting procedural structure

Step sequence:

  1. Administer the calculated Loading Dose (20 mg/kg of caffeine citrate) as a single, slow intravenous infusion over 30 minutes, or orally.
  2. Wait a minimum of 24 hours after the loading dose before administering the first maintenance dose.
  3. Administer the Maintenance Dose (5 mg/kg of caffeine citrate) every 24 hours, administered over 10 minutes (IV) or orally (via feeding tube).

Connection to the overall use protocol: The protocol for using this product dictates a precise sequence: an initial loading dose to achieve target concentration quickly, followed by once-daily maintenance dosing. Due to its use in a fragile patient population and variability in drug clearance, the administration is highly controlled, requiring accurate measurement, specified administration times, and mandatory laboratory monitoring to avoid toxicity.

Recent Clinical Evidence

Research evidence / Overview of studies for CAF

Evidence for Use in Acute Ocular Bacterial Involvement

The research for the anti-infective component involves Randomized Controlled Trials (RCTs) and Systematic Reviews. This research was studied for its relevance in patients experiencing acute, superficial bacterial presence in the eye, such as infective conjunctivitis. The studies were applied in research contexts involving fluctuating or unstable symptoms, with researchers monitoring outcomes related to Clinical Cure and the time until symptoms ceased in the observed populations.

Research examined short-term symptom changes, reporting measurements of symptom duration and resolution rates. Studies report how symptoms evolved in the observed populations, describing patterns where measurements of clinical remission were tracked alongside placebo.

Research on the Supporting Component's Role

The Vitamin A component was evaluated in separate clinical trials. These studies were applied in research contexts involving temporary physiological imbalance to explore its role in maintaining ocular health. Research examined outcomes linked to inflammatory or irritative states, focusing on metrics of ocular surface health like corneal staining scores and tear film stability.

Long-Term Studies and Follow-Up Data

Follow-up periods for the anti-infective studies ranged from short-term (a few days for early remission) to intermediate (up to 7 to 10 days for overall remission). Limited information for long-term outcomes means long-term patterns after the study period are not fully established. Data describing how outcomes related to physical discomfort evolve over extended periods are limited.

What is Still Uncertain About CAF

The primary limitation noted in the research is the lack of high-level evidence (such as large-scale RCTs) specifically for the fixed-dose combination product. Research has not clearly established whether the combination is associated with an additional measured outcome compared to using the anti-infective agent alone. Follow-up durations were limited in many studies, meaning long-term patterns are not fully established, and there is limited information for long-term outcomes. Findings describe group patterns, not personal outcomes.

Key Studies & References Chloramphenicol eye drops containing borax and boric acid buffers: review of the use in children under 2 years (Regulatory Document)

Frequently Asked Questions (FAQ)

Common questions about CAF (FAQ)


Q: Is CAF available over the counter, or do I need a prescription?

Regulatory documents classify this medicine as a prescription-only medicine (POM) or equivalent legal status. This means that a valid authorization from a healthcare professional is typically required for its dispensing.


Q: Is CAF considered a pain reliever?

According to the official product information, the ophthalmic preparation is classified as an anti-infective and tissue-supportive agent. Its general purpose is for bacterial control and epithelial support, and it is not classified as a pain-relieving medication.


Q: How quickly can someone expect to notice the effects of CAF?

Official research documentation does not typically state a precise time frame for when the medication begins working. Instead, studies focused on measuring outcomes such as the time until symptoms began to cease and tracking overall short-term symptom changes in the groups being observed.


Q: What is the typical duration of action for a single dose of CAF?

Official pharmacokinetic data is available for the active ingredients, which includes the elimination half-life. This measure describes the rate at which the drug component is cleared from the body's system.


Q: Are there common side effects that usually go away after the first few days?

According to official product information, common local irritative effects like a burning sensation or stinging may be more noticeable when treatment is first started. This regulatory note suggests that the local irritation may be transient and lessen over time.


Q: Can CAF cause changes in sleep patterns?

If changes in sleep patterns, such as insomnia or somnolence (drowsiness), are known risks, they would be documented under the CNS effects (central nervous system) section of the official adverse reaction listings.


Q: Can older adults typically use CAF safely?

Official regulatory documents generally state whether special monitoring or a dose adjustment is required when the medicine is used in the elderly population. This information indicates whether use is permitted as per the general guidelines.


Q: Is CAF a narcotic or a controlled substance?

According to national drug schedules and regulatory classifications, this medicine is defined as a non-controlled substance. It is not listed in the official schedules that regulate narcotics or other controlled prescription products.


Q: Is CAF safe for women who are pregnant or planning to become pregnant?

The regulatory text includes specific statements about using the medicine during pregnancy and lactation (breastfeeding). These statements typically detail specific restrictions for use during pregnancy and lactation, often noting the need for a formal risk assessment by a prescribing professional.


Q: Is there a generic version of the drug CAF available?

Regulatory drug listings maintained by authorities like the FDA and others typically confirm the current market status of the product. This information includes whether a generic equivalent of the medicine is available for dispensing.


Q: What is the purpose of the black box warning on CAF's label?

If a Boxed Warning (Black Box Warning) is present, its purpose is to highlight the most serious safety concern related to the Chloramphenicol component. This concern is the rare, idiosyncratic, and potentially fatal suppression of bone marrow function.


Q: What should be done if a dose of CAF is forgotten?

Official regulatory documents generally contain a procedure for handling a forgotten dose. If specific guidance is not explicitly stated, the rule is typically to avoid increasing the next scheduled dose to compensate.


Q: Is it true that CAF can cause dizziness?

Dizziness, if it has been documented as a known risk, is listed under the frequency-classified adverse reactions section of the official regulatory documents.


Q: Does CAF affect liver function?

The label for the related Caffeine Citrate product specifies that dose adjustment and close monitoring are required for infants with impaired hepatic (liver) function). The ophthalmic product primarily focuses safety concerns on bone marrow function.


Q: Are children generally eligible to use CAF?

Regulatory documents include a special note on the population of Neonates and Infants, stating that they require specific caution due to the potential for increased systemic exposure. The related Caffeine Citrate product is strictly indicated for infants of a specific gestational age.


Q: Can people with kidney problems use CAF?

The label for the related Caffeine Citrate product specifies that dose adjustment and close monitoring are required for infants with impaired renal (kidney) function). The ophthalmic product focuses safety concerns on bone marrow function.


Q: How long does CAF stay in the system after the last dose?

Official pharmacokinetic data, which is the regulatory basis for estimating clearance, includes the half-life of the active component. This measure is used to calculate how long it takes for the drug to clear from the body's system.


Q: Is CAF linked to weight changes?

If weight change is a known or documented adverse reaction, it would be explicitly listed in the frequency-classified adverse reactions section of the official regulatory documents.


Q: Are there specific times of day when CAF is usually taken?

While official dosing instructions define the required frequency of administration (e.g., daily), they typically do not specify a precise time of day for taking the medicine. A specific time would only be noted if it were essential for the drug’s effectiveness or safety profile.


Q: What are the rules about driving or operating machinery while taking CAF?

Official regulatory documents specifically address whether the medicine may affect the ability to drive or operate heavy machinery. This guidance is often provided in relation to documented side effects, such as the possibility of transient visual blurring following application.


Q: Can CAF affect mood or cause emotional changes?

If mood changes or emotional changes are known risks, they would be documented under the adverse reaction listings as psychiatric effects. This section lists any changes such as anxiety or depression that have been observed and reported.


Q: Are there any known issues with taking CAF long-term?

Regulatory warnings indicate that the possibility of serious blood disorders, such as aplastic anemia, may be associated with repeated or prolonged courses of treatment. Official research evidence also notes that there is limited data on long-term outcomes following the study periods.


Q: Is CAF recommended for short-term or long-term use?

Official research studies typically report short-term to intermediate follow-up periods. Regulatory warnings exist regarding the potential risk of serious effects associated with prolonged courses of treatment.


Q: What specific information does the patient leaflet provide about overdose?

Official regulatory documents contain a dedicated section that details the clinical features and management of a potential overdose. This information is intended for the treating professional and summarizes the available data on overdose presentation and care.


Q: Is CAF known to cause stomach upset or nausea?

Stomach upset or nausea, if known to be associated with this medicine, would be specifically listed and categorized under the frequency-classified adverse reactions section of the regulatory safety profile.


Q: Why are there different strengths or dosages of CAF available?

The availability of different strengths of a medicine is typically related to the needs of different patient populations or to permit varied dosing to achieve the intended clinical response. This is outlined in the official formulation details.

How should CAF be stored and disposed of?

Storage & Disposal Map: How to Store and Dispose of CAF — official regulatory information

Entity Requirement
Labeled storage temperature requirements: Store the medicine at temperatures not exceeding 25 C or 30 C and do not freeze.
Light/moisture protection requirements: The medicine must be protected from light and stored in a dry place.
Stability after opening/reconstitution (if applicable): The product must be discarded after a specific period (e.g., 28 days) following the first opening of the container.
Handling requirements: The container must be kept tightly closed after use to maintain the product's sterility.
Packaging-related storage rules (if applicable): Store the ophthalmic preparation in its original container.
Disposal instructions (as documented in government sources): Do not dispose of unused or expired medicine via wastewater or household waste. Consult the pharmacist for proper disposal procedures.
Child-protection storage requirements (if stated): The medicine must be stored out of the sight and reach of children.

Official storage and disposal statements:

  • Store below the temperature specified on the label and do not freeze.
  • The product is sensitive to light and must be stored in the original, tightly closed container.
  • Any remaining product must be discarded 28 days after initial opening.

The regulatory documents strictly define that this product must be stored under specific temperature and light constraints to maintain its stability and sterility. A mandatory time limit for use after opening is imposed, and all unused medicine must be disposed of as regulated pharmaceutical waste, strictly prohibiting its disposal in household waste or water systems.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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