Apraclonidine Hydrochloride

Trade Names:Iopidine- Ophthalmic Solution 0.5% (as base)- Solution 1% (as base)

Pharmacology

Relatively selective ophthalmic alpha-adrenergic agonist, used to reduce IOP and has minimal effect on cardiovascular parameters.

Pharmacokinetics

Onset

1 h.

Peak

3 to 5 h.

Indications and Usage

Short-term adjunctive therapy in patients on maximally tolerated medical therapy who require additional IOP reduction.

Control or prevent postsurgical elevations in IOP that occur in patients after argon laser trabeculoplasty, Nd: YAG posterior capsulotomy, or iridotomy.

Contraindications

Hypersensitivity to any component of this medication or to clonidine; concurrent MAOI therapy.

Dosage and Administration

Ophthalmic Instill 1 to 2 drops in affected eye(s) 3 times daily. Apraclondine 0.5% will be used with other ocular glaucoma therapies, use approximately 5 min interval between instillation of each medication to prevent washout of previous dose.

Ophthalmic Instill 1 drop in scheduled operative eye 1 h before initiating anterior segment laser surgery. Instill second drop into same eye immediately upon completion of surgery.

Storage/Stability

Store in refrigerator or at controlled room temperature (34° to 77°F). Protect from freezing and light. Keep dropper bottle tightly closed. Store 0.1 mL plastic ophthalmic dispensers in original pouch and foil overwrap until time of use.

Drug Interactions

Drugs that may interact include CV agents and MAOIs (see contraindications). May potentiate effects on pulse and BP.

Laboratory Test Interactions

None well documented.

Adverse Reactions

CNS

Asthenia; decreased libido; depression; dizziness; dream disturbance; fatigue; headache; insomnia; irritability; nervousness; somnolence.

Cardiovascular

Arrhythmia; bradycardia; irregular heart rate; palpitations; orthostatic episode; peripheral edema; vasovagal attack.

EENT

Abnormal vision; blanching; blurred or dimmed vision; burning; conjunctival microhemorrhage; conjunctivitis; discharge; discomfort; dry eye; dry nose; edema; foreign body sensation; hyperemia; hypotonia; itching; lid edema; lid margin crusting; mydriasis; nasal burning or dryness; nasal decongestion; pharyngitis; pruritus; photophobia; tearing; upper lid elevation.

GI

Abdominal pain or stomach discomfort; constipation; diarrhea; dry mouth; nausea; taste perversion; vomiting.

Respiratory

Asthma; dyspnea; sinusitis.

Miscellaneous

Abnormal coordination; body heat sensation; chest pain; clammy/sweaty palms; contact dermatitis; extremity pain or numbness; shortness of breath.

Precautions

Pregnancy

Category C .

Lactation

Undetermined. Consider discontinuing breast-feeding for the day when apraclonidine is used.

Children

Safety and efficacy not established.

CV

Use with caution in patients with severe CV, hypertension, recent MI, cerebral vascular disease, coronary insufficiency, chronic renal failure, Reynaud disease, or thromboangiitis obliterans.

IOP reduction

Monitor patients for exaggerated reduction.

Vasovagal attack

May occur, use with caution in patients with a history of such attacks.

Overdosage

Symptoms

Bradycardia, drowsiness, hypothermia.

Patient Information

• Teach patient proper technique for instilling eye drops: Wash hands; do not allow dropper tip to touch eye. Tilt head back, look up; pull lower eyelid down; instill prescribed number of drops. Close eye for 1 to 2 min and apply gentle pressure to bridge of nose for 3 to 5 min. Do not rub eye.
• Advise patient that if more than 1 topical ophthalmic drug is being used to separate administration of each drug by at least 5 min.
• Advise patients who wear contact lenses to remove lenses before instilling this medicine and to wait at least 15 min after instilling eye drop before inserting lenses.
• Advise patient that medication may cause dizziness or drowsiness and to use caution while driving or performing other tasks requiring mental alertness or coordination until tolerance is determined.
• Advise patient to discontinue therapy and immediately notify health care provider if serious or unusual reactions occur in the eye (eg, redness, itching, discomfort, tearing, foreign body sensation, swelling, eyelid inflammation).
• Remind patient that eye examinations and measurement of IOP and visual fields will be necessary while using this medication and to keep appointments.

Copyright © 2009 Wolters Kluwer Health.