DrugindexOnline^{2nd edition}

Pronouncation: (app-rah-KLOE-nih-deen)
Class: Alpha adrenergic agonist

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

Iopidine 0.5% (Canada)
Iopidine 1% (Canada)

Mechanism of Action

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

0.5% solution

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

1% solution

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

0.5% solution

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.

1% solution

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

Monitor Allergic reaction Assess patient for allergic-like ocular reaction (eg, hyperemia, pruritus, discomfort, tearing, foreign body sensation, edema of lids and conjunctiva). Inform health care provider if noted or suspected. Be prepared to discontinue apraclonidine. Depression Monitor patient with depression or history of depression during treatment with apraclonidine. Immediately inform health care provider if depressive symptoms noted or if preexisting depression appears to worsen. IOP Ensure IOPs are measured and documented in the patient's record before starting therapy and periodically thereafter. Immediately inform health care provider of abnormal readings, including exaggerated reductions in IOP. Visual fields Ensure visual fields are monitored periodically in patient using apraclonidine to delay argon laser surgery.

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.