DrugindexOnline^{2nd edition}

Pronouncation: (die-PIHV-eh-FRIN HIGH-droe-KLOR-ide)
Class: Sympathomimetic

Trade Names:
Propine
- Solution 0.1%

Mechanism of Action

Pharmacology

Dipivefrin is a prodrug of epinephrine and is converted to epinephrine in the eye by hydrolysis. It exerts its action by decreasing aqueous production and enhancing outflow facility.

Pharmacokinetics

Absorption

Absorbed into the eye.

Metabolism

Metabolized by hydrolysis to epinephrine.

Onset

About 30 min.

Peak

Approximately 1 h.

Indications and Usage

Control of IOP in chronic open-angle glaucoma.

Contraindications

Narrow-angle glaucoma; hypersensitivity to any component of the product.

Dosage and Administration

Adults

Ophthalmic 1 gtt in affected eye(s) every 12 h.

General Advice

• For topical ophthalmic use only.
• Do not allow tip of container to touch any surface, the eyelids, or surrounding areas.
• If using other topical ophthalmic drugs, separate each medication by at least 5 min.

Storage/Stability

Store at controlled room temperature (59° to 77°F). Keep container tightly closed and protected from light.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; arrhythmias; hypertension.

CNS

Headache.

EENT

Burning, stinging (6%); follicular conjunctivitis; eye pain; mydriasis; blurry vision; eye pruritus.

Miscellaneous

Allergy.

Precautions

Monitor Ensure that IOPs are measured and documented in the patient's record before starting therapy and periodically during therapy. Monitor patient for ocular and systemic reactions.

Pregnancy

Category B .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Aphakic patients

Macular edema occurred in up to 30% of aphakic patients treated with epinephrine.

Patient Information

• Advise patient that usual dose is 1 drop in the affected eye(s) twice daily.
• Caution patient not to change the dose or discontinue therapy unless advised by health care provider.
• Teach patient proper technique for instilling eye drops: Wash hands; do not allow dropper 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 wait at least 5 min before instilling the second medication.
• Advise patient that if a dose is missed to skip that dose. Caution patient not to try to catch up on the missed dose by instilling more than 1 dose at a time.
• Inform patient that burning or stinging of the eye are the most common side effects and to contact health care provider if these occur and are bothersome.
• 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 to contact eye doctor if eye or eyelid inflammation is noted and of any eye injury or eye surgery.
• Remind patient that eye examinations and measurement of IOP will be necessary while using this medication and to keep appointments.