Cyclopentolate Hydrochloride / Phenylephrine Hydrochloride

Pronunciation: SYE-kloe-PEN-toe-late HYE-droe-KLOR-ide/FEN-il-EF-rin HYE-droe-KLOR-ide
Class: Mydriatic combination

Trade Names

Cyclomydril
- Solution, ophthalmic cyclopentolate hydrochloride 0.2%/phenylephrine hydrochloride 1%

Pharmacology

Inhibits action of acetylcholine at muscarinic receptors.

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Stimulates postsynaptic alpha receptors, resulting in vasoconstriction.

Indications and Usage

For production of mydriasis.

Contraindications

Untreated narrow-angle glaucoma; untreated anatomically narrow angles; hypersensitivity to any component of product.

Dosage and Administration

Ophthalmic Instill 1 drop in each eye every 5 to 10 min.

General Advice

• Do not allow tip of dropper bottle to touch eye, eyelid, fingers, or any other surface.
• Compress lacrimal sac for 2 to 3 min following instillation to reduce systemic absorption.
• If using other topical ophthalmic medications, instill drops first, wait at least 5 min, and instill ointment last.

Storage/Stability

Store between 46° and 80°F.

Drug Interactions

Cyclopentolate may interfere with the ocular antihypertensive action of these agents.

Adverse Reactions

Cardiovascular

Hypertension; tachycardia; vasodilation.

CNS

Psychotic reactions and behavioral disturbances in children including ataxia, disorientation as to time and place, failure to recognize people, hallucinations, hyperactivity, incoherent speech, restlessness, and seizures.

EENT

Blurred vision; burning/irritation upon instillation; decreased secretion in salivary glands, pharynx, and nasal passages; increased IOP; photophobia; superficial punctate keratitis.

GI

Decreased GI motility.

Genitourinary

Urinary retention.

Respiratory

Decreased secretion in bronchi.

Miscellaneous

Decreased secretion in sweat glands; hyperpyrexia.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Psychotic reactions and behavioral disturbances may occur in children. Signs and symptoms include ataxia, disorientation as to time and place, failure to recognize people, hallucinations, hyperactivity, incoherent speech, restlessness, and seizures. Discontinue therapy and inform health care provider immediately if noted and significant. In infants, feeding intolerance may occur; withhold feeding for 4 h after examination.

Special Risk Patients

Use with caution in the presence of Down syndrome and in those predisposed to angle-closure glaucoma. Use of this combination may have adverse effects on individuals with CV disease, hypertension, and hyperthyroidism.

Overdosage

Symptoms

Behavioral disturbances; coma; death; decreased secretion in salivary and sweat glands, pharynx, bronchi, and nasal passages; diminished GI motility; elevated IOP; hyperpyrexia; hypertension; medullary paralysis; tachycardia; urinary retention; vasodilation.

Patient Information

• Teach patient, parent, or caregiver proper technique for instilling eye drops: Wash hands and do not allow tip of dropper bottle to touch eye, eyelid, fingers, or any other surface. Tilt head back, look up; pull lower eyelid down to form pocket; place prescribed number of drops in the pocket. Look downward before closing eye; apply pressure to lacrimal sac for 2 to 3 min. Do not rub eye. Wash hands (and child's hands) after instillation.
• Advise parent or guardian to discontinue therapy and notify health care provider immediately if any of the following occur after instilling drops: changes in thinking or behavior, fever, rapid heart rate, speech changes, stumbling.
• Warn patient that sensitivity to light may be experienced, and to protect eyes in bright illumination while pupils are dilated.
• Caution patient to avoid driving or engaging in hazardous activities while pupils are dilated.
• Inform patient that blurred vision, stinging or burning, and sensitivity to light are the most common adverse reactions and to contact their health care provider if they occur and are bothersome.
• Advise patient that follow-up visits and eye examinations may be necessary following therapy and to keep appointments.
• Advise parent or guardian that feeding intolerance may follow ophthalmic use when used in infants and to withhold feeding for 4 h following installation of drops.
• Advise parents to avoid instilling this medication in child's mouth.

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