Professional Information

Cyclopentolate Hydrochloride / Phenylephrine Hydrochloride

Pronouncation: (SIGH-kloe-pen-TOLL-ate HIGH-droe-KLOR-ide/fen-ill-EFF-rin HIGH-droe-KLOR-ide)
Class: Mydriatic combination

Trade Names:
Cyclomydril
- Solution 0.2% cyclopentolate hydrochloride, 1% phenylephrine hydrochloride

Pharmacology

Cyclopentolate

Inhibits action of acetylcholine at muscarinic receptors.

Phenylephrine

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

Adults and Children

Ophthalmic 1 drop each eye every 5 to 10 min.

General Advice

For ophthalmic use only. Not for use in the ears or on the skin.
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 solution at controlled room temperature (40° to 80°F). Keep bottle tightly capped.

Drug Interactions

Carbachol, pilocarpine, ophthalmic cholinesterase inhibitors

Cyclopentolate may interfere with antihypertensive action of these agents.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Tachycardia; vasodilation.

CNS

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

EENT

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

GI

Decreased GI motility.

Genitourinary

Urinary retention.

Respiratory

Decreased secretion in bronchi.

Miscellaneous

Hyperpyrexia; decreased secretion in sweat glands.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Psychotic reactions and behavioral disturbances may occur in children. Signs and symptoms include ataxia, incoherent speech, restlessness, hallucinations, hyperactivity, seizures, disorientation as to time and place, and failure to recognize people. Observe infants for 30 min following instillation for CNS and cardiopulmonary adverse reactions. Discontinue therapy and inform health care provider immediately if noted and significant.

Overdosage

Symptoms

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

Patient Information

Teach patient, parent or caregiver proper technique for instilling eye drops: wash hands; 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 withhold feeding for 4 h following installation of drops.
Advise parent or guardian to discontinue therapy and notify health care provider immediately if any of the following occur after instilling drops: stumbling, speech changes, changes in thinking or behavior, rapid heart rate, fever.
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 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.