Homatropine Hydrobromide

Pronunciation: hoe-MAT-roe-peen/HYE-droe-BROE-mide
Class: Cycloplegic mydriatic

Trade Names

Isopto Homatropine
- Solution, ophthalmic 2%
- Solution, ophthalmic 5%

Pharmacology

Blocks the responses of the sphincter muscle of the iris and the accommodative muscle of the ciliary body to cholinergic stimulation, producing pupillary dilation (mydriasis) and paralysis of accommodation (cycloplegia).

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Pharmacokinetics

Absorption

Mydriasis and cycloplegia peak within 30 and 60 min, respectively. Recovery from both the mydriatic and cycloplegic effects occurs within 1 to 3 days.

Indications and Usage

Production of cycloplegia and mydriasis for cycloplegic refraction for pre- and postoperative states when mydriasis is required; treatment of inflammatory conditions of the uveal tract; use as an optical aid in some cases of axial lens opacities.

Contraindications

Primary glaucoma or a tendency toward glaucoma (eg, narrow anterior chamber angle); hypersensitivity to one or more components in the preparation.

Dosage and Administration

Mydriasis and cycloplegia for refraction
Adults

Ophthalmic Instill 1 or 2 drops of the 2% or 5% solution in the affected eye(s). May be repeated in 5 or 10 min if necessary.

Children

Ophthalmic Instill 1 or 2 drops of the 2% solution only in the affected eye(s). May be repeated in 5 or 10 min if necessary.

Uveitis
Adults

Ophthalmic Instill 1 or 2 drops of the 2% or 5% solution into the affected eye(s) up to every 3 or 4 h.

Children

Ophthalmic Instill 1 or 2 drops of the 2% solution only into the affected eye(s) up to every 3 or 4 h.

General Advice

• To avoid excessive systemic absorption, the lacrimal sac should be compressed by digital pressure for 1 min after instillation.
• Individuals with heavily pigmented irides may require larger doses.
• For topical ophthalmic use only.

Storage/Stability

Store between 46° and 75°F.

Drug Interactions

None well documented.

Adverse Reactions

Ophthalmic

Edema, exudate, eye irritation (not present before therapy), follicular conjunctivitis, increased sensitivity to light, local irritation, transient symptoms of stinging and burning, vascular congestion.

Miscellaneous

Eczematoid dermatitis, thirst or dryness of the mouth.

Precautions

Monitor Monitor patient for signs and symptoms of ocular adverse reactions (eg, burning, irritation, stinging pain) and improvement in uveitis.

Pregnancy

Category C .

Lactation

Undetermined.

Children

Use cautiously in infants and small children. Safety and efficacy of the 5% solution have not been established.

Elderly

Use with caution.

Special Risk Patients

Use with caution in patients with keratoconus (may produce fixed, dilated pupil), patients with Down syndrome, and children with brain damage.

Angle-closure glaucoma

To avoid inducing angle-closure glaucoma, estimate the depth of the angle of the interior chamber.

Systemic effects

Excessive topical use of this drug can potentially lead to a confusional state characterized by delirium, agitation, and, rarely, coma. This is more apt to occur in children and elderly patients.

Overdosage

Symptoms

Abdominal distention in infants, blurred vision, fever, flushing and dryness of the skin (a rash may be present in children), loss of neuromuscular coordination, mental aberration (hallucinosis), rapid and irregular pulse.

Patient Information

• Advise patients not to drive or engage in other hazardous activities while pupils are dilated.
• Teach patient proper technique for instilling eye drops: wash hands; do not allow dropper to touch eye. Tilt head back and 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. Do not rub eye.
• Advise patients that they may experience sensitivity to light and should protect eyes from bright illumination during dilation.
• Warn patients not to get this medication in their child's mouth and to wash their own hands and the child's hands following administration.
• Do not touch dropper tip to any surface, as this may contaminate the solution.
• Advise patient that if more than 1 topical ophthalmic drug is being used to administer the drugs at least 5 min apart.
• Advise patient to inform health care provider if ocular adverse reactions occur and become bothersome.

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