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AK-Pro (dipivefrin ophthalmic) Disease Interactions

There are 2 disease interactions with AK-Pro (dipivefrin ophthalmic):


Ophthalmic epinephrine (Includes AK-Pro) ↔ aphakia

Severe Potential Hazard, High plausibility. Applies to: Aphakia

Up to 30% of aphakic patients treated chronically with ophthalmic epinephrine (of which dipivefrin is a prodrug) may develop cystoid macular edema, which is generally reversible following withdrawal of the medication. Ophthalmic epinephrine preparations should be administered cautiously with appropriate monitoring in patients with aphakia. Therapy should be discontinued if blurred or distorted vision, central scotoma, and/or loss of visual acuity occur. Slight visual impairment may respond to a reduction in the concentration or frequency of administration of the drug.


  1. Mehelas TJ, Kollarits CR, Martin WG "Cystoid macular edema presumably induced by dipivefrin hydrochloride (Propine)." Am J Ophthalmol 94 (1982): 682
  2. Thomas JV, Gragoudas ES, Blair NP, Lapus JV "Correlation of epinephrine use and macular edema in aphakic glaucomatous eyes." Arch Ophthalmol 96 (1978): 625-8
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  4. Mackool RJ, Muldoon T, Fortier A, Nelson D "Epinephrine-induced cystoid macular edema in aphakic eyes." Arch Ophthalmol 95 (1977): 791-3
  5. "Product Information. Epifrin Sterile Ophthalmic Solution (epinephrine)." Allergan Inc, Irvine, CA.
  6. "Product Information. Propine (dipivefrin)." Allergan Inc, Irvine, CA.
  7. Kolker AE, Becker B "Epinephrine maculopathy." Arch Ophthalmol 79 (1968): 552-62
  8. Cerasoli JR "Effects of drugs on the retina." Int Ophthalmol Clin 11 (1971): 121-35
  9. Obstbaum SA, Galin MA, Poole TA "Topical epinephrine and cystoid macular edema." Ann Ophthalmol 8 (1976): 455-8
  10. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
View all 10 references

Ophthalmic epinephrine (Includes AK-Pro) ↔ narrow angles

Severe Potential Hazard, High plausibility. Applies to: Glaucoma (Narrow Angle)

The use of ophthalmic preparations of epinephrine, including dipivefrin (a prodrug of epinephrine), is contraindicated in patients with narrow-angle glaucoma or anatomically narrow angles. These agents stimulate both alpha-1 and alpha-2 adrenergic receptors, thus topical administration can induce transient mydriasis, either with or without the use of concomitant miotic agents. In patients with narrow angles, any degree of pupillary dilation can provoke an acute attack of angle-closure glaucoma. In contrast, sympathomimetic agents with relative alpha-2 adrenergic selectivity such as apraclonidine and brimonidine produce little to no mydriasis at normally recommended dosages.


  1. "Product Information. Epifrin Sterile Ophthalmic Solution (epinephrine)." Allergan Inc, Irvine, CA.
  2. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  3. "Product Information. Propine (dipivefrin)." Allergan Inc, Irvine, CA.

AK-Pro (dipivefrin ophthalmic) drug interactions

There are 57 drug interactions with AK-Pro (dipivefrin ophthalmic)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.