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Epinal (epinephrine ophthalmic) Disease Interactions

There are 5 disease interactions with Epinal (epinephrine ophthalmic):

Major

Ophthalmic Epinephrine (Includes Epinal) ↔ 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.

References

  1. Kolker AE, Becker B "Epinephrine maculopathy." Arch Ophthalmol 79 (1968): 552-62
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Mackool RJ, Muldoon T, Fortier A, Nelson D "Epinephrine-induced cystoid macular edema in aphakic eyes." Arch Ophthalmol 95 (1977): 791-3
View all 10 references
Major

Ophthalmic Epinephrine (Includes Epinal) ↔ Cardiovascular

Severe Potential Hazard, Moderate plausibility

Applies to: Cerebrovascular Insufficiency, Hyperthyroidism, Cardiovascular Disease, Corneal Abrasion

Topically applied epinephrine is systemically absorbed, with the potential for producing clinically significant systemic effects. In cardiac tissues, epinephrine produces positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart are increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, extrasystoles, arrhythmia and hypertension have been reported rarely during the use of ophthalmic epinephrine products, but may be more likely if the corneal epithelium is damaged or permeability is increased by tonometry, surgery, inflammation, or topical application of a local anesthetic. Therapy with ophthalmic epinephrine should be administered cautiously in patients with corneal abrasion, sensitivity to sympathomimetic amines, hyperthyroidism or underlying cardiovascular or cerebrovascular disorders, especially coronary insufficiency, cardiac arrhythmia, or hypertension. Dipivefrin, a prodrug of epinephrine, is associated with considerably fewer and milder local and systemic adverse effects and may be preferable in some of these patients.

References

  1. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  2. Leon AS, Abrams WB "The role of catecholamines in producing arrhythmias." Am J Med Sci 262 (1971): 9-13
  3. Keates EU, Stone RA "Safety and effectiveness of concomitant administration of dipivefrin and timolol maleate." Am J Ophthalmol 91 (1981): 243-8
View all 10 references
Major

Ophthalmic Epinephrine (Includes Epinal) ↔ 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.

References

  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.
Moderate

Ophthalmic Epinephrine (Includes Epinal) ↔ Bph

Moderate Potential Hazard, Moderate plausibility

Applies to: Benign Prostatic Hyperplasia

Topically applied epinephrine is systemically absorbed, with the potential for producing clinically significant systemic effects. In patients with prostatic hypertrophy, urinary difficulty may develop or worsen due to smooth muscle contraction in the bladder neck via stimulation of alpha-1 adrenergic receptors. Therapy with ophthalmic epinephrine products should be administered cautiously in patients with prostate enlargement. Dipivefrin, a prodrug of epinephrine, is associated with considerably fewer and milder local and systemic adverse effects and may be preferable in some of these patients.

References

  1. "Product Information. Epifrin Sterile Ophthalmic Solution (epinephrine)." Allergan Inc, Irvine, CA.
  2. Lansche RK "Systemic reactions to topical epinephrine and phenylephrine." Am J Ophthalmol 61 (1966): 95-8
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
Moderate

Topical Sympathomimetics (Includes Epinal) ↔ Diabetes

Moderate Potential Hazard, Moderate plausibility

Applies to: Diabetes Mellitus

Topically applied sympathomimetic agents are systemically absorbed, particularly during prolonged or indiscriminate use. Slight increases in blood glucose concentrations may occur with the use of these drugs. Therapy with topical sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate. It is important that the recommended dosages of the individual products not be exceeded.

References

  1. "Product Information. Ocuclear (oxymetazoline ophthalmic)" Schering-Plough, Liberty Corner, NJ.
  2. "Product Information. Vicks Vapor Inhaler (desoxyephedrine nasal)" Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  3. "Product Information. Otriviv (xylometazoline nasal)" Novartis Pharmaceuticals, East Hanover, NJ.
View all 14 references

Epinal (epinephrine ophthalmic) drug Interactions

There are 75 drug interactions with Epinal (epinephrine 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.

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

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