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E-Pilo-4 (epinephrine / pilocarpine ophthalmic) Disease Interactions

There are 9 disease interactions with E-Pilo-4 (epinephrine / pilocarpine ophthalmic):

Major

Miotics (Includes E-Pilo-4) ↔ retinal detachment

Severe Potential Hazard, High plausibility. Applies to: Aphakia, Myopia, Retinal Disorder

The use of miotic agents may occasionally cause retinal detachment due to drug-induced ciliary or accommodative spasm, which causes the lens and vitreous to move forward and create a retinal tear. Therapy with miotic agents should be administered with extreme caution, if at all, in patients with risk factors for retinal detachment, such as old age, retinal degenerative changes or other retinal disorders, aphakia, prior cataract extraction, or a history of severe myopia or retinal detachment.

References

  1. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  4. Benedict WL, Shami M "Impending macular hole associated with topical pilocarpine." Am J Ophthalmol 114 (1992): 765-6
  5. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  6. "Product Information. Isopto Carbachol (carbachol ophthalmic)" Alcon Laboratories Inc, Ft Worth, TX.
  7. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  8. "Product Information. Isopto Carpine (pilocarpine ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
  9. Zimmerman TJ, Wheeler TM "Miotics: side effects and ways to avoid them." Ophthalmology 89 (1982): 76-80
View all 9 references
Major

Miotics (Includes E-Pilo-4) ↔ uveitis

Severe Potential Hazard, High plausibility. Applies to: Uveitis (Anterior)

The use of miotic agents is contraindicated in patients with active anterior uveitis and/or glaucoma associated with iridocyclitis. Pupillary constriction produced by these agents may aggravate the inflammation and predispose these patients to the development of posterior synechiae.

References

  1. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  4. "Product Information. Isopto Carbachol (carbachol ophthalmic)" Alcon Laboratories Inc, Ft Worth, TX.
  5. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  6. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  7. "Product Information. Isopto Carpine (pilocarpine ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
View all 7 references
Major

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

Ophthalmic epinephrine (Includes E-Pilo-4) ↔ 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
  4. Sonntag JR, Brindley GO, Shields MB, Arafat NI, Phelps CD "Timolol and epinephrine. Comparisin of efficacy and side effects." Arch Ophthalmol 97 (1979): 273-7
  5. Blondeau P, Cote M "Cardiovascular effects of epinephrine and dipivefrin in patients using timolol: a single-dose study." Can J Ophthalmol 19 (1984): 29-32
  6. Fiore PM, Cinotti AA "Systemic effects of intraocular epinephrine during cataract surgery." Ann Ophthalmol 20 (1988): 23-5
  7. Lansche RK "Systemic reactions to topical epinephrine and phenylephrine." Am J Ophthalmol 61 (1966): 95-8
  8. Wandel T, Spinak M "Toxicity of dipivalyl epinephrine." Ophthalmology 88 (1981): 259-60
  9. "Product Information. Epifrin Sterile Ophthalmic Solution (epinephrine)." Allergan Inc, Irvine, CA.
  10. Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
View all 10 references
Major

Ophthalmic epinephrine (Includes E-Pilo-4) ↔ 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

Miotics (Includes E-Pilo-4) ↔ cataracts

Moderate Potential Hazard, Moderate plausibility. Applies to: Cataracts

The use of miotic agents has been associated with the development of lens opacities characterized by the appearance of anterior subcapsular vacuoles. The incidence of cataracts appears to be highest in patients treated with long-acting cholinesterase inhibitors (e.g., demecarium and echothiophate) and may also be related to age (higher in patients > 60 years of age), drug concentration, frequency of use, and duration of therapy (>= 6 months). Lens opacities usually regress if miotic therapy is withdrawn early in their development but often become progressive once they are established. Therapy with miotic agents should be administered cautiously in patients with or predisposed to cataracts. Slit-lamp examinations should be performed regularly, and miotic therapy discontinued if necessary.

References

  1. Zimmerman TJ, Wheeler TM "Miotics: side effects and ways to avoid them." Ophthalmology 89 (1982): 76-80
  2. "Product Information. Isopto Carpine (pilocarpine ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
  3. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  6. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  7. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
View all 7 references
Moderate

Miotics (Includes E-Pilo-4) ↔ systemic vagotonic effects

Moderate Potential Hazard, Moderate plausibility. Applies to: Corneal Abrasion, Asthma, Chronic Obstructive Pulmonary Disease, Dyspepsia, Heart Block, Hypotension, Irritable Bowel Syndrome, Myocardial Infarction, Parkinsonism, Peptic Ulcer, Post MI Syndrome, Seizures, Sinus Node Dysfunction, Urinary Tract Obstruction, Congestive Heart Failure, Hypertension

Topically applied cholinergic agents are systemically absorbed, with the potential for producing rare but clinically significant systemic effects, including urinary incontinence, tightness of the bladder, increased gastric contractility and acid secretion, bradycardia, severe hypotension, bronchospasm, seizures, and coma. Increases in blood pressure may occur rarely due to a nicotinic effect on sympathetic ganglia. Therapy with ophthalmic cholinergic agents, particularly the long-acting cholinesterase inhibitors (e.g., demecarium and echothiophate), should be administered cautiously in patients with corneal abrasion (which may increase drug penetration), bronchospastic diseases, spastic gastrointestinal disturbances, urinary tract obstruction, peptic ulcer, pronounced bradycardia and hypotension, vascular hypertension, acute cardiac failure, recent myocardial infarction, epilepsy, parkinsonism, and other conditions that may respond adversely to vagotonic effects. The usual precautions should be followed to minimize the risk of systemic toxicity, including digital compression of the nasolacrimal ducts (1 to 2 minutes) following instillation to limit drainage into the nasal chamber, where extensive absorption may occur, and washing hands after use to prevent skin absorption. Excessive cholinergic effects may be reversed with parenterally administered atropine.

References

  1. Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Babinski M, Smith B, Wickerham EP "Hypotension and bradycardia following intraocular acetylcholine injection. Report of a case." Arch Ophthalmol 94 (1976): 675-6
  4. Rongey KA, Weisman H "Hypotension following intraocular acetylcholine." Anesthesiology 36 (1972): 412
  5. Gombos DS "Acetylcholine in ophthalmology: a revisit." Ann Ophthalmol 20 (1988): 455,462
  6. Zimmerman TJ, Wheeler TM "Miotics: side effects and ways to avoid them." Ophthalmology 89 (1982): 76-80
  7. Marmion VJ "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol 97 (1984): 799-80
  8. Rasch D, Holt J, Wilson M, Smith RB "Bronchospasm following intraocular injection of acetylcholine in a patient taking metoprolol." Anesthesiology 59 (1983): 583-5
  9. Sekiya M, Okayama H, Suzuki M, Kobayashi T, Matsuoka H, Sumimoto T, Hamada M, Hiwada K "Acetylcholine-induced myocardial ischemia without epicardial coronary artery spasm: a possible vasospasm of small coronary arteries--a case report." Angiology 44 (1993): 811-5
  10. Brinkley JR Jr, Henrick A "Vascular hypotension and bradycardia following intraocular injection of acetylcholine during cataract surgery." Am J Ophthalmol 97 (1984): 40-2
  11. "Product Information. Isopto Carpine (pilocarpine ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
  12. "Product Information. Eserine (physostigmine ophthalmic)." Ciba Vision Ophthalmics, Duluth, GA.
  13. Treasure CB, Vita JA, Cox DA, Fish RD, Selwyn AP, Alexander RW, Ganz P "Acute myocardial infarction with normal coronary arteries associated with acetylcholine-induced vasoconstriction in the absence of a positive ergonovine test." Am J Cardiol 65 (1990): 255-7
  14. "Product Information. Miochol (acetylcholine chloride, intraocular)." Ciba Vision Ophthalmics, Duluth, GA.
  15. "Product Information. Isopto Carbachol (carbachol ophthalmic)" Alcon Laboratories Inc, Ft Worth, TX.
  16. "Product Information. Humorsol Ophthalmic Solution (demecarium bromide ophthalmic)." Merck & Co, Inc, West Point, PA.
  17. Gombos GM "Systemic reactions following intraocular acetylcholine instillation." Ann Ophthalmol 14 (1982): 529-30
  18. Taytard A, Vergeret J, Auzerie J, Freour P "Acetylcholine-induced bronchospasm in asthma patients: dose/response curves." Eur J Respir Dis Suppl 128(Pt 2) (1983): 513-4
  19. Benjamin KW "Toxicity of ocular medications." Int Ophthalmol Clin 19 (1979): 199-255
  20. "Product Information. Phospholine iodide (echothiophate iodide)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 20 references
Moderate

Ophthalmic epinephrine (Includes E-Pilo-4) ↔ 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. Lansche RK "Systemic reactions to topical epinephrine and phenylephrine." Am J Ophthalmol 61 (1966): 95-8
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. "Product Information. Epifrin Sterile Ophthalmic Solution (epinephrine)." Allergan Inc, Irvine, CA.
Moderate

Topical sympathomimetics (Includes E-Pilo-4) ↔ 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. Tyzine (tetrahydrozoline)." Kenwood Laboratories, Fairfield, NJ.
  3. "Product Information. Otriviv (xylometazoline nasal)" Novartis Pharmaceuticals, East Hanover, NJ.
  4. "Product Information. Vicks Vapor Inhaler (desoxyephedrine nasal)" Procter and Gamble Pharmaceuticals, Cincinnati, OH.
  5. "Product Information. Privine (naphazoline nasal)" Novartis Consumer Health, Summit, NJ.
  6. "Product Information. Neo-Synephrine (phenylephrine ophthalmic)" Sanofi Winthrop Pharmaceuticals, New York, NY.
  7. Ellis PP "Systemic reactions to topical therapy." Int Ophthalmol Clin 11 (1971): 1-11
  8. "Product Information. Collyrium Fresh (tetrahydrozoline)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. "Product Information. Benzedrex (propylhexedrine nasal)" Menley and James Laboratories Inc, Horsham, PA.
  10. Lansche RK "Systemic reactions to topical epinephrine and phenylephrine." Am J Ophthalmol 61 (1966): 95-8
  11. "Product Information. Afrin (oxymetazoline nasal)" Schering-Plough, Liberty Corner, NJ.
  12. "Product Information. Neo-Synephrine Nasal (phenylephrine nasal)" Southwood Pharmaceuticals Inc, Irvine, CA.
  13. "Product Information. Pretz-D (ephedrine nasal)" Parnell Pharmaceuticals Inc, San Rafael, CA.
  14. "Product Information. Naphcon (naphazoline ophthalmic)" Alcon Laboratories Inc, Fort Worth, TX.
View all 14 references

E-Pilo-4 (epinephrine / pilocarpine ophthalmic) drug interactions

There are 434 drug interactions with E-Pilo-4 (epinephrine / pilocarpine ophthalmic)

E-Pilo-4 (epinephrine / pilocarpine ophthalmic) alcohol/food interactions

There is 1 alcohol/food interaction with E-Pilo-4 (epinephrine / pilocarpine 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.

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