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Cyclopentolate and Phenylephrine

Pronunciation

(sye kloe PEN toe late & fen il EF rin)

Index Terms

  • Phenylephrine and Cyclopentolate

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, ophthalmic:

Cyclomydril: Cyclopentolate hydrochloride 0.2% and phenylephrine hydrochloride 1% (2 mL, 5 mL) [contains benzalkonium chloride]

Brand Names: U.S.

  • Cyclomydril®

Pharmacologic Category

  • Ophthalmic Agent, Mydriatic

Pharmacology

The anticholinergic effects of cyclopentolate and the adrenergic effects of phenylephrine cause a greater mydriasis than produced by either agent alone, and cause little cycloplegia.

Onset of Action

15-60 minutes

Duration of Action

4-12 hours

Use: Labeled Indications

Mydriasis: For the production of mydriasis.

Contraindications

Untreated narrow-angle glaucoma; untreated anatomically narrow angles; hypersensitivity to any component of the formulation

Dosing: Adult

Diagnostic aid (mydriasis): Ophthalmic: Instill 1 drop into the eye every 5 to 10 minutes.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Diagnostic aid (mydriasis): Infants, Children, and Adolescents: Ophthalmic: Refer to adult dosing.

Administration

Finger pressure should be applied to lacrimal sac for 1 to 2 minutes after instillation to decrease risk of absorption and systemic reactions. Do not touch dropper to eye. Wash hands following administration. Contains benzalkonium chloride, which may be adsorbed by contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.

In general, administer 15 to 45 minutes prior to the test; may need up to 3 doses (AAP 2008; Visser 2013).

Storage

Store at 8°C to 25°C (46°F to 77°F).

Drug Interactions

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1-Agonists may antagonize Alpha1-Blocker vasodilation. Monitor therapy

AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. Monitor therapy

Cocaine: May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Consider therapy modification

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Monitor therapy

Ergot Derivatives: May enhance the hypertensive effect of Alpha1-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha1-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline. Avoid combination

Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Avoid combination

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification

MAO Inhibitors: May enhance the hypertensive effect of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Exceptions: Linezolid; Tedizolid. Avoid combination

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Tricyclic Antidepressants: May enhance the vasopressor effect of Alpha1-Agonists. Tricyclic Antidepressants may diminish the vasopressor effect of Alpha1-Agonists. Monitor therapy

Adverse Reactions

See individual agents.

Warnings/Precautions

Concerns related to adverse effects:

• CNS effects: May cause CNS disturbances. Patients must be cautioned about performing hazardous activities (eg, operating machinery or driving) while pupils are dilated.

• Intraocular pressure: May cause a transient elevation in intraocular pressure.

Disease-related concerns:

• Cardiovascular effects: Use caution in patients with cardiovascular disease or hypertension.

• Down syndrome: Use caution in patients with Down syndrome.

• Glaucoma: Use caution in patients predisposed to angle-closure glaucoma.

• Hyperthyroidism: Use caution in patients with hyperthyroidism.

Special populations:

• Contact lens wearers: Contains benzalkonium chloride, which may be adsorbed by contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.

• Pediatric: May result in psychotic reactions and behavioral disturbances in children; risk may be increased with brain damage or spastic paralysis. Observe infants for at least 30 minutes following instillation. Feeding intolerance may occur in infants; withhold feeding for 4 hours after examination.

Other warnings/precautions:

• Appropriate use: For topical ophthalmic use and short term administration only. To minimize systemic absorption, apply pressure over the lacrimal sac for 2 to 3 minutes after application.

Monitoring Parameters

Infants should be monitored for at least 30 minutes following application.

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted with this combination.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience ocular burning sensation, blurred vision, or sensitivity to lights. Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, tachycardia, severe headache, flushing, difficult urination, confusion, hallucinations, seizures, change in balance, abnormal gait, slurred speech, or agitation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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