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Homatropine

Pronunciation

(hoe MA troe peen)

Index Terms

  • Homatropine Hydrobromide

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Ophthalmic, as hydrobromide:

Homatropaire: 5% (5 mL)

Isopto Homatropine: 2% (5 mL [DSC]); 5% (5 mL [DSC])

Generic: 5% (5 mL)

Brand Names: U.S.

  • Homatropaire
  • Isopto Homatropine [DSC]

Pharmacologic Category

  • Anticholinergic Agent, Ophthalmic
  • Ophthalmic Agent, Mydriatic

Pharmacology

Blocks response of iris sphincter muscle and the accommodative muscle of the ciliary body to cholinergic stimulation resulting in dilation (mydriasis) and paralysis of accommodation (cycloplegia)

Use: Labeled Indications

Mydriasis and cycloplegia for refraction: Producing cycloplegia and mydriasis for refraction; for pre- and postoperative states when mydriasis is required.

Optical aid: Use as an optical aid in some cases of axial lens opacities.

Uveitis: Treatment of inflammatory conditions of the uveal tract.

Contraindications

Primary glaucoma or tendency toward glaucoma (eg, narrow anterior chamber angle); hypersensitivity to homatropine or any component of the formulation.

Documentation of allergenic cross-reactivity for belladonna alkaloids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Dosing: Adult

Note: Patients with heavily pigmented irides may require increased dose.

Refraction: Ophthalmic: 2% or 5% solution: 1 to 2 drops into the affected eye(s); may repeat in 5 to 10 minutes if necessary

Uveitis: Ophthalmic: 2% or 5% solution: 1 to 2 drops into the affected eye(s) every 3 to 4 hours

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Note: Patients with heavily pigmented irides may require increased dose.

Uveitis, Refraction: Infants ≥3 months, Children, and Adolescents: Ophthalmic: 2% solution: Refer to adult dosing

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Administration

Ophthalmic instillation: Wash hands before and after use. Avoid touching tip of applicator to eye or other surfaces. Contact lenses should be removed before instillation; do not reinsert contact lenses within 15 minutes of drops. Finger pressure should be applied to lacrimal sac for 1-3 minutes after instillation to decrease risk of absorption and systemic reactions

Storage

Isopto homatropine: Store at 8°C to 24°C (46°F to 75°F).

Other preparations: Store at 15°C to 30°C (59°F to 86°F).

Drug Interactions

AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy

Acetylcholinesterase Inhibitors: Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Acetylcholinesterase Inhibitors may diminish the therapeutic effect of Anticholinergic Agents. Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy

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

Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Avoid combination

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy

Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Avoid combination

OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy

RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Consider therapy modification

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Adverse Reactions

Frequency not defined.

Cardiovascular: Edema

Central nervous system: Burning sensation, stinging sensation

Dermatologic: Eczema

Endocrine & metabolic: Increased thirst

Gastrointestinal: Xerostomia

Local: Local irritation

Ophthalmic: Blurred vision, follicular conjunctivitis, increased intraocular pressure, ocular exudate, photophobia, vascular congestion of the eye

Warnings/Precautions

Concerns related to adverse effects:

• CNS effects: Excessive use may cause CNS disturbances, including confusion, delirium, agitation, and coma (rare). May occur with any age group, although children and the elderly are more susceptible. Patients should be cautioned about performing tasks which require mental alertness (eg, operating machinery, driving).

• Light sensitivity (ocular): May cause sensitivity to light; appropriate eye protection should be used.

Disease-related concerns:

• Down syndrome: Patients with Down syndrome are predisposed to angle-closure glaucoma; use with caution.

• Keratoconus: May result in fixed pupil dilation in patients with keratoconus; use with caution.

Special populations:

• Elderly: Use with caution in the elderly due to susceptibility to systemic effects.

• Pediatric: Safety and efficacy have not been established in infants and young children; use with caution in children with brain damage due to susceptibility of systemic effects. Avoid use during the first 3 months of life.

Dosage form specific issues:

• Contact lens wearers: Some strengths may contain benzalkonium chloride which may be adsorbed by contact lenses (Chapman 1990); remove contacts prior to administration and wait 15 minutes before reinserting.

Other warnings and precautions:

• Appropriate use: For topical ophthalmic use only. To minimize systemic absorption, apply pressure over the lacrimal sac for 1 to 3 minutes after instillation. To avoid contamination, do not touch dropper tip to any surface. To avoid precipitating angle closure glaucoma, an estimation of the depth of the anterior chamber angle should be made prior to use.

Pregnancy Risk Factor

C

Pregnancy Considerations

Animal reproduction studies have not been conducted.

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 sensitivity to lights, burning, stinging, dry mouth, or increased thirst. Have patient report immediately to prescriber vision changes, eye pain, severe eye irritation, confusion, 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 health care 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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