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Epifrin Side Effects

Generic name: epinephrine ophthalmic

Medically reviewed by Drugs.com. Last updated on Jul 9, 2023.

Note: This document contains side effect information about epinephrine ophthalmic. Some dosage forms listed on this page may not apply to the brand name Epifrin.

Applies to epinephrine ophthalmic: ophthalmic solution.

Serious side effects of Epifrin

Along with its needed effects, epinephrine ophthalmic (the active ingredient contained in Epifrin) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking epinephrine ophthalmic:

Less common

Symptoms of too much medicine being absorbed into the body

Other side effects of Epifrin

Some side effects of epinephrine ophthalmic may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Less common

For Healthcare Professionals

Applies to epinephrine ophthalmic: ophthalmic solution.

Ocular

Chronic ophthalmic application of epinephrine to aphakic patients may cause maculopathy in up to 28% of patients (macular edema, vascular spasm, hemorrhages), which can result in distorted vision, central scotoma, and/or loss of visual acuity. This maculopathy can reverse within six months upon drug withdrawal.

A single case of madarosis (loss of eyelashes) has been associated with topical epinephrine. After the therapy was discontinued, the lashes grew back.[Ref]

Ocular side effects have included stinging and burning, lacrimation, and local discomfort upon application in up to 62% of patients. Browache, eye pain/ache, conjunctival hyperemia, allergic lid reactions, mydriasis, blurry vision, photophobia have been reported. Ocular cicatrization, pemphigoid, loss of eyelashes, and maculopathy have been reported rarely. Prolonged use can cause corneal edema, refractoriness of superficial blood vessels to constrict, and deposition of brownish oxidation products of epinephrine in the palpebral conjunctiva.[Ref]

Cardiovascular

Cardiovascular side effects associated with ocularly applied epinephrine have rarely included palpitations, tachycardia, extrasystoles, premature ventricular depolarizations, cardiac arrhythmias, and hypertension.[Ref]

Nervous system

Nervous system side effects associated with ocularly applied epinephrine have included faintness, trembling, pallor, headache, tremors, and perspiration.[Ref]

Hypersensitivity

Hypersensitivity reactions after ocular application may present as diffuse vascular engorgement, follicular hypertrophy, chemosis, conjunctivitis, and/or iritis.[Ref]

General

In general, systemic side effects after topical application of epinephrine to the eye are more likely if the corneum is damaged or permeability is increased by tonometry, surgery, inflammation, or topical application of a local anesthetic.[Ref]

References

1. Kass MA, Mandell AI, Goldberg I, Paine JM, Becker B. Dipivefrin and epinephrine treatment of elevated intraocular pressure: a comparative study. Arch Ophthalmol. 1979;97:1865-6.

2. Thomas JV, Gragoudas ES, Blair NP, Lapus JV. Correlation of epinephrine use and macular edema in aphakic glaucomatous eyes. Arch Ophthalmol. 1978;96:625-8.

3. Mackool RJ, Muldoon T, Fortier A, Nelson D. Epinephrine-induced cystoid macular edema in aphakic eyes. Arch Ophthalmol. 1977;95:791-3.

4. Becker B, Montgomery SW, Kass MA, Shin DH. Increased ocular and systemic responsiveness to epinephrine in primary open-angle glaucoma. Arch Ophthalmol. 1977;95:789-90.

5. Kass MA, Stamper RL, Becker B. Madarosis in chronic epinephrine therapy. Arch Ophthalmol. 1972;88:429-31.

6. Spaeth GL. Nasolacrimal duct obstruction caused by topical epinephrine. Arch Ophthalmol. 1967;77:355-7.

7. Mahmood MA, Pillai S. Epinephrine staining of a soft contact lens. Case report. Arch Ophthalmol. 1987;105:1021-2.

8. Mooney D. Pigmentation after long-term topical use of adrenaline compounds. Br J Ophthalmol. 1970;54:823-6.

9. Fiore PM. Drug-induced ocular cicatrization. Int Ophthalmol Clin. 1989;29:147-50.

10. Henkind P, Friedman AH. External ocular pigmentation. Int Ophthalmol Clin. 1971;11:87-111.

11. Cerasoli JR. Effects of drugs on the retina. Int Ophthalmol Clin. 1971;11:121-35.

12. Obstbaum SA, Galin MA, Poole TA. Topical epinephrine and cystoid macular edema. Ann Ophthalmol. 1976;8:455-8.

13. Wandel T, Spinak M. Toxicity of dipivalyl epinephrine. Ophthalmology. 1981;88:259-60.

14. Drance SM, Ross RA. The ocular effects of epinephrine. Surv Ophthalmol. 1970;14:330-5.

15. Product Information. Epifrin (EPINEPHrine ophthalmic). Allergan Inc. 2022.

16. Goldstein JH. Effects of drugs on cornea, conjunctiva, and lids. Int Ophthalmol Clin. 1971;11:13-34.

17. Lansche RK. Systemic reactions to topical epinephrine and phenylephrine. Am J Ophthalmol. 1966;61:95-8.

18. Ellis PP. Systemic reactions to topical therapy. Int Ophthalmol Clin. 1971;11:1-11.

19. Korey MS, Hodapp E, Kass MA, Goldberg I, Gordon M, Becker B. Timolol and epinephrine: long-term evaluation of concurrent administration. Arch Ophthalmol. 1982;100:742-5.

20. Leon AS, Abrams WB. The role of catecholamines in producing arrhythmias. Am J Med Sci. 1971;262:9-13.

21. Meyers EF, Ramirez RC, Boniuk I. Grand mal seizures after retrobulbar block. Arch Ophthalmol. 1978;96:847.

22. Kolker AE, Becker B. Epinephrine maculopathy. Arch Ophthalmol. 1968;79:552-62.

23. Alani SD, Alani MD. Allergic contact dermatits and conjunctivitis from epinephrine. Contact Dermatitis. 1976;2:147-50.

24. Gaspari AA. Contact allergy to ophthalmic dipivalyl epinephrine hydrochloride: demonstration by patch testing. Contact Dermatitis. 1993;28:35-7.

25. Sonntag JR, Brindley GO, Shields MB, Arafat NI, Phelps CD. Timolol and epinephrine. Comparisin of efficacy and side effects. Arch Ophthalmol. 1979;97:273-7.

26. Fiore PM, Cinotti AA. Systemic effects of intraocular epinephrine during cataract surgery. Ann Ophthalmol. 1988;20:23-5.

Further information

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

Some side effects may not be reported. You may report them to the FDA.