Homatropine

Pronunciation

(hoe MA troe peen)

U.S. Brand Names

Isopto® Homatropine

Synonyms

Homatropine Hydrobromide

Generic Available

Use

Producing cycloplegia and mydriasis for refraction; treatment of acute inflammatory conditions of the uveal tract

Pregnancy Risk Factor

Contraindications

Hypersensitivity to the drug or any component of the formulation; narrow-angle glaucoma, acute hemorrhage

Warnings/Precautions

Use with caution in patients with hypertension, cardiac disease, or increased intraocular pressure; safety and efficacy not established in infants and young children, therefore, use with extreme caution due to susceptibility of systemic effects; use with caution in obstructive uropathy, paralytic ileus, ulcerative colitis, unstable cardiovascular status in acute hemorrhage

Adverse Reactions

>10%: Ocular: Blurred vision, photophobia

1% to 10%:

Local: Stinging, local irritation

Ocular: Increased intraocular pressure

Respiratory: Congestion

<1%: Vascular congestion, edema, drowsiness, exudate, eczematoid dermatitis, follicular conjunctivitis

Overdosage/Toxicology

Symptoms of overdose include blurred vision, urinary retention, tachycardia

Anticholinergic toxicity is caused by strong binding of the drug to cholinergic receptors. For anticholinergic overdose with severe life-threatening symptoms, physostigmine 1-2 mg (0.5 mg or 0.02 mg/kg for children) SubQ or I.V., slowly may be given to reverse these effects.

Stability

Protect from light

Mechanism of Action

Blocks response of iris sphincter muscle and the accommodative muscle of the ciliary body to cholinergic stimulation resulting in dilation and loss of accommodation

Pharmacodynamics/Kinetics

Onset of action: Accommodation and pupil effect: Ophthalmic:

Maximum mydriatic effect: Within 10-30 minutes

Maximum cycloplegic effect: Within 30-90 minutes

Duration:

Mydriasis: 6 hours to 4 days

Cycloplegia: 10-48 hours

Dosage

Ophthalmic:

Children:

Mydriasis and cycloplegia for refraction: Instill 1 drop of 2% solution immediately before the procedure; repeat at 10-minute intervals as needed

Uveitis: Instill 1 drop of 2% solution 2-3 times/day

Adults:

Mydriasis and cycloplegia for refraction: Instill 1-2 drops of 2% solution or 1 drop of 5% solution before the procedure; repeat at 5- to 10-minute intervals as needed; maximum of 3 doses for refraction

Uveitis: Instill 1-2 drops of 2% or 5% 2-3 times/day up to every 3-4 hours as needed

Administration

Ophthalmic instillation: Finger pressure should be applied to lacrimal sac for 1-2 minutes after instillation to decrease risk of absorption and systemic reactions

Patient Education

May cause blurred vision; if irritation persists or increases, discontinue use

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Nasal congestion.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause drowsiness

Mental Health: Effects on Psychiatric Treatment

None reported

Dosage Forms

Solution, ophthalmic, as hydrobromide: 2% (5 mL); 5% (5 mL, 15 mL) [contains benzalkonium chloride]

References

Barker DB and Solomon DA, "The Potential for Mental Status Changes Associated With Systemic Absorption of Anticholinergic Ophthalmic Medications: Concerns in the Elderly," DICP Ann Pharmacother , 1990, 24(9):847-50.

International Brand Names

Bell Homatropine® (IN); Bromhydrate d'homatropine-Chauvin® (LU); Bromhydrate d'homatropine Faure® (FR); Colirio LLorens Homatrop® (ES); Colirio Ocul Homatropina® (ES); Homatro® (ID); Homatropine® (BD, BE, GB); Homatropine Faure® (FR); Homatropine Minims® (BE, NL); Homatropin® (NO); Homatropin-POS® (DE); Isopto Homatropine® (AU, NZ, SG, ZA); Minima - Homatropinhydrobromid® (AT); Minims-Homatropin® (AT); Minims Homatropine Hydrobromide® (AT, GB, IE, NZ, ZA); Minims-Homatropinhydrobromid® (AT); Omatropina® (IT)

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