Apraclonidine Hydrochloride

Name: Apraclonidine Hydrochloride

Uses for Apraclonidine Hydrochloride

Inhibition of Perioperative IOP Increases

Apraclonidine 1% is used prophylactically to prevent or reduce intraoperative and postoperative increases in intraocular pressure (IOP) before and after ocular laser surgery (e.g., argon laser trabeculoplasty, argon laser iridotomy, neodymium yttrium aluminum garnet [Nd:YAG] laser posterior capsulotomy).1 2 16 17 18 19 20

Glaucoma

Apraclonidine 0.5% is used for short-term (<1 month) adjunctive therapy in patients with open-angle glaucoma receiving maximally tolerated drug therapy (i.e., a topical β-adrenergic blocking agent in conjunction with a systemically administered carbonic anhydrase inhibitor and a sympathomimetic and/or a parasympathomimetic agent) who require additional reduction in IOP.62 65

Apraclonidine Hydrochloride Dosage and Administration

Administration

For topical ophthalmic use only.62 Not for injection or oral use.62

Ophthalmic Administration

Apply topically to the affected eye(s) as an ophthalmic solution.1 2 16 17 18 19 20 54 62

Avoid contamination of the solution container.34 62

If more than one topical ophthalmic drug is used, administer the drugs at least 5 minutes apart.c

1% solution is for single use only; use a separate container for each single-drop dose of 1% solution and discard each container after use.b

Dosage

Available as apraclonidine hydrochloride; dosage expressed in terms of apraclonidine.1 a

Adults

Inhibition of Perioperative IOP Increases Ophthalmic

Apraclonidine 1% solution: 1 drop in the eye undergoing surgery 1 hour before surgery; instill 1 drop in the same eye immediately upon completion of surgery.1 16 17 18 19

Glaucoma Ophthalmic

Apraclonidine 0.5% solution: 1 or 2 drops in the affected eye(s) 3 times daily.62 65 Benefit of therapy for most patients is <1 month.62 65 (See Tachyphylaxis under Cautions.)

Special Populations

No special population dosage recommendations at this time.b c

Interactions for Apraclonidine Hydrochloride

Specific Drugs

Drug

Interaction

Comments

Antidepressants, tricyclic (imipramine, desipramine)

Potential decrease in IOP-lowering effect62

Use concomitantly with caution62

Antipsychotic agents

Possible additive hypotensive effects62

Reported with concomitant systemic clonidine therapy; not evaluated with concomitant apraclonidine therapy1 62

Cardiac glycosides

Possible decrease in heart rate and BP62

Use concomitantly with caution62

CNS depressants (e.g., barbiturates, opiates, anesthetics, sedatives, alcohol)

Possible additive CNS effects62

Hypotensive agents

Possible decrease in heart rate and BP62

Use concomitantly with caution62

MAO inhibitors

Possible excess of circulating catecholamines with withdrawal of apraclonidine62

Concomitant use contraindicatedb c

No data available on the circulating plasma concentrations of catecholamines following apraclonidine withdrawal62

Ocular hypotensive agents

Additive IOP-lowering effect16 17

Used to therapeutic advantage16 17 18

Stability

Storage

Ophthalmic

Solution

0.5% solution: Tight, light-resistant container at 2–27°C; do not freeze.62

1% solution: Tight, light-resistant container at 2–25°C.1 b

Advice to Patients

  • Importance of learning and adhering to proper administration techniques to avoid contamination of the solution container.c If more than one topical ophthalmic drug is used, importance of administering at least 5 minutes apart.c

  • Importance of delaying insertion of soft contact lenses for at least 15 minutes after apraclonidine instillation, since benzalkonium chloride preservative in the solution may be absorbed by soft lenses.c

  • Risk of dizziness or fatigue; use caution when driving or operating machinery.62

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.c

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.c

  • Importance of informing patients of other important precautionary information. (See Cautions.)

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