Drug Guide
Dipivefrin Hydrochloride
Classification
Therapeutic: Glaucoma agent
Pharmacological: Adrenergic agonist
FDA Approved Indications
- Open-angle glaucoma
- Ocular hypertension
Mechanism of Action
Dipivefrin is a prodrug of epinephrine. It is converted to epinephrine in the eye, stimulating alpha-adrenergic receptors, leading to pupillary dilation and increased outflow of aqueous humor, thereby reducing intraocular pressure.
Dosage and Administration
Adult: One drop in the affected eye(s) twice daily or as prescribed.
Pediatric: Use in children only under ocular specialist supervision; dosage typically similar to adults, but safety and efficacy are not well established.
Geriatric: Use with caution; monitor intraocular pressure and cardiovascular status.
Renal Impairment: No specific dosing adjustments; monitor closely.
Hepatic Impairment: No specific data; use with caution and monitor.
Pharmacokinetics
Absorption: Absorbed through the cornea into ocular tissues.
Distribution: Localized to ocular tissues; minimal systemic absorption.
Metabolism: Partially converted to epinephrine in the eye.
Excretion: Metabolites excreted in urine.
Half Life: Approximately 30-60 minutes in ocular tissues.
Contraindications
- Allergy to epinephrine or other adrenergic drugs.
Precautions
- Use with caution in patients with cardiovascular disease, hyperthyroidism, or diabetes; may cause systemic adrenergic effects, including increased blood pressure, rapid heartbeat, and nervousness.
Adverse Reactions - Common
- Ocular irritation or allergic conjunctivitis (Common)
- Palpitations or tachycardia (Uncommon)
Adverse Reactions - Serious
- Increased intraocular pressure in some cases (Rare)
- Systemic cardiovascular effects (hypertension, arrhythmias) (Rare)
Drug-Drug Interactions
- Caution when combined with other adrenergic or monoamine oxidase inhibitors (MAOIs).
Drug-Food Interactions
- No significant interactions noted.
Drug-Herb Interactions
- Limited data; caution with herbal products affecting blood pressure or adrenergic activity.
Nursing Implications
Assessment: Baseline intraocular pressure, cardiovascular status, and allergy history.
Diagnoses:
- Risk for increased intraocular pressure
- Risk for systemic adrenergic side effects.
Implementation: Administer eye drops as prescribed; teach proper instillation technique; monitor cardiovascular status and intraocular pressure.
Evaluation: Assess intraocular pressure periodically; monitor for adverse systemic effects.
Patient/Family Teaching
- Use medication exactly as prescribed.
- Report any unusual ocular irritation, vision changes, or systemic symptoms.
- Avoid overlooking or contaminating the dropper tip.
- Report signs of allergic reactions or cardiovascular effects.
Special Considerations
Black Box Warnings:
- Potential for systemic adrenergic effects, especially in susceptible populations.
Genetic Factors: No specific genetic considerations.
Lab Test Interference: May affect intraocular pressure measurements temporarily.
Overdose Management
Signs/Symptoms: Severe systemic adrenergic effects such as hypertension, arrhythmias, or nervousness.
Treatment: Discontinue drug; provide supportive care; manage cardiovascular symptoms; contact poison control or emergency services.
Storage and Handling
Storage: Store at room temperature, protected from light.
Stability: Stable until expiration if stored properly.