Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Ophthalmic, as hydrobromide:
Homatropaire: 5% (5 mL)
Generic: 5% (5 mL)
Pharmacology
Mechanism of Action
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.
Dosage and Administration
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.
Mydriasis and cycloplegia for refraction: Infants ≥3 months, Children, and Adolescents: Ophthalmic: 5% solution: Instill 1 to 2 drops into eye(s) immediately prior to procedure; may repeat once in 5 to 10 minutes if necessary
Uveitis: Infants ≥3 months, Children, and Adolescents: Ophthalmic: 5% solution: Instill 1 to 2 drops into affected eye(s) up to every 3 to 4 hours
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
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination
Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy
Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy
Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of 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. Monitor therapy
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination
Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. 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. Monitor therapy
Opioid Agonists: Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. 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
Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. 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
Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Avoid combination
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of 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
Pregnancy Risk Factor
C
Pregnancy Considerations
Animal reproduction studies have not been conducted.
Patient Education
What is this drug used for?
- It is used to treat eye swelling.
- It is used to widen the pupil before an eye exam or eye surgery.
- It is used to treat certain eye problems after eye surgery.
- It may be given for other reasons. Talk with the doctor.
Frequently reported side effects of this drug
- Sensitivity to lights
- Burning
- Stinging
- Eye irritation
- Dry mouth
- Increased thirst
Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:
- Eye or eyelid swelling
- Confusion
- Agitation
- Signs of a significant reaction like 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. Talk to your doctor if you have questions.
Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.
