Version May 2024
Ocular itching/redness: Ophthalmic: Instill 1 to 2 drops into the affected eye(s) up to 4 times daily.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Ocular itching/redness: Children ≥6 years and Adolescents: Ophthalmic: Refer to adult dosing.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no adverse reactions listed in the manufacturer's labeling.
Postmarketing: Ophthalmic: Mydriasis (Nakatsuka 2018)
OTC labeling: When used for self-medication, do not use if you have hypersensitivity to naphazoline, pheniramine, or any component of the formulation.
Concerns related to adverse effects:
• Ocular effects: Pupils may become enlarged with use; temporary light sensitivity may occur. Brief tingling after administration may occur.
Disease-related concerns:
• Cardiovascular disease: Use naphazoline with caution in patients with cardiovascular abnormalities or hypertension.
• Diabetes: Use naphazoline with caution in patients with diabetes mellitus.
• Hyperthyroidism: Use naphazoline with caution in patients with hyperthyroidism.
• Infection/injury: Use naphazoline with caution in patients with local infection or injury.
Dosage form specific issues:
• Benzalkonium chloride: May contain benzalkonium chloride which may be absorbed by soft contact lenses.
Other warnings/precautions:
• Appropriate use: For ophthalmic use only. Inadvertent contamination of multiple-dose ophthalmic solutions, has caused bacterial keratitis; avoid contamination.
• Self-medication (OTC use): When used for self-medication (OTC), patients with narrow-angle glaucoma or prostatic hyperplasia should consult health care provider before use. Do not use >72 hours; overuse may cause more eye redness. Notify healthcare provider if eye pain or vision changes occur or if redness or irritation gets worse or lasts >72 hours. Do not use with contact lenses. Do not use if solution changes color or becomes cloudy.
• Accidental ingestion: Accidental ingestion by children of over-the-counter (OTC) imidazoline-derivative eye drops and nasal sprays may result in serious harm. Serious adverse reactions (eg, coma, bradycardia, respiratory depression, sedation) requiring hospitalization have been reported in children ≤5 years of age who had ingested even small amounts (eg, 1 to 2 mL). Contact a poison control center and seek emergency medical care immediately for accidental ingestion (FDA Drug Safety Communication 2012).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, ophthalmic:
Naphcon-A: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (5 mL) [contains benzalkonium chloride; 2 bottles/box], (15 mL) [contains benzalkonium chloride]
Opcon-A: Naphazoline hydrochloride 0.027% and pheniramine maleate 0.3% (15 mL) [contains benzalkonium chloride]
Visine: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (15 mL) [contains benzalkonium chloride, edetate disodium]
Visine-A: Naphazoline hydrochloride 0.025% and pheniramine maleate 0.3% (15 mL) [contains benzalkonium chloride]
Generic: Naphazoline hydrochloride 0.027% and pheniramine maleate 0.315% (15 mL)
Yes
Solution (Naphcon-A Ophthalmic)
0.025-0.3% (per mL): $0.63
Solution (Visine Ophthalmic)
0.025-0.3% (per mL): $0.42
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Ophthalmic: For ophthalmic use only. Remove contact lenses prior to administration. Avoid allowing the tip of the dispensing container to contact the eye or surrounding structures. Do not use if solution changes color or becomes cloudy.
Ophthalmic: For ophthalmic use only. Remove contact lenses prior to administration (solution contains benzalkonium chloride). Avoid allowing the tip of the dispensing container to contact the eye or surrounding structures. Do not use if solution changes color or becomes cloudy.
Ocular itching/redness: Temporary relief of itching and redness of the eye(s) caused by grass, ragweed, pollen, animal dander and hair.
Visine may be confused with Visken
Accidental ingestion: Serious adverse reactions (eg, coma, bradycardia, respiratory depression, sedation) requiring hospitalization have been reported in children ≤5 years of age who have accidentally ingested even small amounts (eg, 1-2 mL) of imidazoline-derivative (ie, tetrahydrozoline, oxymetazoline, or naphazoline) eye drops or nasal sprays. Store these products out of reach of children at all times. Contact poison control or seek medical attention if accidental ingestion occurs.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1-Agonists may antagonize Alpha1-Blocker vasodilation. Risk C: Monitor therapy
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Atropine (Systemic): May enhance the hypertensive effect of Alpha1-Agonists. Risk C: Monitor therapy
Bromocriptine: May enhance the hypertensive effect of Alpha1-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider therapy modification
Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification
Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May enhance the vasoconstricting effect of Alpha1-Agonists. Risk X: Avoid combination
Esketamine: Decongestants (Nasally Administered) may diminish the therapeutic effect of Esketamine. Management: Patients who require a nasal decongestant on an esketamine dosing day should administer the nasal decongestant at least 1 hour before esketamine. Risk D: Consider therapy modification
FentaNYL: Decongestants may decrease the serum concentration of FentaNYL. Risk C: Monitor therapy
Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may diminish the therapeutic effect of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Risk X: Avoid combination
Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination
Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider therapy modification
Lisuride: May enhance the hypertensive effect of Alpha1-Agonists. Risk X: Avoid combination
Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Risk X: Avoid combination
Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Pergolide: May enhance the hypertensive effect of Alpha1-Agonists. Risk C: Monitor therapy
Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Tricyclic Antidepressants: May enhance the therapeutic effect of Alpha1-Agonists. Tricyclic Antidepressants may diminish the therapeutic effect of Alpha1-Agonists. Risk C: Monitor therapy
Zavegepant: Decongestants (Nasally Administered) may decrease the serum concentration of Zavegepant. Management: Avoid the concurrent administration of intranasal decongestants with zavegepant. If combined use is unavoidable, intranasal decongestants should be administered at least 1 hour after zavegepant administration. Risk D: Consider therapy modification
Refer to individual monographs.
Refer to individual monographs.
Naphazoline: Stimulates alpha-adrenergic receptors in the arterioles of the conjunctiva to produce vasoconstriction.
Pheniramine: Inhibits the effect of histamine on conjunctival epithelial cells by preventing its release from mast cells.
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