Homatropine: Drug information

For additional information see "Homatropine: Patient drug information" and "Homatropine: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: US

Homatropaire

Pharmacologic Category

Anticholinergic Agent, Ophthalmic;
Ophthalmic Agent, Mydriatic

Dosing: Adult

Note: Patients with heavily pigmented irides may require increased dose.

Refraction

Refraction: Ophthalmic: 1 to 2 drops into the affected eye(s); may repeat in 5 to 10 minutes if necessary

Uveitis

Uveitis: Ophthalmic: 1 to 2 drops into the affected eye(s) every 3 to 4 hours

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Homatropine: Pediatric drug information")

Note: Patients with heavily pigmented irides may require increased dose.

Mydriasis and cycloplegia for refraction

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

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

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Adverse Reactions

Frequency not defined:

Endocrine & metabolic: Increased thirst

Gastrointestinal: Xerostomia

Ophthalmic: Eye irritation, photophobia, transient burning or stinging in the eyes

Postmarketing:

Cardiovascular: Tachycardia (Reid 1989)

Nervous system: Ataxia (Rengstorff 1982), confusion (Rengstorff 1982), dysarthria (Rengstorff 1982), hallucination (Rengstorff 1982)

Ophthalmic: Accommodation disturbance (Rengstorff 1982), blurred vision (Rengstorff 1982), eye discomfort (Rengstorff 1982), eye pain (Rengstorff 1982), increased intraocular pressure (Rengstorff 1982), ocular allergy (Rengstorff 1982)

Contraindications

Primary glaucoma or tendency toward glaucoma (eg, narrow anterior chamber angle); hypersensitivity to homatropine or any component of the formulation.

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:

• Older adult: 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: May contain benzalkonium chloride which may be adsorbed by contact lenses (Chapman 1990).

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.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Ophthalmic, as hydrobromide:

Homatropaire: 5% (5 mL)

Generic Equivalent Available: US

Pricing: US

Solution (Homatropaire Ophthalmic)

5% (per mL): $4.16

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.

Administration: Adult

Ophthalmic instillation: Wash hands before and after use. Avoid touching tip of applicator to eye or other surfaces. Finger pressure should be applied to lacrimal sac for 1 to 3 minutes after instillation to decrease risk of absorption and systemic reactions.

Administration: Pediatric

Ophthalmic: Wash hands before and after use. Do not touch tip of container to eye. Contact lenses should be removed before instillation; do not reinsert contact lenses within 15 minutes of drops. Apply gentle pressure to lacrimal sac during and immediately following instillation (2 to 3 minutes) or instruct patient to gently close eyelid after administration, to decrease systemic absorption of ophthalmic drops (Ref).

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.

Medication Safety Issues

Sound-alike/look-alike issues:

Homatropine may be confused with Humatrope, somatropin

Metabolism/Transport Effects

None known.

Drug Interactions

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 drug interactions program by clicking on the “Launch drug interactions program” link above.

Acetylcholinesterase Inhibitors: May decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Acetylcholinesterase Inhibitors. Risk C: Monitor

Aclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Acrivastine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Amantadine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Benperidol: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Benperidol. Risk C: Monitor

Benztropine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Benztropine. Risk C: Monitor

Biperiden: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Biperiden. Risk C: Monitor

Bornaprine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Bornaprine. Risk C: Monitor

Botulinum Toxin-Containing Products: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Bromperidol: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Bromperidol. Risk C: Monitor

Buclizine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Buclizine. Risk C: Monitor

Cannabinoid-Containing Products: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of Cannabinoid-Containing Products. Risk C: Monitor

Chlorprothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Chlorprothixene. Risk C: Monitor

Cimetropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Cimetropium. Risk X: Avoid

CloZAPine: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider Therapy Modification

Cyclizine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Darifenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Darifenacin. Risk C: Monitor

Dicyclomine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dicyclomine. Risk C: Monitor

Dimethindene (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Dimethindene (Systemic). Risk C: Monitor

DroNABinol: Agents with Clinically Relevant Anticholinergic Effects may increase tachycardic effects of DroNABinol. Risk X: Avoid

Eluxadoline: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Eluxadoline. Risk X: Avoid

Fesoterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Fesoterodine. Risk C: Monitor

FluPHENAZine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Gastrointestinal Agents (Prokinetic): Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Gastrointestinal Agents (Prokinetic). Risk C: Monitor

Gepotidacin: May decrease anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Glucagon: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor

Glycopyrrolate (Oral Inhalation): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Oral Inhalation). Risk X: Avoid

Glycopyrrolate (Systemic): Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Glycopyrrolate (Systemic). Risk C: Monitor

Glycopyrronium (Topical): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Ipratropium (Nasal): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Ipratropium (Oral Inhalation): May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Itopride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Itopride. Risk C: Monitor

Levosulpiride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Levosulpiride. Risk X: Avoid

Maprotiline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Maprotiline. Risk C: Monitor

Melperone: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Methotrimeprazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Methotrimeprazine. Risk C: Monitor

Methscopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Methscopolamine. Risk C: Monitor

Mirabegron: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Mirabegron. Risk C: Monitor

Nitroglycerin: Agents with Clinically Relevant Anticholinergic Effects may decrease absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor

OLANZapine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OLANZapine. Risk C: Monitor

Opioid Agonists: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor

Opipramol: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Oxatomide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

OxyBUTYnin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of OxyBUTYnin. Risk C: Monitor

Perazine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Perphenazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Perphenazine. Risk C: Monitor

Potassium Chloride: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid

Potassium Citrate: Agents with Clinically Relevant Anticholinergic Effects may increase ulcerogenic effects of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid

Pramlintide: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. These effects are specific to the GI tract. Risk X: Avoid

Promethazine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Promethazine. Risk C: Monitor

Propantheline: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Propantheline. Risk C: Monitor

Propiverine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

QuiNIDine: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk C: Monitor

Ramosetron: Agents with Clinically Relevant Anticholinergic Effects may increase constipating effects of Ramosetron. Risk C: Monitor

Revefenacin: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Revefenacin. Risk X: Avoid

Rivastigmine: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Rivastigmine. Rivastigmine may decrease therapeutic effects of Agents with Clinically Relevant Anticholinergic Effects. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider Therapy Modification

Scopolamine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Scopolamine. Risk C: Monitor

Secretin: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider Therapy Modification

Sofpironium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Sofpironium. Risk X: Avoid

Thiazide and Thiazide-Like Diuretics: Agents with Clinically Relevant Anticholinergic Effects may increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Thiothixene: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Thiothixene. Risk C: Monitor

Tiapride: Agents with Clinically Relevant Anticholinergic Effects may decrease therapeutic effects of Tiapride. Risk C: Monitor

Tiotropium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tiotropium. Risk X: Avoid

Tolterodine: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tolterodine. Risk C: Monitor

Topiramate: Agents with Clinically Relevant Anticholinergic Effects may increase adverse/toxic effects of Topiramate. Risk C: Monitor

Tricyclic Antidepressants: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Tricyclic Antidepressants. Risk C: Monitor

Trimethobenzamide: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trimethobenzamide. Risk C: Monitor

Trospium: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Trospium. Risk C: Monitor

Umeclidinium: May increase anticholinergic effects of Agents with Clinically Relevant Anticholinergic Effects. Risk X: Avoid

Zuclopenthixol: Agents with Clinically Relevant Anticholinergic Effects may increase anticholinergic effects of Zuclopenthixol. Risk C: Monitor

Pregnancy Considerations

Animal reproduction studies have not been conducted.

Breastfeeding Considerations

It is not known if homatropine is excreted in breast milk. The manufacturer recommends that caution be exercised when administering homatropine to nursing women.

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)

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AR) Argentina: Antiespasmodico veinfar;
(AU) Australia: Homatropine | Isopto homatropine;
(BD) Bangladesh: Homatropine | Matropin;
(BE) Belgium: Homatropine | Homatropine bournonville pharm;
(CZ) Czech Republic: Homatropin;
(DE) Germany: Homatropin | Homatropin pos;
(EC) Ecuador: Espasmogeme;
(ES) Spain: Colircusi homatropina | Colirio Oculos Homatropina | Homatropina Llorens;
(FR) France: Isopto homatropine;
(GB) United Kingdom: Homatropin hydrobromide | Homatropin hydroxide | Homatropine;
(HK) Hong Kong: Homatropine;
(ID) Indonesia: Homatro;
(IN) India: Bell homatropine | Dilide | Ha2 | Homacid | Homarin | Homatropine | Homatropine forte | Homide | Mydryn;
(IT) Italy: Omatropina lux;
(KR) Korea, Republic of: Hanlim homapine | Homapine | Homatropine | Ocuhomapine;
(LT) Lithuania: Homatropin;
(LV) Latvia: Homatropin;
(MX) Mexico: Homo grin;
(MY) Malaysia: Aurohom | Homa | Homacid | Isopto homatropine;
(NG) Nigeria: Homatropine;
(NL) Netherlands: Homatropinehydrobromide | Homatropinehydrobromide ratiopharm;
(NO) Norway: Homatropin;
(NZ) New Zealand: Isopto homatropine;
(PH) Philippines: Isopto homatropine;
(PK) Pakistan: Homatropine | Isopto homatropine;
(PL) Poland: Homatropin;
(PR) Puerto Rico: Homatropine hbr | Isopto homatropine;
(PT) Portugal: Homatrocil;
(SA) Saudi Arabia: Homapin | Homatropin hbr;
(SG) Singapore: Homatropine | Isopto homatropine;
(SK) Slovakia: Homatropin;
(ZA) South Africa: Isopto homatropine

Chapman JM, Cheeks L, Green K. Interactions of benzalkonium chloride with soft and hard contact lenses. Arch Ophthalmol.1990;108(2):244-246. [PubMed 2302109]
Homatropaire (homatropine hydrobromide) [prescribing information]. Aquobogue, NY: Altaire Pharmaceuticals; May 2013.
Reid D, Fulton JD. Tachycardia precipitated by topical homatropine. BMJ. 1989;299(6702):795-796. doi:10.1136/bmj.299.6702.795-d [PubMed 2508935]
Rengstorff RH, Doughty CB. Mydriatic and cycloplegic drugs: a review of ocular and systemic complications. Am J Optom Physiol Opt. 1982;59(2):162-177. [PubMed 7039329]
Urtti A, Salminen L. Minimizing systemic absorption of topically administered ophthalmic drugs. Surv Ophthalmol. 1993;37(6):435-456. [PubMed 8100087]
Zimmerman TJ, Kooner KS, Kandarakis AS, Ziegler LP. Improving the therapeutic index of topically applied ocular drugs. Arch Ophthalmol. 1984;102(4):551-553. [PubMed 6704011]

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Homatropine: Drug information