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Homatropine: Drug information

Homatropine: Drug information
(For additional information see "Homatropine: Patient drug information" and see "Homatropine: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (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: Hepatic 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: Hepatic 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. [DSC] = Discontinued product

Solution, Ophthalmic, as hydrobromide:

Homatropaire: 5% (5 mL)

Generic: 5% (5 mL [DSC])

Generic Equivalent Available: US

Yes

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

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Risk C: Monitor therapy

Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Risk C: Monitor therapy

Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Risk C: Monitor therapy

Chlorprothixene: Anticholinergic Agents may enhance the anticholinergic effect of Chlorprothixene. Risk C: Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination

CloZAPine: Anticholinergic Agents may enhance the constipating effect 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

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X: Avoid combination

Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Risk C: 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. Risk C: 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. Risk C: Monitor therapy

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: 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. Risk X: Avoid combination

Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect 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 combination

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Risk X: Avoid combination

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy

Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Risk X: Avoid combination

Rivastigmine: Anticholinergic Agents may diminish the therapeutic effect of Rivastigmine. Rivastigmine may diminish the therapeutic effect of Anticholinergic Agents. 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

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. Risk D: Consider therapy modification

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination

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 | Dallapasmo | Espasmotropin | Homatropina fabra | Homatropina lafedar | Paratropina;
  • (AU) Australia: Homatropine | Isopto homatropine;
  • (BD) Bangladesh: Homatropine | Matropin;
  • (BE) Belgium: Homatropine | Homatropine bournonville pharm;
  • (BR) Brazil: Homatropin | Novatropina;
  • (CL) Chile: Aspasmon;
  • (CO) Colombia: Espagen;
  • (CZ) Czech Republic: Homatropin;
  • (DE) Germany: Homatropin | Homatropin pos;
  • (EC) Ecuador: Espasmogeme | Sedotropina;
  • (EG) Egypt: Novatropine;
  • (ES) Spain: Colircusi homatropina | Colirio Oculos Homatropina | Homatropina Llorens;
  • (FR) France: Isopto homatropine;
  • (GB) United Kingdom: Homatropin hydrobromide | Homatropin hydroxide | Homatropine;
  • (GR) Greece: Nopar;
  • (HK) Hong Kong: Homatropine;
  • (ID) Indonesia: Homatro;
  • (IN) India: Bell homatropine | Ha2 | Homacid | Homarin | Homatropine | Homatropine forte | Homide | Mydryn;
  • (IQ) Iraq: Anti spasdain | Antiespasmeen d | Antispasmine | Antispasmine.d | Spasmol;
  • (IT) Italy: Omatropina lux;
  • (KR) Korea, Republic of: Hanlim homapine | Homapine | Homatropine | Ocuhomapine;
  • (LT) Lithuania: Homatropin;
  • (LV) Latvia: Homatropin;
  • (MX) Mexico: Homatropil | Homo grin | Infafren simple;
  • (MY) Malaysia: Aurohom | Homa | Homacid | Isopto homatropine;
  • (NG) Nigeria: Homatropine | Nospamin;
  • (NL) Netherlands: Homatropinehydrobromide | Homatropinehydrobromide ratiopharm;
  • (NO) Norway: Homatropin;
  • (NZ) New Zealand: Isopto homatropine;
  • (PE) Peru: Colitropina | Dolotropin | Novatropina | Sedotropina;
  • (PH) Philippines: Isopto homatropine;
  • (PK) Pakistan: Homatropine | Isopto homatropine;
  • (PL) Poland: Homatropin;
  • (PR) Puerto Rico: Homatropine hbr | Isopto homatropine;
  • (PT) Portugal: Homatrocil;
  • (PY) Paraguay: Homatropina quimfa | Paratropina;
  • (SA) Saudi Arabia: Homapin | Homatropin hbr;
  • (SG) Singapore: Homatropine | Isopto homatropine;
  • (SK) Slovakia: Homatropin;
  • (UY) Uruguay: Bernardtropina | Homatropina | Metilbromuro de Homatropina Veinfar | Paratropina;
  • (VE) Venezuela, Bolivarian Republic of: Litropina;
  • (ZA) South Africa: Isopto homatropine
  1. 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]
  2. Homatropaire (homatropine hydrobromide) [prescribing information]. Aquobogue, NY: Altaire Pharmaceuticals; May 2013.
  3. 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]
  4. 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]
  5. Urtti A, Salminen L. Minimizing systemic absorption of topically administered ophthalmic drugs. Surv Ophthalmol. 1993;37(6):435-456. [PubMed 8100087]
  6. 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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