Introduction

Mydriatic and cycloplegic; tertiary amine antimuscarinic.

Uses for Homatropine

Ophthalmologic Examination

Used to produce mydriasis and cycloplegia for refraction. However, because homatropine has prolonged mydriatic and relatively weak cycloplegic effects, other antimuscarinics may be preferred.

Ophthalmic Inflammation

Management of acute inflammatory conditions (e.g., iridocyclitis) of the uveal tract.

Perioperative Mydriasis

Used for pre- and postoperative states when mydriasis is required.

Axial Lens Opacities

Used as an optical aid in some cases of axial lens opacities.

Homatropine Dosage and Administration

General

• Prior to initiation of therapy, estimate depth of the angle of the anterior chamber to avoid induction of angle-closure glaucoma in susceptible patients.

Administration

Ophthalmic Administration

Apply topically to eye(s) as an ophthalmic solution.

For topical ophthalmic use only. Not for injection.

Following topical application, apply finger pressure on lacrimal sac for 2–3 minutes to avoid excessive systemic absorption.

Avoid contamination of solution container.

Dosage

Available as homatropine hydrobromide; dosage expressed in terms of the salt.

In patients with heavily pigmented irides, higher dosages may be required.

Pediatric Patients

Use only the 2% solution in pediatric patients.

Ophthalmologic Examination

Ophthalmic

1 drop of a 2% solution in the eye(s) immediately before the procedure; may repeat at 10-minute intervals as necessary.

Ophthalmic Inflammation

Ophthalmic

1 drop of a 2% solution in the eye(s) 2 or 3 times daily.

Adults

Ophthalmologic Examination

Ophthalmic

1 or 2 drops of a 2 or 5% solution in the eye(s) immediately before the procedure; may repeat in 5–10 minutes if necessary.

Ophthalmic Inflammation

Ophthalmic

1 or 2 drops of a 2 or 5% solution in the eye(s) 2 or 3 times daily or, if necessary, up to every 3–4 hours.

Special Populations

No special population dosage recommendations at this time.

Contraindications

• Known or suspected angle-closure (narrow-angle) glaucoma or a predisposition to angle-closure glaucoma.

• Known hypersensitivity to homatropine or any ingredient in the formulation.

Warnings/Precautions

Warnings

Concomitant Conditions

Consider risks and benefits in patients with keratoconus (homatropine may produce fixed dilated pupil), Down’s syndrome, and children with brain damage.

Sensitivity Reactions

Discontinue if signs or symptoms of sensitivity occur during treatment.

General Precautions

Systemic Effects

Excessive use, especially in children, geriatric patients, or other susceptible individuals, may produce adverse systemic antimuscarinic effects, including delirium, agitation, and coma. Parenteral physostigmine is the recommended antidote for systemic anticholinergic symptoms.

Specific Populations

Pregnancy

Category C.

Lactation

Not known whether homatropine is distributed into milk. Caution when used in nursing women.

Pediatric Use

Safety and efficacy not established in pediatric patients.

Use with extreme caution in infants and young children because of increased susceptibility to the systemic effects of the drug in these patients. Consider risks and benefits of use in children with brain damage.

Geriatric Use

No substantial differences in safety or efficacy relative to younger adults.

Use cautiously due to increased susceptibility to the systemic effects of the drug in geriatric patients.

Common Adverse Effects

Elevated IOP, transient stinging, burning. With prolonged administration, local irritation (characterized by follicular conjunctivitis, vascular congestion, edema, exudate, and eczematoid dermatitis ), thirst, dry mouth, increased light sensitivity of eyes.

General

• Prior to initiation of therapy, estimate depth of the angle of the anterior chamber to avoid induction of angle-closure glaucoma in susceptible patients.

Administration

Ophthalmic Administration

Apply topically to eye(s) as an ophthalmic solution.

For topical ophthalmic use only. Not for injection.

Following topical application, apply finger pressure on lacrimal sac for 2–3 minutes to avoid excessive systemic absorption.

Avoid contamination of solution container.

Dosage

Available as homatropine hydrobromide; dosage expressed in terms of the salt.

In patients with heavily pigmented irides, higher dosages may be required.

Pediatric Patients

Use only the 2% solution in pediatric patients.

Ophthalmologic Examination

Ophthalmic

1 drop of a 2% solution in the eye(s) immediately before the procedure; may repeat at 10-minute intervals as necessary.

Ophthalmic Inflammation

Ophthalmic

1 drop of a 2% solution in the eye(s) 2 or 3 times daily.

Adults

Ophthalmologic Examination

Ophthalmic

1 or 2 drops of a 2 or 5% solution in the eye(s) immediately before the procedure; may repeat in 5–10 minutes if necessary.

Ophthalmic Inflammation

Ophthalmic

1 or 2 drops of a 2 or 5% solution in the eye(s) 2 or 3 times daily or, if necessary, up to every 3–4 hours.

Special Populations

No special population dosage recommendations at this time.