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Pronunciation

(dye PI ve frin)

Generic Available (U.S.)

No

Index Terms

• Dipivalyl Epinephrine
• Dipivefrin Hydrochloride
• DPE

Brand Names: Canada

• Ophtho-Dipivefrin™
• PMS-Dipivefrin
• Propine®

Pharmacologic Category

• Alpha/Beta Agonist
• Ophthalmic Agent, Antiglaucoma
• Ophthalmic Agent, Vasoconstrictor

Pharmacologic Category Synonyms

• Adrenergic Agonist, Alpha/Beta
• Antiglaucoma Agent, Ophthalmic
• Glaucoma Treatment, Ophthalmic
• Vasoconstrictor, Ophthalmic

Use: Labeled Indications

Reduces elevated intraocular pressure in chronic open-angle glaucoma; also used to treat ocular hypertension, low tension, and secondary glaucomas

Pregnancy Risk Factor

B

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies when administered orally. Systemic adverse events (eg, arrhythmias, hypertension) have been reported following ophthalmic application; use is not recommended in pregnancy (Razeghinejad, 2011).

Lactation

Excretion in breast milk unknown/use caution

Breast-Feeding Considerations

Systemic adverse events (eg, arrhythmias, hypertension) have been reported following ophthalmic application; use is not recommended in breast-feeding women (Razeghinejad, 2011).

Contraindications

Hypersensitivity to dipivefrin, any component of the formulation, or epinephrine; angle-closure glaucoma

Warnings/Precautions

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with cardiovascular disease.

• Hypertension: Use with caution in patients with hypertension.

Special populations:

• Aphakic patients: Use with caution in aphakic patients.

Dosage form specific issues:

• Sodium metabisulfite: Product may contain sodium metabisulfite.

Adverse Reactions

1% to 10%:

Central nervous system: Headache

Local: Burning, stinging

Ocular: Blepharoconjunctivitis, blurred vision, bulbar conjunctival follicles, cystoid macular edema, ocular congestion, ocular pain, mydriasis, photophobia

<1%: Arrhythmias, hypertension

Metabolism/Transport Effects

None known.

Drug Interactions

Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Cannabinoids: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Ergot Derivatives: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Exceptions: Ergoloid Mesylates. Risk X: Avoid combination

Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X: Avoid combination

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Risk D: Consider therapy modification

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Risk D: Consider therapy modification

Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

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

Storage

Avoid exposure to light and air. Discolored or darkened solutions indicate loss of potency.

Mechanism of Action

Dipivefrin is a prodrug of epinephrine which is the active agent that stimulates alpha- and/or beta-adrenergic receptors increasing aqueous humor outflow

Pharmacodynamics/Kinetics

Ocular pressure effect:

Onset of action: ~30 minutes

Duration: ≥12 hours

Mydriasis:

Onset of action: ~30 minutes

Duration: Several hours

Absorption: Rapid into aqueous humor

Metabolism: Converted to epinephrine

Dosage

Adults: Ophthalmic: Instill 1 drop every 12 hours into the eyes

Patient Education

May cause transient burning or stinging

Geriatric Considerations

Use with caution in patients with heart disease. Evaluate the patient's or caregiver's ability to safely administer the correct dose of ophthalmic medication.

Anesthesia and Critical Care Concerns/Other Considerations

Systemic absorption can occur, although minimal.

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

None reported

Mental Health: Effects on Psychiatric Treatment

None reported

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, ophthalmic, as hydrochloride [drops]:

Propine®: 0.1% (10 mL [DSC]) [contains benzalkonium chloride]

References

Razeghinejad MR, Tania Tai TY, Fudemberg SJ, et al, "Pregnancy and Glaucoma," Surv Ophthalmol, 2011, 56(4):324-35.

International Brand Names

• D Epifrin (DE)
• D'epifrin (PL)
• Difrin (IL)
• Diopine (ES, GR, NL)
• Diopine-C (MX)
• Dipoquin (NZ)
• Diprine (TW)
• Glaucothil (AT, DE)
• Glaudrops (ES)
• Oftanex (PL)
• Pivepol (PL)
• Propine (AE, AU, BE, BH, BR, CY, EG, FI, FR, GB, IE, IN, IQ, IR, IT, JO, KW, LB, LY, NO, OM, PT, QA, SA, SG, SY, TH, TR, YE)

Lexi-Comp.com

Last full review/revision February 2012

Content last modified February 2012