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Ocular: 5% to 15%: Discomfort, hyperemia, pruritus 1% to 5%: Blanching, blurred vision, conjunctivitis, discharge, dry eye, foreign body sensation, lid edema, tearing <1% (Limited to important or life-threatening): Abnormal vision, blepharitis, blepharoconjunctivitis, conjunctival edema, conjunctival follicles, corneal erosion, corneal infiltrate, corneal staining, edema, irritation, keratitis, keratopathy, lid disorder, lid erythema, lid margin crusting, lid retraction, lid scales, pain, photophobia

Other body systems: 1% to 10%: Gastrointestinal: Dry mouth (10%) <3%: Cardiovascular: Arrhythmia, chest pain, facial edema, peripheral edema Central nervous system: Depression, dizziness, headache, insomnia, malaise, nervousness, somnolence Dermatologic: Contact dermatitis, dermatitis Gastrointestinal: Constipation, nausea, taste perversion Neuromuscular & skeletal: Abnormal coordination, myalgia, paresthesia, weakness Respiratory: Asthma, dry nose, dyspnea, parosmia, pharyngitis, rhinitis Postmarketing and/or case reports: Allergic reactions, bradycardia Contraindications Hypersensitivity to apraclonidine, clonidine, or any component of the formulation; use with or within 14 days of MAO inhibitors Warnings/Precautions

Disease-related concerns: • Cardiovascular disease: Use with caution in patients with cardiovascular disease, coronary insufficiency, or recent myocardial infarction. • Vasovagal reactions: Use with caution in patients with history of vasovagal reactions.

Other warnings/precautions: • Monitoring efficacy: The IOP-lowering efficacy observed during the first month of therapy may not always reflect the long-term level of IOP reduction; routinely monitor IOP. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) Hypotensive Agents: May enhance the adverse/toxic effect of other Hypotensive Agents. Risk C: Monitor therapy MAO Inhibitors: May enhance the hypertensive effect of Alpha2-Agonists (Ophthalmic). Risk X: Avoid combination MAO Inhibitors: May enhance the orthostatic hypotensive effect of Orthostatic Hypotension Producing Agents. Risk C: Monitor therapy Pregnancy Risk Factor C ( show table ) Pregnancy Implications Embryocidal effects were observed in some animal studies. There are no adequate and well-controlled studies in pregnant women. Lactation Excretion in breast milk unknown/use caution Pricing: U.S. (Medi-Span®)

Solution (Iopidine Ophthalmic) 0.5% (5 mL): $137.40 1% (1): $22.84 Monitoring Parameters Closely monitor patients who develop exaggerated reductions in intraocular pressure International Brand Names Alfadrops (IN); Iopidine (AR, AT, AU, BE, BF, BG, BJ, BR, CH, CI, CN, DE, DK, ET, FI, FR, GB, GH, GM, GN, GR, HK, HN, IE, IL, IT, KE, KP, LR, LU, MA, ML, MR, MU, MW, MY, NE, NG, NL, NO, NZ, PE, PL, PT, PY, SC, SD, SE, SG, SL, SN, TN, TR, TZ, UG, VE, ZA, ZM, ZW); Iopimax (ES) Mechanism of Action Apraclonidine is a potent alpha-adrenergic agent similar to clonidine; relatively selective for alpha 2 -receptors but does retain some binding to alpha 1 -receptors; appears to result in reduction of aqueous humor formation; its penetration through the blood-brain barrier is more polar than clonidine which reduces its penetration through the blood-brain barrier and suggests that its pharmacological profile is characterized by peripheral rather than central effects. Pharmacodynamics/Kinetics Onset of action: 1 hour Peak effect: Decreased intraocular pressure: 3-5 hours Absorption: Ocular: Systemically absorbed Half-life elimination, systemic: 8 hours Use of UpToDate is subject to the Subscription and License Agreement . Topic 8863 Version 34.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.4 - C21.36 Licensed to: Southeast Alabama Med Ctr | Support Tag: [1105-213.131.41.98-90976AC03E-S244013.14]