General Monograph,

Mydriatic – Cycloplegic – Anticholinergic

Homatropine HBr is a tertiary amine anticholinergic agent used topically to produce mydriasis and cycloplegia. It blocks the responses of the iris sphincter and ciliary muscle to cholinergic stimuli. Homatropine is less potent than atropine and has a shorter duration of action. Complete cycloplegia is not usually attainable. The maximum mydriatic effect occurs in about 10 to 30 minutes, and the maximum cycloplegic effect in about 30 to 90 minutes. Mydriasis may last 6 hours to 4 days and cycloplegia may persist 10 to 48 hours.

Indications: To dilate the pupils prior to retinoscopy, in the treatment of uveitis and keratitis and to paralyze accommodation temporarily.

Contraindications: Patients with primary glaucoma or a predisposition to glaucoma; patients whose intraocular pressures are unknown; patients with narrow angle or shallow anterior chambers since they are susceptible to acute angle-closure glaucoma; hypersensitivity to belladonna alkaloids.

Precautions: Measurement of the depth of the angle of the anterior chamber should be obtained prior to administration of homatropine to patients with a predisposition to glaucoma.

Excessive ophthalmic use, especially in children and the elderly, may produce systemic symptoms of atropine poisoning. Do not exceed recommended dosage. Not for frequent or prolonged use. If dryness of the mouth occurs, decrease dosage. Discontinue use if rapid pulse or dizziness occurs. Homatropine may cause an increase in intraocular pressure. If eye pain occurs, discontinue use immediately as this may indicate undiagnosed glaucoma.

Pregnancy: Safety has not been established.

Lactation: Documentation is lacking or conflicting regarding the excretion of anticholinergics (especially atropine) in breast milk and the reduction in breast milk production caused by these drugs. Although there is no documentation of adverse effects in breast-fed infants, it is advisable to closely monitor infants of nursing mothers for anticholinergic side effects.

Children: Young children and infants may be more susceptible to the systemic effects of homatropine.

tag_Adverse Effects:Adverse Effects: Prolonged use may cause local irritation. Increased intraocular pressure may occur, especially in patients with glaucoma (see Precautions). Excessive use may produce atropine-like systemic effects. Low doses may produce dry mouth, thirst, tachycardia, palpitations, constipation, visual disturbances, flushed dry skin and temperature elevation. Higher doses may produce headache, restlessness, excitement, disorientation, delirium and hallucinations.

Dosage: To produce mydriasis and cycloplegia for diagnostic purposes: Adults: Instill one drop of 2% or 5% solution in the eye(s) immediately prior to procedure; may be repeated at 5- to 10-minute intervals as needed.

Children: 1 drop of 2% solution instilled in the eye(s) immediately prior to procedure; may be repeated at 10-minute intervals as needed.

Treatment of Inflammatory Conditions of the Uveal Tract: Adults: 1 drop of 2% or 5% solution instilled in the eye(s) 2 or 3 times daily.

Children: 1 drop of 2% solution 2 or 3 times daily.

HOMATROPINE General Monograph,Mydriatic – Cycloplegic – Anticholinergic

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