Dipivefrin (Ophthalmic)

Dipivefrin is a prescription ophthalmic solution that is used in the treatment of glaucoma.

Overview

What is Dipivefrin?

Dipivefrin, sold under the trade name of Propine, is used to treat glaucoma which has been diagnosed to be open-angle. The drug sinks into the cornea where it turns into epinephrine by the enzymes naturally found in the body. Epinephrine performs several actions on the eye, effectively reducing the pressure that glaucoma patients typically suffer. More effective in the long term on a consistent basis, Dipivefrin is preferred to epinephrine itself.

How does Dipivefrin work?

Dipivefrin is known as a prodrug; it is not in itself active and requires transformation by natural body chemicals and enzymes to become therapeutic in nature. Dipivefrin is the prodrug of epinephrine and enhances absorption of the drug, making it more efficient as the delivery agent for epinephrine, causing fewer side effects at the same time.

What is glaucoma?

Glaucoma is a general name for a group of conditions that affect the eyes. The optic nerve, after being exposed to excessive pressure by the glaucoma condition, begins to deteriorate vision and gets worse over time, eventually leading to blindness. Eye continuously produce fluid to properly operate. This fluid is known as aqueous and it must be increased and decreased at a normal rate to keep eye pressure healthy. Patients suffering from glaucoma do not have the ability to pressurize their eyes at a normal rate, leading to a build-up of aqueous. Dipivefrin, after turning to epinephrine, normalizes the pressure flow in the eye, getting it back to normal and protecting the optic nerve from long term damage. Dipivefrin is not a cure for glaucoma. There is no cure for this condition, but pressure lowering drugs such as Dipivefrin are very commonly prescribed for treatment of the condition.

Conditions Treated

  • Chronic open-angle glaucoma
  • Ocular hypertension

Type Of Medicine

  • Prodrug

Side Effects

Though only a prodrug and not an active medication, Dipivefrin may, though its own mechanism of operation, cause unwanted symptoms and effects during treatment. Some of these unwanted effects may require you to contact your physician on an urgent basis. If you show symptoms like those that follow, contact your doctor immediately:

  • Rapid heart rhythm
  • Hypertension
  • Swollen eyes, eyelids or other irritations such as itching, redness or pain
  • Rash on skin or hives
  • Watery, teary eyes

There are other possible side effects that should not cause concern but may be uncomfortable. Most of these go away after a period of adjustment time, but should they become severe or prolonged, contact your doctor if you show signs of:

  • Vision that is blurry
  • Stinging, burning eyes
  • Headache
  • Light sensitivity
  • Enlarged pupils

There may be other side effects than those listed, so if you have any changes in your health or well being while on Dipivefrin, report these changes to your health care provider.

Dosage

Use Dipivefrin only as your doctor has prescribed it for you. Do not take more of the drug or use it more frequently than your prescription instructs. Doing so could increase your side effect risks or cause an overdose of the drug.

Different patients will require different prescriptions of Dipivefrin, so the following information is a general guide to the dosage prescribed. In general, the eye drops containing Dipivefrin will be prescribed as one drop administered twice daily in adults. The following instructions will be provided as instruction on how to take the dose of Dipivefrin:

  • Wash hands
  • Tilt head back and press a finger gently to the skin below one eyelid
  • Gently make a gap between the eyelid and eye and drop the medicine into the gap
  • Remove finger from the eyelid and close eyes without blinking
  • Keep eyes closed, applying pressure on the inner corner of the eye for one to two minutes
  • Wash hands immediately after administering eye drops
  • Do not touch applicator to eye
  • Keep container tightly closed when not in use

Some doses of Dipivefrin arrive with a special cap known as a C Cap, in which C stands for compliance. This cap assists you with keeping track of your dosage, making sure you take Dipivefrin every day. Before the initial use of the c-cap, turn the cap until the number one or the proper day of the week appears in the cap window. After using the drug, replace the cap and rotate the bottle until you hear a clicking sound, which will indicate your next dose. Every time you use the Dipivefrin, turn the bottle so that the next dose indication appears.

If you miss a dose of Dipivefrin, do not double up if it is near the time you would take your next dose normally. It is better to skip a dose and move forward to the regular schedule than taking more of this drug that prescribed.

Interactions

Medications are prescribed to treat certain conditions, but also come with associated risks. Your own health picture can determine the safety and effectiveness of any drug prescribed for you. If you have had any reactions to other medications that were determined to be allergy-related, make these known to your health care providers in order to insure your safety. Patients who are allergic to preservatives, dyes, foods, animals or other substances should also make these known to their doctor in case of a relationship to the drug.

Only adult patients have been studied with regard to safety and effective treatment with Dipivefrin. Pediatric patients do not typically receive prescriptions of this drug with any regularity. Each patient and doctor must determine the risk and reward outcome of prescribing Dipivefrin to a child.

Geriatric patients have not been studied specifically with regard to use of Dipivefrin, however, there is no expectation that they will react differently than adult patients with regard to this treatment.

There has not been a study on pregnant women or breastfeeding women to determine if they are able to safely take Dipivefrin. Make sure your doctor is aware that you are pregnant or breastfeeding if you have been discussing treatment with this drug. Ultimately, each benefit and risk must be determined and weighed carefully with regard to being prescribed this treatment.

Discuss using Dipivefrin with food or with eating certain types of food for their recommendation to lower any risk of side effect. Use of tobacco products, illegal drugs or alcoholic beverages should also be discussed with your health care provider in case of any known interactions or recommendations.

If you have other ocular problems, Dipivefrin could worsen your condition. Discuss any eye conditions with your doctor and include any medications you are currently taking for these conditions. Disclosure of your medical history as well as any prescription, over the counter, herbal or vitamin therapies to your medical team is recommended.

Patients taking the following prescription drugs are warned that they have reacted negatively in the past with Dipivefrin. If you are on the following medications, warn your physician before being prescribed Dipivefrin:

  • Belladonna, Phenobarbital, ergotamine combination such as Bellamine, Bel-Tabs, Belcomp, Durgal, E-Caff, Eperbel, Ergocaf, Ergomar, etc.
  • Caffeine with ergotamine combinations such as Cafatine, Cafergot, Cafetrate
  • Dikhydroergotamine
  • Ergonovine
  • Ergotrate
  • Ergotamine
  • Methergine
  • Methysergide maleate
  • Methylergonovine
  • Micomp-PB
  • Migergot
  • Migracet
  • Migranal
  • Sansert
  • Spastrin
  • Wigraine

Warnings

Patients who have had the lens of the eye surgically removed have an elevated risk of developing cystoids macular edema with use of Dipivefrin. For this reason, these patients must be treated cautiously with this medication.

Narrow angle glaucoma patients should not be treated with Dipivefrin for any reason. Dipivefrin stimulates the wrong receptors in the nerves, potentially causing abnormal, uneven pupil dilation and provoke acute glaucoma attacks.

Regular visits to your health care provider are mandatory in order to check the pressure in your eyes and determine if there are any ill effects caused by your treatment with Dipivefrin and if there has been any improvement to your condition. Do your best to keep all these appointments for your own safety.

It is possible that the dosage of Dipivefrin you are given will contain inactive ingredients such as preservatives or sulfites, which are potential allergy triggers. If you have had allergies in the past, notify your health care provider or pharmacist prior to taking this drug.

Patients who suffer from hypertension or heart rhythm irregularities should notify their physician prior to taking this drug, as Dipivefrin can exacerbate the symptoms of these diseases.

If swallowed, Dipivefrin could cause overdose symptoms such as breathing trouble or loss of consciousness. Call emergency medical services urgently if this occurs.

Storage

Keep your prescribed amount of Dipivefrin in the original packaging. Do not rinse or attempt to clean the dropper mechanism for any reason. Keep Dipivefrin at room temperature, away from light, moisture or heat exposure. Dipivefrin, as with all other drugs, should be kept out of sight and reach of children and pets. If you have expired Dipivefrin or unused doses of this medication, consult with your doctor or pharmacist on the safest way to dispose of this drug. Never share this medication with other people even if they have the same condition as you.

Summary

Dipivefrin is an ophthalmic solution prescription drug used to treat open angle glaucoma. Known as a prodrug, Dipivefrin has no active ingredient itself. It works by becoming another compound when the body's enzymes connect with and change the substance. In the case of Dipivefrin, it becomes epinephrine once these enzymes have made the transition and works to lower the pressure in the eye due to the fluid build-up irregularity in glaucoma patients.

Thought it is different for every patient, most patients are prescribed one drop to each eye on a twice daily basis. Pediatric patients are not typically prescribed this drug, as there is no data showing if they are at an increased risk for side effects or not. The same holds true for pregnant and breastfeeding women, who are typically not recommended for prescription treatment with Dipivefrin.

Patients who have had the lens of the eye removed or those who have narrow angle type of glaucoma are not recommended for prescription treatment with Dipivefrin and, in fact, could make their conditions worse if they take this drug. Hypertensive patients or those who have heart rhythm conditions should also use caution when being treated with Dipivefrin.

Dipivefrin can be stored at room temperature as long as it does not come in contact with heat, light or moisture. Dipivefrin should be disposed of safely when expired or no longer required. Instructions for safe disposal can be found with your health care professional or your pharmacist. Do not share this medication with others.