cyclopentolate hydrochloride: clinical use

Prescribing considerations

• Assess anterior-chamber depth and angle-closure risk before use in susceptible patients.
• Use particular caution in infants, premature babies and people susceptible to belladonna alkaloids because systemic toxicity is more likely.
• Exercise caution with cardiovascular disease, epilepsy, ataxia, dementia, myasthenia gravis, gastrointestinal obstruction, toxic megacolon, dry nasal mucosa or obstructive urinary disorders.
• Punctal occlusion reduces nasolacrimal absorption and is especially important in children and other higher-risk groups.

Contraindications and cautions

• Hypersensitivity to cyclopentolate or an excipient.
• Narrow-angle glaucoma or a predisposition to angle closure, including a shallow anterior chamber.
• Children with organic brain syndromes, including congenital or neurodevelopmental abnormalities that predispose to seizures.

Monitoring

• Ensure vision has cleared before driving or hazardous tasks.
• Observe paediatric patients for systemic anticholinergic or neurological reactions after administration.
• In premature infants, monitor urgently for bradycardia, vomiting, feeding intolerance, abdominal distension or bloody stools.
• Consider intraocular-pressure monitoring in patients at risk of glaucoma.

Clinical pharmacology

A synthetic tertiary-amine antimuscarinic producing mydriasis and cycloplegia. Systemic absorption can occur through the cornea, skin and nasolacrimal or nasal mucosa.

Formulation and product differences

• Selected Minims products are available in two strengths as clear, preservative-free, sterile single-use eye drops.
• Systemic toxicity is concentration-related and is less likely with the lower-strength solution, although children remain more susceptible than adults.
• Each unit contains hydrochloric acid for pH adjustment and purified water and should be discarded after one use.

Eye drops

Route: Ophthalmic

Strengths: 0.5%, 1.0%, 1%