lidocaine hydrochloride + phenylephrine hydrochloride + tropicamide: clinical use

Prescribing considerations

• Restricted to adult cataract surgery and administration by an ophthalmic surgeon.
• Confirm satisfactory pupil dilation with topical mydriatic therapy at pre-operative assessment.
• Clinical experience is absent or limited in uncontrolled or insulin-dependent diabetes, corneal endothelial disease, previous uveitis, ocular trauma or pupillary abnormalities, very dark irides and combined corneal transplantation.
• Not recommended with combined vitrectomy, a shallow anterior chamber or a history of acute narrow-angle glaucoma.
• Consider phenylephrine-related cardiovascular and endocrine cautions and lidocaine-related neurological, cardiac, respiratory and severe renal cautions despite low expected systemic exposure.

Contraindications and cautions

• Hypersensitivity to tropicamide, phenylephrine, lidocaine or an excipient.
• Known hypersensitivity to amide-type local anaesthetics.
• Known hypersensitivity to atropine derivatives.

Monitoring

• Assess pupil response and relevant anterior-chamber, iris and corneal risk factors before use.
• Monitor the operative eye for inadequate dilation, iris complications and corneal endothelial concerns.
• After surgery, assess promptly for raised intraocular pressure, retinal swelling, inflammation, pain or deteriorating vision.

Clinical pharmacology

Tropicamide is an antimuscarinic mydriatic and cycloplegic; phenylephrine is a direct alpha-adrenergic mydriatic with little cycloplegic effect; lidocaine is an amide local anaesthetic that stabilises neuronal membranes by blocking impulse conduction. Systemic concentrations following intracameral use are generally undetectable or very low.

Formulation and product differences

• The selected product is a sterile, clear to slightly brownish-yellow intracameral solution in a single-use glass ampoule.
• It is for single-eye use and should be used immediately after opening.
• A sterile filter needle is supplied separately or in the same blister depending on the pack presentation.
• The formulation is essentially sodium-free.