Alpha-2 Adrenoceptor Agonist (Topical IOP-Lowering Agent) Pregnancy: Not recommended during pregnancy - there are no or limited studies in pregnant women. Breast-feeding should be discontinued during treatment (it is not known whether topically applied apraclonidine is excreted in human milk and a risk to newborns/infants cannot be excluded).

Apraclonidine

Brand names: Iopidine

Apraclonidine is a topical alpha-2 adrenergic agonist used to control or prevent rises in intraocular pressure, including peri-operatively after anterior segment laser procedures.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One drop of apraclonidine 0.5% w/v eye drops instilled into the affected eye(s)

Route: Topical ocular (eye drops, 0.5% w/v) - for ocular use only

Frequency: Three times per day (t.i.d.)

eMC 4.2 (Apraclonidine 0.5% w/v Eye Drops, Solution). Maximum recommended duration of therapy is one month because of loss of effect over time (tachyphylaxis), although some patients may benefit from longer treatment. As apraclonidine will be used alongside other ocular glaucoma therapies, allow an interval of approximately five minutes between instillation of each medicine to prevent washout of the previous dose; eye ointments should be administered last. If the drop does not remain in the eye, the patient should repeat the dose with another drop. Nasolacrimal occlusion or gently closing the eyelid after instillation is recommended to reduce systemic absorption. No special precautions for administration to the elderly. Paediatric population: safety and efficacy in children have not been established and no data are available - apraclonidine 0.5% eye drops are CONTRAINDICATED in children (eMC 4.3). Loss of effect over time should be closely monitored, with periodic visual field evaluation; discontinue if intraocular pressure rises significantly, coinciding with initiation of alternative therapy or pressure-relieving surgery. Discontinue if an ocular intolerance reaction occurs (hyperaemia, pruritus, discomfort, increased lacrimation, lid and conjunctival oedema); these are more common after more than one month of treatment. No data on topical use in renal or hepatic failure, but monitoring of such patients is advised. SEPARATE US PRODUCT (different strength and indication, openFDA - IOPIDINE 1% Ophthalmic Solution): one drop instilled in the scheduled operative eye one hour before initiating anterior segment laser surgery, and a second drop in the same eye immediately upon completion of the procedure; a separate single-dose container for each drop, discarded after use.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

History of severe or unstable and uncontrolled cardiovascular disease, including severe uncontrolled arterial hypertension
Children
Hypersensitivity to any component of the formulation or to systemic clonidine
Patients receiving monoamine oxidase inhibitors, systemic sympathomimetics or tricyclic antidepressants

Side effects

Conjunctivitis, eye pruritus, ocular hyperaemia (very common; the most common reactions overall, in approximately 12-23% of patients)
Eyelid oedema, dry eye, conjunctival follicles, foreign body sensation, eyelid margin crusting, increased lacrimation, ocular discomfort (common)
Headache, dysgeusia (common)
Dry mouth, nasal dryness, rhinitis (common)
Uncommon: depression, nervousness, insomnia, dizziness, somnolence; arrhythmia, chest pain, peripheral oedema; mydriasis, keratitis, reduced visual acuity

Interactions

Monoamine oxidase inhibitors - contraindicated concomitantly (eMC 4.3)
Systemic sympathomimetics - contraindicated concomitantly (eMC 4.3)
Tricyclic antidepressants - contraindicated concomitantly (eMC 4.3)
Other ocular glaucoma therapies - separate instillation by about five minutes to prevent washout; give eye ointments last (eMC 4.2)
US labelling states interactions with other agents have not been investigated

Clinical monograph

How it works

By stimulating alpha-2 adrenergic receptors it reduces aqueous humour production, lowering intraocular pressure.

Prescribing in practice

Tachyphylaxis (loss of pressure-lowering effect over time) limits its use to short-term or adjunctive therapy rather than long-term glaucoma control.
Ocular allergic reactions, including lid oedema and conjunctival hyperaemia, are common and may necessitate stopping treatment.
Use with caution in cardiovascular disease and avoid concurrent use with monoamine oxidase inhibitors.

Monitoring

Monitor intraocular pressure and watch for local allergic responses and any reduction in efficacy with continued use.

Counselling the patient

Report eye redness, swelling or itching, which may indicate an allergic reaction.
Drowsiness or dry mouth can occur; take care if affected.
Use only for the short period directed by your ophthalmologist.

Evidence & guidelines

Apraclonidine is established for preventing post-laser intraocular pressure spikes and as short-term adjunctive therapy in current prescribing references.

Reference: NICE NG81 (Glaucoma: diagnosis and management, 2017 updated 2022); RCOphth Guidelines on glaucoma; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways