Alpha-2 Adrenergic Agonist (Ophthalmic) Pregnancy: Avoid — limited data

Apraclonidine

Brand names: Iopidine

Adult dose

Dose: Short-term (perioperative): 1 drop of 1% solution 1h before and immediately after laser surgery. Short-term glaucoma adjunct: 1 drop of 0.5% TDS.

Route: Topical ophthalmic

Frequency: Perioperative doses or TDS (short-term)

Max: 1 drop TDS (0.5% — short-term only)

For prevention of IOP rise after laser procedures and short-term adjunct in glaucoma when other treatments insufficient. NOT for chronic use — tachyphylaxis after 1 month and frequent contact allergy.

Paediatric dose

Route: N/A

Frequency: N/A

Max: Not recommended in children (CNS effects — as brimonidine)

Not recommended in children <6 years; avoid <2 years

Dose adjustments

Renal

Caution in renal impairment

Hepatic

Caution in hepatic impairment

Clinical pearls

Short-term use only: contact allergy develops in up to 30% with chronic use; used perioperatively or for 1–2 month bridge
Post-YAG laser: apraclonidine 1% dramatically reduces IOP spike after Nd:YAG laser capsulotomy/PI — administer 1h before and immediately after
Tachyphylaxis: loss of IOP effect within 3–4 weeks — only bridges to other treatment

Contraindications

MAOIs within 14 days
Severe cardiovascular disease

Side effects

Tachyphylaxis (loss of IOP effect within 1 month)
Contact allergy (10–30% with chronic use — eyelid/conjunctival)
Dry mouth and nose
Lid retraction and lid ptosis (paradoxical)

Interactions

MAOIs — hypertensive crisis

Monitoring

IOP response
Signs of contact allergy
Blood pressure

Reference: BNFc; BNF; RCOphth Glaucoma Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways