Apraclonidine
Glaucoma · Rx
Trade namesIopidine
Drug classAlpha-2 adrenergic agonist (less selective)
Strength0.5%, 1%
AvailabilityRx
Mechanism of actionAlpha-2 agonist (with some alpha-1 activity); reduces aqueous production. Does not cross the blood-brain barrier well, so fewer CNS effects than brimonidine, but marked tachyphylaxis limits chronic use.
Indication / reason for usePrevention/control of post-laser IOP spikes (1% before and after ALT/PI/capsulotomy); short-term adjunct while awaiting surgery. Also a diagnostic aid for Horner syndrome (reverses anisocoria).
Usual adult dosingPeri-laser: 1 drop 1 h before and immediately after. Short-term adjunct: 1 drop TID (rarely useful beyond a month).
PreservativeBAK 0.01%
Contact lensesRemove lenses; reinsert after 15 minutes.
Common / important adverse effectsLid retraction, mydriasis, conjunctival blanching then hyperemia, high rate of allergic blepharoconjunctivitis, dry mouth.
Contraindications & cautionsMAO inhibitor use; severe cardiovascular disease.
Pregnancy / lactationLimited data; short-term use only.
Practice notesIn suspected Horner syndrome, apraclonidine reverses the anisocoria (the denervation-supersensitive miotic pupil dilates).
Chair-side reference only. Dosing, contraindications and pregnancy guidance here are not exhaustive. Confirm against the current prescribing information and the patient’s full history before prescribing or advising.