Cyclopentolate

S01F - Mydriatics and cycloplegics ATC S01FA04 Small molecule approved 1974 Topical Natural product

JFDA label: Pentolate 1% eye drops

Mechanism of Action

Prevents the muscle of the ciliary body and the sphincter muscle of the iris from responding to cholinergic stimulation, causing mydriasis and cycloplegia

Indications

Approved

Mydriasis/Cycloplegia

Off-label

Anterior uveitis (acute)

Contraindications

Source: Lexicomp

Hypersensitivity to cyclopentolate or any component of the formulation Absolute
presence of untreated anatomically narrow angles Absolute
untreated narrow-angle glaucoma Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Cardiac disorders (1)

Common Tachycardia

Nervous system disorders (7)

Common Ataxia · hallucination · hyperactivity · incoherent speech · psychosis · restlessness · seizure

Immune system disorders (1)

Common Hypersensitivity reaction

Skin and subcutaneous tissue disorders (1)

Common Burning sensation of skin

Eye disorders (2)

Common Accommodation disturbance (loss) · increased intraocular pressure

Dosing

Source: Lexicomp

Mydriasis, cycloplegia: Ophthalmic: Instill 1 or 2 drops of 0.5%, 1%, or 2% solution; may repeat in 5 to 10 minutes; heavily pigmented irides may require use of higher strengths. Anterior uveitis (off-label use): Ophthalmic: Instill 1 drop of 1% solution 3 times daily (AOA [Alexander, 2004]).

(For additional information see "Cyclopentolate: Pediatric drug information") Mydriasis, cycloplegia: Note: Cyclopentolate and phenylephrine combination formulation is the preferred agent for use in infants due to lower cyclopentolate concentration and reduced risk for systemic reactions (Chew, 2005). Infants: Ophthalmic: Instill 1 drop of 0.5% solution as a single dose. Children and Adolescents: Ophthalmic: Instill 1 or 2 drops of 0.5%, 1%, or 2% solution; may repeat with 0.5% or 1% solution in 5 to 10 minutes.

Refer to adult dosing.

There are no dosage adjustments provided in the manufacturer’s labeling.

Warnings & Precautions

Source: Lexicomp

CNS effects

May cause CNS disturbances, especially with the higher concentrations. May occur with any age group, although children are more susceptible.

Intraocular pressure

May cause a transient elevation in intraocular pressure. Disease-related concerns:

Down syndrome

Patients with Down syndrome are predisposed to angle-closure glaucoma; use with caution. Concurrent drug therapy issues:

Drug-drug interactions

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Special populations:

Contact lens wearers

Contains benzalkonium chloride which may be adsorbed by contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.

Elderly

Use with caution in the elderly; may be predisposed to increased intraocular pressure.

Pediatric

May result in psychotic reactions and behavioral disturbances in pediatric patients, especially with the 2% solution; increased susceptibility to these effects has been reported in young infants, young children, and in children with spastic paralysis or brain damage; effects usually occur ~30 to 45 minutes after instillation; observe infants for at least 30 minutes following instillation. Feeding intolerance may occur in infants; withhold feeding for 4 hours after examination. Other warnings and precautions:

Appropriate use

For topical ophthalmic use only. To minimize absorption, apply pressure over the nasolacrimal sac for 2 to 3 minutes after instillation.

Pregnancy & Lactation

Pregnancy

FDA category C

Animal reproduction studies have not been conducted.

Lactation

It is not known if cyclopentolate is excreted in breast milk. The manufacturer recommends that caution be exercised when administering cyclopentolate to nursing women.

Chemistry & Properties

Formula	C17H25NO3
Molecular weight	291.39 g/mol
IUPAC name	2-(dimethylamino)ethyl 2-(1-hydroxycyclopentyl)-2-phenylacetate
CAS	512-15-2
PubChem CID	2905
InChIKey	`SKYSRIRYMSLOIN-UHFFFAOYSA-N`
logP	2.18 (XLogP 2.7)
Polar surface area	49.77 Å²
H-bond acceptors / donors	4 / 1
Drug-likeness (QED)	0.82
Lipinski violations	0

SMILES

CN(C)CCOC(=O)C(c1ccccc1)C1(O)CCCC1

Biology & Pharmacokinetics

Pharmacokinetics

BBB penetrant	No

Enzyme interactions

Enzyme	Role	Detail
CYP1A2	Substrate	—
CYP2C19	Substrate	—
CYP2D6	Substrate	—
CYP3A4	Substrate	—

Transporters

BCRP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)OATP1B3 (Inhibitor)OCTN2 (Inhibitor)P-gp (Inhibitor)P-gp (Substrate)

Registered Products (3)

Brand	Form / strength	Pack	Agent	Citizen (JOD)
Pentolate 1% eye drops	Ophthalmic Solution 1 %	10 ml	Amman Pharmaceutical Industries Co	1.260
Colircusi Cicloplejico E/D	Ophthalmic Solution 10 mg/ml	10 ml	Jarzeem Drug Store	1.520
Minims Cyclopentolate Hcl 1% e/d	Ophthalmic Solution 1 %	0.5 ml	Petra Drug Store	—