Irifrin bk side effects. Irifrin: instructions for use for eye drops

1 ml of a 2.5% solution of the drug contains:

active substance : phenylephrine hydrochloride 25 mg,

Excipients: disodium edetate 1.0 mg, sodium metabisulfite 2.0 mg, citric acid 1.16 mg, sodium citrate dihydrate q.s., hypromellose 3.0 mg, water for injection up to 1 ml.

Clear solution from colorless to light yellow.

Phenylephrine is a sympathomimetic. It has a pronounced alpha-adrenergic activity.

When applied topically in ophthalmology, it causes pupil dilation, improves the outflow of intraocular fluid and constricts the vessels of the conjunctiva.

Phenylephrine has a pronounced stimulating effect on postsynaptic alpha-adrenergic receptors, has a very weak effect on beta-adrenergic receptors of the heart. The drug has a vasoconstrictor effect similar to the action of norepinephrine (norepinephrine), while it has practically no chronotropic and inotropic effects on the heart. The vasopressor effect of phenylephrine is weaker than that of norepinephrine, but is longer lasting. Causes vasoconstriction 30-90 seconds after instillation, duration 2-6 hours.

After instillation, it contracts the pupillary dilator and the smooth muscles of the conjunctival arterioles, thereby causing the pupil to dilate. Mydriasis occurs within 10-60 minutes after a single instillation. Continues after instillation of a 2.5% solution and persists for 2 hours. Mydriasis caused by phenylephrine is not accompanied by cycloplegia.

Phenylephrine easily penetrates into the tissues of the eye, the peak plasma concentration occurs 10-20 minutes after topical application. excreted by the kidneys unchanged (<20%) или в виде неактивных метаболитов.

In patients with type II diabetes - an increased risk of high blood pressure.

In elderly patients, an increased risk of reactive miosis.

Exceeding the recommended dose of a 2.5% solution in patients with injuries, diseases of the eye or its appendages, in the postoperative period, or with reduced tear production may lead to increased absorption of phenylephrine and the development of systemic side effects.

Due to the fact that it causes conjunctival hypoxia - in patients with sickle cell anemia, when wearing contact lenses, after surgical interventions (decreased healing).

In ophthalmology, the most commonly used topical medicines are in the form of eye drops. If you want to expand the pupil or affect the vessels of the eye, alpha-agonists are used, one of which is Irifrin. Especially for children, a preparation without preservatives is produced, called Irifrin BK. When is it prescribed to a child and in what dosage is it dripped?

Release form

The drug is presented as a clear liquid, which has a light yellow tint, but it can also be colorless. The solution is placed in a disposable tube-dropper in the amount of 0.4 ml each. Five of these tubes are packed in a laminated bag, and one carton box includes 3 bags, that is, a total of 15 tubes in a package.

Compound

The active substance in drops is represented by phenylephrine in the form of hydrochloride. Since the solution has a concentration of 2.5%, one milliliter of it contains 25 mg of phenylephrine. The addition to this ingredient are hypromellose, citric acid and disodium edetate. There is also water for injection, sodium metabisulphite and sodium citrate dihydrate in the composition of the drug.

Operating principle

The drug is a group of sympathomimetics that affect alpha-adrenergic receptors. For ophthalmologists, such local effects of Irifrin as vasoconstriction in the conjunctiva, pupil dilation and stimulation of the outflow of intraocular fluid are important.

With a sufficiently strong effect on the alpha receptors of the eyes, the drug has almost no effect on the beta receptors located in the heart. Pupil dilation can be observed in a patient 10-60 minutes after phenylephrine has entered the conjunctiva. The effect of the medicine lasts up to two hours.

Indications

• For diagnostic procedures requiring pupil dilation.
• For the treatment of iridocyclitis.
• With redness and irritation of the mucous membrane of the eyes.
• With high visual load, to prevent spasm of accommodation and asthenopia.
• To relieve spasm of accommodation, as well as to stop progressive myopia.

At what age is it allowed to take?

Annotation for drops does not indicate any age restrictions, but the use of the drug in children under one year old should only be under the supervision of a doctor.

And now we offer you to watch a video on how to properly drip the eyes of a child.

Contraindications

The drug is not used:

• If the child has hypersensitivity to any component of the drops.
• If closed- or narrow-angle glaucoma is diagnosed.
• If the patient has elevated blood pressure, tachycardia or arrhythmia is detected.
• With diabetes.
• If the newborn's body weight is too low.
• If the child has hyperthyroidism.
• With a lack of glucose 6 phosphate dehydrogenase.
• In violation of the integrity of the eye.
• With violations of the production of tears.

Caution in the treatment of Irifrin is required for sickle cell anemia or bronchial asthma, as well as after surgery in the eye area, since such a medication will interfere with healing.

Side effects

The use of drops can cause local reactions such as a burning sensation, swelling in the eye area, inflammation of the conjunctiva, increased intraocular pressure, blurred vision, increased tear secretion, redness, and others. It is also possible the appearance of reactive pupil dilation the next day after using the medication.

In some patients, Irifrin BK can cause dermatitis. In addition, the drug can adversely affect the cardiovascular system, which is manifested by tachycardia, high blood pressure, arrhythmia and other signs.

Instructions for use and dosage

• If ophthalmoscopy is performed, then you need to inject 1 drop of the drug into the conjunctival sac once and wait 15-30 minutes before the examination, and if necessary, prolonged pupil dilation after 1 hour, re-drop the eye.
• In the treatment of iridocyclitis, the drug is dripped two or three times a day, one drop for 5-10 days. More precisely, the duration of therapy is determined by the doctor based on the severity of the disease.
• School-age children with mild myopia are recommended to use Irifrin BK prophylactically, one drop in each eye during a period of high visual load. The drug is used before bedtime.
• If a child has an average degree of myopia and the disease progresses, regular prophylactic use at bedtime three times a week, 1 drop, is prescribed.
• In the treatment of myopia (both true and false), the child is prescribed Irifrin BK for 1 month. The drug is dripped at night 2 or 3 times a week, 1 drop.

Overdose

A very high dose of drops affects the child's behavior (he becomes nervous, restless), heartbeat (it becomes more frequent) and breathing (it becomes weaker). Perhaps the appearance of vomiting, complaints of dizziness, increased sweating. To eliminate these symptoms of an overdose, adrenoblocking drugs, such as phentolamine, are used.

And now we offer a video release of a program on eye diseases from Dr. Komarovsky about children's conjunctivitis.

Interaction with other drugs

• The drug is not advised to combine with antihypertensive drugs and tricyclic antidepressants. It is also incompatible with monoamine oxidase inhibitors.
• If you drip Irifrin BK along with atropine, this will enhance the effect of pupil dilation. However, due to the effect on the vessels, this combination of drugs can cause tachycardia. A similar effect will be in a situation where Irifrin and Midriacil are used simultaneously.
• If local anesthetics are dropped into the eyes before using Irifrin, this will increase the absorption of the drug into the bloodstream and its systemic effects, as well as lengthen the period of pupil dilation.

Terms of sale and storage

The tool is sold in a pharmacy by prescription, and the price of one package is an average of 550-580 rubles. At home, it is advised to store the solution at a temperature of 0 to 25 degrees Celsius. For storage, choose a place protected from direct sunlight, where small children do not have access. Shelf life drops - 2 years. It is impossible to store the opened tube; immediately after instillation, the remainder of the medicine and the opened package are thrown away.

In the pharmacy network, if you have a prescription, you can buy Irifrin eye drops, whose analogues (structural) may seem cheaper. What are the therapeutic effects of the active substance that is part of the drug, how to use the drug, can there be complications during therapy?

Phenylephrine is the main component of Irifrin eye drops. Analogues of the drug containing this active substance are listed below:

• 2.5% "Irifrin BK" ("Pro Med", India) - 522-616 rubles;
• "Vistosan" ("Pharma Allergan", Germany);
• 5% and 10% "Neosynephrine - Pos" 10 ml, 1 pc. (production URSAPARM) - 95-210 rubles;
• "Vizofrin" 2.5% 5 ml - 120-280 rubles;
• 1% 1.0 "Mezaton", eye drops No. 10 ampoules in a package, Russia, "Dalkhimfarm" - 38-54 rubles; 2.5% 1 ml, Ukraine - 85-100 rubles.

Pharmacological effects due to which phenylephrine is used in ophthalmic practice

Phenylephrine belongs to the group of sympathomimetics. When instilling drops in the eyes:

• dilates the pupil for 10-60 minutes, the duration of mydriasis is 2 hours, 10% drops dilate the pupil for 3-7 hours;
• constricts conjunctival vessels within 30-90 seconds after instillation, duration of action up to 2-6 hours;
• stimulates the outflow of intraocular fluid;
• does not significantly stimulate the CNS.

The hypotensive effect of the drug "Irifrin" (eye drops), the analogues of which are indicated above, is used to treat eye pathology. The study of the mechanisms of development of myopia (myopia), the development of ways to prevent its progression remain important problems in ophthalmology. The pressure inside the eye (IOP) in the case of progression of myopia is higher than in emmetropia (normal vision) and stable myopia.

With progressive myopia, large fluctuations in IOP are noted. With deterioration during the course of the disease, the eyeball is stretched due to accommodative overloads (accommodation is a change in the curvature of the lens to clearly focus the image on the retina), causing a relative increase in IOP. This effect is associated with the work of the ciliary muscle (located inside the eye, responsible for changing the curvature of the lens). Groups of drugs that affect its tone and, as a result, reduce intraocular pressure are:

• cholinomimetics (tropic to parasympathetic fibers);
• adrenomimetics (stimulate the sympathetic nervous system).

One of the effects of a cholinomimetic is the stimulation of the ciliary muscle-scleral spur-trabecula chain.

There is a hypotensive effect that occurs under the action of drugs from the pharmacologically opposite group - adrenomimetics. Ophthalmologists prescribe "Irifrin" (analogues: "Mezaton", "Neosynephrine - pos"). The drug prevents the growth of pressure inside the eye and stops the progression of myopia.

With the introduction of a 10% solution of the drug "Irifrin" (analogues: "Vizofrin", "Vistosan", etc.) occurs:

• deepening of the anterior eye chamber;
• increase in supraciliary space;
• pupil dilation.

conclusions

When instilled sympathomimetic changes the tone of the ciliary muscle and becomes less IOP.

"Irifrin" (eye drops), whose analogues are indicated above, reduces pressure in people with emmetropic (normal) refraction (in 79%) and progressive myopia (in 78%) with their high intraocular pressure.

In these patients, it is necessary to slightly reduce IOP using a drug with an antihypertensive effect. It is better to use an adrenomimetic, because it does not increase the tension of parasympathetic fibers in the ciliary muscle and there is no refraction shift towards myopia.

When studying the work of the ciliary muscle, it was clarified that the sympathomimetic reduces the pressure inside the eye. When using 10% drops of "Irifrin" for the eyes (its analogs have the same effect), there is a decrease in IOP in people with normal refraction and in patients with progressive myopia.

When using Irifrin, eye pressure decreases due to stimulation of those parts of the ciliary muscle that are innervated by the sympathetic system. As a result, the supraciliary space expands, and the outflow of fluid from the eye improves.

People with progressive myopia and high IOP need to use "Irifrin" (similar to "Mezaton", etc.) for some pressure reduction.

Combined treatment of spasm of accommodation

Myopia (nearsightedness) very often develops in schoolchildren and students, because they have a large load on vision, which leads to the formation of accommodation spasm. If such a violation persists in patients for a long time, then this causes an increase in the size of the eyeball and the development of first false and then true myopia.

Now there are many conservative tactics for the treatment of such a disorder. They are divided into two groups:

• without the use of drugs;
• medical.

The first are designed to increase the contractility of the ciliary muscle. It:

• exercises;
• ultrasound therapy;
• electrical stimulation of the ciliary muscle;
• magnetotherapy, etc.

Treatment with drugs is aimed at normalizing the work of the ciliary muscle. Recently, this method has become widespread due to the possibility of using it at home.

Since this muscle is innervated by the sympathetic and parasympathetic systems, treatment can be carried out with the simultaneous use of drops of adrenomimetics and M-anticholinergics.

M-cholinolytics weaken the meridional and circular fibers of the radial muscle.

Among these drugs are often used:

• 1% and 0.5% atropine;
• 0.5%, 1% tropicamide;
• 1% cyclopentolate;
• scopolamine.

Another direction in the treatment of accommodation spasm is the use of sympathomimetics. Their work is associated with the stimulation of Ivanov's radial fibers in the ciliary muscle. Due to their strengthening, the work of the muscles of the ciliary body (meridional and circular) is weakened. The activity of sympathomimetics has two effects: the Ivanov muscle that disturbs accommodation increases and the Brücke and Müller muscles weaken. Among the drugs with such an effect, Irifrin drops (analogous to Mezaton 1%, etc.) have become widespread.

To test the effectiveness of combination therapy, patients received the following treatment. Daily 1 cap. 1 p./day 2.5% drops of "Irifrin" (similar to "Irifrin BK", etc.). M-anticholinergics - 1% "Midriacil" ("Tropicamide") was added to the instillation of "Irifrin". Buried 1 month. As a result of treatment, it was proved that this combination significantly reduced the severity of spasm.

The study of pupil diameter under normal conditions and the effect of "Irifrin" on its width in healthy people and in people with glaucoma

In patients with glaucoma, the pupil diameter under normal conditions is about 4.5 mm. It is smaller than in healthy people (approximately 5.1 mm). The smaller the pupil diameter, the more the disease progresses.

Open-angle glaucoma is a serious eye disease. It has a chronic course and leads to disability and blindness. The annual increase in blindness from glaucoma continues. Recently, ideas about its development have changed. New approaches to diagnostics have emerged. Now both the optic nerve head and the state of the retina are being evaluated.

Glaucoma often occurs and develops asymmetrically. Its asymmetry manifests itself from the onset of the disease. In recent decades, there have been great advances in the study of the asymmetry of the back of the eyeball. During the inspection of the bottom of the eye evaluate:

• glaucomatous atrophy of the optic disc;
• thinning and smoothing of nerve endings, etc.

Asymmetry in glaucoma is determined by the defeat of the posterior and anterior segments of the eye. This applies to:

• violations of the pigment border of the iris;
• changes in the components of the angle of the anterior eye chamber, etc.

With glaucoma, the motor activity of the pupil is also disturbed:

• dilatation of the pupil in patients with glaucoma is difficult when instilled with mydriatics;
• the amplitude of the pupil dilation decreases already at the beginning of the formation of glaucoma in comparison with the norm.

Rules for the "irifrin test": instilled three times with an interval of 5 minutes to establish the asymmetry of the diameter of the pupils in the eyes and the level of their expansion. Pupil size is measured before and after 3 injections of Irifrin 45 minutes after the last injection.

When studying pupil diameter under normal conditions in healthy people and people with glaucoma and evaluating the effect of phenylephrine on the pupil, a decrease in its dilation in glaucoma patients was noted due to a change in the function of the iris, which develops along with the progression of the disease.

In healthy people, there is a normal asymmetry in the width of the pupils. The difference range is 0.42 mm.

The smaller diameter of the pupils under normal conditions and their worse expansion after the introduction of a sympathomimetic indicates the presence of glaucoma.

An increase in pupillary difference of more than 0.5 mm after the administration of phenylephrine is a manifestation of pathology. With such a difference in their diameter, glaucoma should be excluded.

The sensitivity of the test is 76%, the specificity is 94%.

"Irifrin" (eye drops): instructions, analogues of the drug

It is a colorless or light yellow, clear solution from India. 1 ml contains 25 or 100 mg of phenylephrine, preservatives, excipients, water.

2.5% eye drops are widely used on an outpatient basis, at home, as prescribed by an ophthalmologist.

10% drops are more often used in hospitals during preparation for operations, diagnostic procedures due to the high risk of complications, especially in the elderly and children.

It has a structural analogue of "Irifrin" (eye drops). This is Irifrin BK. This preparation does not contain preservatives and does not cause a burning sensation when used. The active substance in it is unstable. Therefore, the medicine is sold in disposable vials that cannot be stored after opening. You can replace "Irifrin" (eye drops). Analogues are cheaper, and the active substance and effects of the drug remain the same.

For example, the cost of "Irifrin" 2.5% - 342-449 rubles, and "Neosynephrine - Pos" 5% 10 ml - 95-210 rubles.

It should be remembered when replacing "Irifrin": analogues are not always cheaper, you can also lose as a treatment. It will cost more.

In the drug "Irifrin" instructions for use (analogues have the same indications) indicate that it is used for:

• therapy of iridocyclitis and iritis, often complicated by pressure fluctuations inside the eye;
• dilation of the pupil (10% drops) in eye surgery during preparation for surgery, before laser correction in the fundus;
• diagnostic expansion of the pupil for examination of the posterior part of the eye;
• performing a test in patients with suspected glaucoma and a narrow angle in the anterior eye chamber;
• treatment of glaucoma crises;
• accommodation spasm therapy;
• treatment of myopia;
• fight against the "red eye" syndrome (2.5% drops);
• in the complex therapy of open-angle glaucoma.

Purpose features

A solution of phenylephrine 2.5% for iridocyclitis (10% in a hospital) is dripped into the conjunctiva of the diseased eye 1 drop 2-3 times a day.

Before the operation, 30-60 minutes before, 10% "Irifrin" is dripped once to open the pupil. When the shells of the eye are opened, it is impossible to bury the drug again.

For ophthalmoscopy, 1 drop of a 2.5% solution is used once. Maximum mydriasis occurs within 15-30 minutes. and is held for 1-3 hours. If the expansion of the pupil needs to be extended, then after 1 hour the drug can be re-introduced.

A 2.5% solution of drops is administered once:

• for diagnostics in people with suspected glaucoma and the presence of a narrow angle in the anterior chamber, with a pressure difference before and after the introduction of "Irifrin" of 3-5 mm. rt. Art. - the test is positive;
• to diagnose the cause of redness of the vessels of the eye, if after instillation h / s 5 min. the vessels of the eye are narrowed, then the expansion is superficial, with persistent hyperemia, additional examination is necessary to exclude scleritis or iridocyclitis.

If the pupil was not dilated enough or the pigmentation of the iris is pronounced, then a 10% drop can be used for diagnosis.

Adults and children over 6 years old for the treatment of accommodation spasm are prescribed 1 drop of a 2.5% solution in both eyes at night every day for a month.

With a steady spasm of accommodation, it is possible to use 10% drops in children over 12 years old and adults - 1 drop at night for 2 weeks.

In glaucoma crises, due to the vasoconstrictor effect of phenylephrine, intraocular pressure decreases. The result is better with instillation of 10% drops. To stop the crisis, the drug is administered 2-3 times a day.

10% drops are not used for irrigation, injection under the conjunctiva, wetting tampons during operations.

Side effects of eye drops containing phenylephrine

From the side of the eyes:

• periorbital edema;
• conjunctivitis;
• burning at the beginning of use;
• lacrimation;
• redness;
• blurred vision;
• increased pressure inside the eye.

The next day from the start of using Irifrin, the pupil may narrow. With repeated instillation during this period, pupil dilation (mydriasis) may be less than the day before. This effect occurs more often in the elderly.

From the side of the heart and blood vessels are possible:

• interruptions;
• heartbeat;
• bradycardia;
• increased pressure, up to hypertensive crises;
• heart attack;
• pulmonary embolism;
• collapse;
• hemorrhagic stroke.

Skin manifestations: contact dermatitis.

Contraindications

Relative and absolute contraindications to the use of phenylephrine in the form of eye drops are:

• allergy to the components of the drug;
• elderly age;
• glaucoma;
• vascular and heart diseases;
• violation of tear production and integrity of the eye;
• hepatic porphyria;
• thyrotoxicosis;
• hereditary enzyme deficiency;
• arterial aneurysms;
• 10% solution for children under 12;
• combination with MAO inhibitors (you can start taking 3 weeks after stopping the intake of inhibitors).

Pregnancy and lactation

The medicine can cause early labor and fetal growth retardation. The effect of the drug in these conditions in women has not been studied enough. Therefore, the appointment of "Irifrin" and analogues in these patients should be made only if the benefit of treatment for the mother is greater than the risk to the infant or fetus.

Overdose

It is manifested by agitation, irritability, tearfulness, anxiety, dizziness, nausea, vomiting, tachycardia, arrhythmia, shallow and rare breathing.

Antidote - alpha-blocker.

Release the drug on prescription. Keep out of the reach of children, protected from light, at a temperature not exceeding 25°C. Can't be frozen. Valid for 2 years. You can use it for a month after opening the bottle.

After reading the section that describes "Irifrin", instructions, analogues, you must remember that the drug can only be used as directed by a doctor. The instruction is intended only for acquaintance with the substance.

"Irifrin" (eye drops): reviews. Are analogues better or worse?

The main side effects in the reviews on the use of "Irifrin" and its analogues ("Mezaton", "Neosynephrine - POS"), patients note lacrimation, burning of the eyes after instillation, they occur less frequently when using 1% mezaton and are almost absent in Irifrin BK.

Many are concerned about pupil dilation, which is retained in some people in the morning, decreased vision and redness of the eyes. These effects are more pronounced at the beginning of treatment, in most people gradually decrease over the course of a week.

Some patients practically do not feel side effects, many note an improvement in vision, a decrease in pain and redness of the eyes.

Many people note the high price of "Irifrin" and the possibility of using it for a month after the drug was opened.

Some analogues of the drug are cheaper, but can only be used after opening for a week ("Mezaton"). "Irifrin BK" is generally specially packaged in containers for single use.

Many tolerate Irifrin well. Analogues (reviews confirm this) sometimes it was necessary, for various reasons, to replace the original medicine.