Epinal and Cardiovascular

Topically applied epinephrine is systemically absorbed, with the potential for producing clinically significant systemic effects. In cardiac tissues, epinephrine produces positive chronotropic and inotropic effects via stimulation of beta-1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart are increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, extrasystoles, arrhythmia and hypertension have been reported rarely during the use of ophthalmic epinephrine products, but may be more likely if the corneal epithelium is damaged or permeability is increased by tonometry, surgery, inflammation, or topical application of a local anesthetic. Therapy with ophthalmic epinephrine should be administered cautiously in patients with corneal abrasion, sensitivity to sympathomimetic amines, hyperthyroidism or underlying cardiovascular or cerebrovascular disorders, especially coronary insufficiency, cardiac arrhythmia, or hypertension. Dipivefrin, a prodrug of epinephrine, is associated with considerably fewer and milder local and systemic adverse effects and may be preferable in some of these patients.