Phenylephrine and Ketorolac (Omidria) - Uses, Dose, Side effects

Phenylephrine and Ketorolac (Omidria) is a combination of an alpha-adrenergic receptor agonist that dilates the pupil and an NSAID that relieves inflammation and pain. It is used during ocular surgeries for pain and for pupillary dilation.

Phenylephrine and ketorolac Uses:

Ophthalmic surgical irrigation:
- It is added to an ophthalmic irrigation solution to dilate the pupil and maintain pupillary size by preventing intraoperative miosis and reducing postoperative ocular pain during cataract surgery or intraocular lens replacement.

Phenylephrine and Ketorolac (Omidria) Dose in Adults

Phenylephrine and Ketorolac (Omidria) Dose in surgical irrigation:

Ophthalmic: Use diluted irrigation solution as needed during the surgical procedure.

Phenylephrine and Ketorolac (Omidria) Dose in Childrens

Phenylephrine and Ketorolac (Omidria) Dose in surgical irrigation:

Infants, Children, and Adolescents:
- Ophthalmic: Use diluted irrigation solution as needed during the surgical procedure for a single patient.

Phenylephrine and Ketorolac (Omidria) Pregnancy Category: C

After ophthalmic irrigation, there may be minimal systemic exposure.
Because of the risk of premature closure of ductus Arteriosus, the manufacturer suggests that you avoid it during late pregnancy.

Use of phenylephrine or ketorolac during breastfeeding

Ophthalmic irrigation can result in minimal systemic absorption.
It is recommended that breastfeeding mothers use it with caution. They should weigh the risks and benefits to their baby's health against the potential harm to the mother.

Dose in Kidney Disease:

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

Dose in Liver disease:

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

Common Side Effects of Phenylephrine and Ketorolac (Omidria):

Ophthalmic:
- Anterior chamber inflammation

Less Common Side Effects of Phenylephrine and ketorolac:

Central nervous system:
- Foreign body sensation of eye
Ophthalmic:
- Increased intraocular pressure
- Posterior capsule opacification
- Eye irritation

Contraindications to Phenylephrine and Ketorolac (Omidria):

Hypersensitivity to phenylephrine, ketorolac, or any component of the formulation

Warnings and precautions

Hypersensitivity
- Hypersensitivity reactions may occur in patients who are allergic to acetylsalicylic acids, phenylacetic and other non-steroidal anti-inflammatory drugs.
- These medications should not be used by patients with hypersensitivity reactions.
- Aspirin allergy patients may experience bronchospasm, exacerbation or bronchospasm.
Hypertension:
- It is possible to absorb systemically. It is possible to have a minimal amount of absorption after irrigation. However, this may cause an increase in blood pressure.
Ocular light sensitivity:
- It can cause photosensitivity.

Phenylephrine and ketorolac injection: Drug Interaction

Risk Factor C (Monitor therapy)
Alpha1-Blockers	May diminish the vasoconstricting effect of Alpha1-Agonists. Similarly, Alpha1Agonists may antagonize Alpha1-Blocker vasodilation.
AtoMOXetine	May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics.
Cannabinoid-Containing Products	May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol.
Corticosteroids (Ophthalmic)	Nonsteroidal Anti-Inflammatory Agents (Ophthalmic) may enhance the adverse/toxic effect of Corticosteroids (Ophthalmic). Healing of ophthalmic tissue during concomitant administration of ophthalmic products may be delayed. Exceptions: Loteprednol.
Doxofylline	Sympathomimetics may enhance the adverse/toxic effect of Doxofylline.
Guanethidine	May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics.
Prostaglandins (Ophthalmic)	Nonsteroidal Anti-Inflammatory Agents (Ophthalmic) may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents (Ophthalmic) may enhance the therapeutic effect of Prostaglandins (Ophthalmic).
Solriamfetol	Sympathomimetics may enhance the hypertensive effect of Solriamfetol.
Sympathomimetics	May enhance the adverse/toxic effect of other Sympathomimetics.
Tedizolid	May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics.
Tricyclic Antidepressants	May enhance the therapeutic effect of Alpha1-Agonists. Tricyclic Antidepressants may diminish the therapeutic effect of Alpha1-Agonists.
Risk Factor D (Consider therapy modification)
Cocaine (Topical)	May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use.
Linezolid	May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available.
Risk Factor X (Avoid combination)
Ergot Derivatives	May enhance the hypertensive effect of Alpha1-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha1-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline.
Iobenguane Radiopharmaceutical Products	Alpha1-Agonists may diminish the therapeutic effect of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose.
Monoamine Oxidase Inhibitors	May enhance the hypertensive effect of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Exceptions: Linezolid; Tedizolid.

Monitoring Parameters:

None mentioned. Monitor Blood pressure and signs and symptoms of sympathetic overdrive such as tachycardia.

How to administer Phenylephrine and Ketorolac (Omidria)?

It is indicated for ophthalmic use only.
The solution must be diluted before irrigating the eye.
Avoid using it if the irrigation solution is cloudy or contains particulate matter.

Mechanism of action of Phenylephrine and Ketorolac (Omidria):

Ketorolac

It is an NSAID which inhibits both COX-1 cyclooxygenase enzymes and COX-2.
It decreases prostaglandin levels, which reduces surgical pain.
It can also be used to prevent pupillary contractures that are caused by the surgery.

Phenylephrine

It is an alpha-adrenergic receptor antagonist that causes pupillary dilation when it is applied topically to the eyes or intravenously.

Absorption:

After ophthalmic irrigation, it is only minimally absorbed by the systemic circulation.
The plasma concentrations of phenylephrine were 1.2 to 1.4 ng/mL within two hours and plasma concentrations of ketorolac were 1 to 4.2 ng/mL within eight hours following irrigation with diluted phenylephrine/ketorolac solution.