Topical apraclonidine toxicity in a 4-month-old infant. Issue 1 (1st January 2018)

• Record Type: Journal Article
• Authors: Stayer, Kelsey; Kane, Ann
• Is Part Of: Toxicology communications. Volume 2:Issue 1(2018)
• Page Start: 105
• Page End: 106
• Publication Date: 2018-01-01
• Subjects: Pediatrics -- ophthalmic agents -- alpha-2 agonist -- apraclonidine -- imidazoline; Toxicology -- Periodicals; 615.9005
• DOI: 10.1080/24734306.2018.1544189
• Languages: English
• ISSNs: 2473-4306

Abstract

Abstract: Apraclonidine, a weak alpha-1-agonist and strong alpha-2-agonist, is commonly used in the evaluation of anisocoria related to Horner's Syndrome (HS) in the form of an ophthalmic solution. Apraclonidine is a polar derivative of clonidine favored in the management of ocular hypertension given its comparative efficacy yet decreased incidence of systemic side effects, postulated to be secondary to the decreased permeability of apraclonidine across the mature blood-brain barrier. Despite the favorable adverse effect profile in adults, our case report illustrates that apraclonidine may lead to systemic side effects in infants, especially those less than 6 months of age. Adverse symptoms reported include lethargy, transient hypertension, bradycardia, bradypnea and hypoxia. Parents of infants treated with apraclonidine should receive warning of these potential adverse effects. Outcomes are generally benign. Pediatric and emergency providers should be aware of the potential for apraclonidine to cause an otherwise alarming presentation of a lethargic infant.