Cardiovascular effects of epinephrine and dipivalyl epinephrine applied topically to the eye in patients with glaucoma.

The cardiovascular effects of topical ophthalmological preparations of 2% epinephrine (EPI), 0.1% dipivalyl epinephrine (DPE), and placebo were studied in double-blind fashion in 20 patients with glaucoma. Both drugs and placebo produced a decrease in heart rate (2 +/- 3 beats/min) which, although small, was highly significant (p less than 0.001). Neither drug not placebo produced a significant effect on mean or systolic blood pressure (BP) over the group as a whole (p greater than 0.1). However, 5 of 20 patients responded to EPI with a significant rise in mean or systolic BP (defined as a change greater than mean change +/- 2 SD), whereas there were no such responses to DPE or placebo. One patient developed marked ventricular ectopy after EPI. We conclude that EPI may cause cardiovascular side effects in a high percentage of patients (25% in this study) through individual susceptibility rather than a predictable effect. DPE, a new epinephrine analogue, appears to be devoid of these effects.