What is the proper procedure for prescribing Upneeq (oxymetazoline hydrochloride) for acquired blepharoptosis?

Prescribing Upneeq for Acquired Blepharoptosis

Upneeq (oxymetazoline hydrochloride ophthalmic solution 0.1%) should be prescribed as one drop into the affected ptotic eye(s) once daily, with patients instructed to discard the single-use container immediately after administration. 1

Patient Selection and Pre-Prescription Assessment

Before prescribing Upneeq, evaluate for:

• Confirmation of acquired blepharoptosis diagnosis

• Potential underlying neurologic conditions that may present with ptosis:

  • Stroke or cerebral aneurysm
  • Horner syndrome
  • Myasthenia gravis
  • External ophthalmoplegia
  • Orbital infection or masses 1

• Cardiovascular status:

  • Use with caution in patients with severe/unstable cardiovascular disease
  • Screen for orthostatic hypotension
  • Assess for uncontrolled hypertension or hypotension 1

• Other contraindications:

  • Untreated narrow-angle glaucoma (increased risk of angle closure) 1
  • Cerebral or coronary insufficiency
  • Sjögren's syndrome 1

Prescription Details

1. Dosage form: Oxymetazoline hydrochloride ophthalmic solution 0.1% (equivalent to 0.09% oxymetazoline base) 1
2. Quantity: Prescribe appropriate number of single-use containers (one container per day)
3. Administration: One drop in affected eye(s) once daily 1
4. Duration: Typically 30-day supply with refills as appropriate

Patient Instructions

Provide these specific instructions to patients:

• Remove contact lenses before instillation and wait 15 minutes before reinserting 1
• If using multiple eye medications, wait at least 15 minutes between applications 1
• Do not touch the tip of the container to the eye or any surface to avoid contamination 1
• Discard the single-use container immediately after use, even if medication remains 1
• Store at room temperature (68°F to 77°F/20°C to 25°C) 1
• Protect from excessive heat 1

Monitoring and Follow-Up

• Schedule follow-up within 2-4 weeks to assess:

  • Efficacy (improvement in ptosis)
  • Visual field improvement
  • Any adverse effects

• Monitor for potential adverse reactions:

  • Common (1-5%): punctate keratitis, conjunctival hyperemia, dry eye, blurred vision, instillation site pain, eye irritation, headache 1
  • Signs of angle closure glaucoma: eye pain, redness, blurred vision, photophobia
  • Cardiovascular effects: changes in blood pressure, signs of vascular insufficiency

Clinical Efficacy

Upneeq has demonstrated significant efficacy in clinical trials:

• Improved superior visual field by 5.9 points on day 1 and 7.1 points by day 14 (vs. 1.8 and 2.4 points with placebo) 2
• Increased marginal reflex distance by 0.96 mm on day 1 and 1.16 mm by day 14 (vs. 0.50 mm with placebo) 2

Important Considerations and Pitfalls

• Rule out serious underlying conditions: Ptosis may be the presenting sign of serious neurologic disease; consider appropriate workup before attributing to age-related or aponeurotic causes 1

• Cardiovascular caution: Alpha-adrenergic agonists can impact blood pressure; use with caution in patients with cardiovascular disease 1

• Patient selection: Upneeq is indicated specifically for acquired blepharoptosis in adults, not for congenital ptosis 1

• Medication interactions: Consider potential interactions with other topical ophthalmic medications; ensure appropriate spacing between applications 1

• Limited duration data: While efficacy has been demonstrated in clinical trials, long-term data beyond 6 weeks is limited 2