What is a key safety concern with dipivefrin, an epinephrine prodrug, in glaucoma therapy?

• A. Systemic adrenergic effects such as tachycardia and hypertension; caution in cardiovascular disease.
• B. Only ocular dryness with no systemic effects.
• C. Immediate cataract formation.
• D. Severe conjunctival scarring.

Answer: (A)

Dipivefrin is an epinephrine prodrug used to lower intraocular pressure by increasing outflow, but it can generate epinephrine in the eye that enters the systemic circulation. The key safety concern is systemic adrenergic effects, especially tachycardia and hypertension from alpha- and beta-adrenergic stimulation. This is why it must be used with caution in patients with cardiovascular disease or other conditions that could be worsened by systemic adrenergic activity. Other effects are typically local or less significant, and the options claiming only ocular dryness or immediate cataract formation or severe scarring don’t capture the main safety issue with this drug.