Ropinirole Ophthalmic

What is ropinirole ophthalmic?

Ropinirole ophthalmic (Clevor®) is the first FDA-approved drug for inducing vomiting in dogs. On-label directions state that this drug should be administered by veterinary personnel.

Your veterinarian may prescribe this drug off label to use for your dog at home. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. 

In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How is ropinirole ophthalmic given?

Ropinirole ophthalmic comes as single-use droppers for use in the eye.

• Administer the appropriate number of eye drops topically, according to Table 1 in the product insert. 
• The number of eye drops administered corresponds to your dog’s body weight.
• If your dog does not vomit within 20 minutes of the first dose, then a second dose may be administered.
• A very small proportion of dogs may fail to respond to the treatment, despite administration of a second dose. It is not recommended to administer further doses to these dogs.

This medication should work within 30 minutes. Vomiting typically subsides within 25 minutes of administration. Most dogs vomit 4–5 times after application.

Be careful when administering this drug.

• Not for use in humans.
• Wear gloves and protective eye wear when handling or administering this product to prevent accidental exposure.
• In case of accidental eye, oral or skin exposure, flush with water. If wearing contact lenses, rinse your eyes first, then remove contact lenses and continue rinsing. 
• Remove contaminated clothing. 
• Seek medical attention if accidental exposure occurs and show the package insert or label to the physician.
• Exposure to this drug may cause adverse reactions such as headache, nausea, vomiting, dizziness, light-headedness after rising from sitting, and sleepiness.
• Avoid contact with the product if pregnant, planning to become pregnant, or breast-feeding, as exposure has been shown to have adverse effects on embryo-fetal development based on rodent studies.

What if I miss giving my pet the medication?

Ropinirole ophthalmic works best when given within 2 hours of ingesting the foreign material or toxin. If you do not give the medication within that time, contact your veterinarian for further advice on the treatment of your dog.

Are there any potential side effects?

Ropinirole ophthalmic may cause the following side effects, which should resolve within 24 hours:

• vomiting, diarrhea
• temporary eye irritation or itchiness
• protrusion of the third eyelid
• increase in tear production
• uncontrolled eyelid twitching
• lethargy
• increased heart rate and/or rapid breathing
• shivering
• instability when walking
• reduced appetite

More serious side effects include:

• extended vomiting for more than 60 minutes
• corneal ulceration

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction each time this medication is used. 

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. 

Ropinirole ophthalmic is a short-acting medication that will stop working within hours. 

Are there any risk factors for this medication?

Ropinirole ophthalmic should NOT BE USED in patients who:

• are allergic or hypersensitive to this medication.
• have conditions in which the reflexes of the larynx are impaired (e.g., laryngeal paralysis)
• have neurological impairment or conditions that increase the risk of vomiting
• have corneal ulceration or ocular injury/irritation
• have ingested something for which vomiting is contraindicated (e.g., sharp foreign objects, and caustic or corrosive agents such as strong acids and alkalis). 
• are in cardiovascular shock or respiratory distress
• are having seizures
• are rodents or rabbits, because they are either unable to vomit or do not have stomach walls strong enough to tolerate the act of vomiting.

This medicine should be USED WITH CAUTION in:

• cases where it may be detrimental to stimulate vomiting (e.g., history of aspiration pneumonia, ingestion of central nervous system stimulant)
• dogs weighing less than 1.8 kg, dogs younger than 4.5 months, and elderly dogs; in these cases, use only according to benefit-risk assessment

Are there any drug interactions I should be aware of?

Make sure your veterinarian is aware of any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment. 

Several medications should be used with caution when given with ropinirole ophthalmic, including:

• antiemetics (e.g., maropitant, ondansetron)
• antihistamines with antiemetic effects (may reduce the effects of ropinirole)
• blood pressure medications (e.g., amlodipine, enalapril, sildenafil, telmisartan)
• phenobarbital
• dopamine antagonists (e.g., domperidone, metoclopramide)
• acepromazine
• promethazine
• amiodarone
• ciprofloxacin
• erythromycin
• mexiletine

Is any monitoring needed with this medication?

• At home, monitor for any side effects such as those noted above. If any side effects occur, discontinue the medication, and contact your veterinarian. 
• Contact your veterinarian for further monitoring instructions after use of this medication.
• In case of prolonged vomiting, your veterinarian may need to prescribe medication to control nausea.

How do I store ropinirole ophthalmic?

• Keep out of reach of children.
• Store in the original package to protect from light.
• Store at controlled room temperature, 20˚C-25˚C (68-77˚F), with excursions permitted to 15˚C-30˚C (59˚F-86˚F). 
• After the first dose, the opened dropper should be kept in the aluminum pouch. The content should be used and discarded within 30 minutes of opening the aluminum pouch.

What should I do in case of emergency?

• If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet's weight and symptoms. 
• Adverse effects should also be reported to the FDA or Health Canada.