Upneeq
Upneeq (oxymetazoline) is an alpha-1 receptor agonist. It's an eye drop used to treat droopy eyelids (acquired blepharoptosis) in people ages 13 years and older. The typical dose of Upneeq (oxymetazoline) is one drop in the affect eye(s) once per day. Side effects of this medication aren't common, but can include eye redness, dry eye, and blurry vision.
What is Upneeq (oxymetazoline)?
What is Upneeq (oxymetazoline) used for?
Droopy eyelids (acquired blepharoptosis) in people ages 13 years and older
How Upneeq (oxymetazoline) works
Upneeq (oxymetazoline) is an alpha-1 receptor agonist. It works by tightening up a muscle in your eyelid, which lifts the eyelid.
Drug Facts
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What are the side effects of Upneeq (oxymetazoline)?
Common Side Effects
- Punctate keratitis (watery eyes, light sensitivity)
- Eye inflammation (pain, swelling, redness)
- Eye pain
- Eye irritation
- Dry eye
- Blurry vision
- Headache
Serious Side Effects
- Worsening heart problems: severe headaches, nosebleeds, difficulty breathing, irregular heartbeat, dizziness, feeling faint, chest pain
- Sudden glaucoma: severe eye or head pain, red eye, sudden loss of vision, blurry vision
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Sudden eye pain or change in vision such as blurry vision, seeing halos around lights, vision loss
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Dry eyes
- Eye irritation or itching
- Headache
Pros and cons of Upneeq (oxymetazoline)
Pros
Given once per day
Works quickly to improve droopy eyelid(s) in some people
Preservative-free
Can be stored at room temperature
Cons
Brand-name medication only
Might be difficult for some people to administer correctly
Can't be used in children younger than 13 years old
Must be used with caution in people with heart conditions and people taking medications that affect the heart
Pharmacist tips for Upneeq (oxymetazoline)
Upneeq (oxymetazoline) must only be used for the treatment of droopy eyelids as instructed by your optometrist or ophthalmologist. Never use Upneeq (oxymetazoline) for other eye problems. If you have other eye problems, such as dry or itchy eyes, there are several treatment options you can use. Ask your eye provider or pharmacist for more information.
Before starting this medication, make sure a healthcare professional teaches you how to give yourself Upneeq (oxymetazoline) so that you avoid accidentally hurting yourself or wasting the medication. Carefully read the instructions on how to give yourself the eye drops. Contact your prescriber or pharmacist if you have any questions.
Only open a single-use Upneeq (oxymetazoline) container when you're ready to use it. Saving this medication to be used later might raise your risk for contamination and eye infection.
Be careful not to touch the tip of the Upneeq (oxymetazoline) single-use container to your eye or to any other surface so it stays clean. If the tip accidentally touches something, throw it away and use a new container. Using a dirty tip raises your risk for infections and injury to your eye(s).
If you need to use multiple different eye products in the same eye, separate each eye product from Upneeq (oxymetazoline) by at least 15 minutes. This makes sure your eye(s) absorb each medication fully.
If you wear contact lenses, take them out before using Upneeq (oxymetazoline) so your eye(s) can absorb all of the medication. Wait at least 15 minutes after using Upneeq (oxymetazoline) to put your lenses back into your eye(s).
Keep Upneeq (oxymetazoline) single-use containers at room temperature and in the foil pouches they come in until you're ready to use the drops.
Oxymetazoline, the active ingredient in Upneeq (oxymetazoline), is in the same medication class (alpha agonists) as many other products, such as phenylephrine nasal spray or Afrin (oxymetazoline) nasal spray. Using more than one medication containing an alpha agonist can raise your risk of serious side effects, including fast heart rate and dizziness. If you're not sure if a product is an alpha agonist, ask your pharmacist.
Make sure to ask your prescriber or pharmacist before starting any new medications so they can help you check for interactions. Taking some medications, like monoamine oxidase inhibitors (MAOIs), might raise your risk for side effects from Upneeq (oxymetazoline).
Frequently asked questions about Upneeq (oxymetazoline)
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What are the risks and warnings for Upneeq (oxymetazoline)?
Upneeq (oxymetazoline) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Symptom of more serious medical condition
Sometimes, having droopy eyelid(s) is a symptom of a more serious medical condition, such as a stroke, Horner's syndrome, an eye infection, or a growth in the eye. Before prescribing you Upneeq (oxymetazoline), your healthcare team will likely check to see if you have a more serious medical condition. If Upneeq (oxymetazoline) doesn't make your droopy eyelid(s) better or if there are other symptoms that occur with your droopy eyelid(s), contact your eye specialist.
Worsening heart problems
Risk factors: Heart disease | High or low blood pressure | Sudden low blood pressure when getting up from a sitting or lying down position (orthostatic hypotension)
Medications similar to Upneeq (oxymetazoline) can affect your blood pressure. If you have a history of heart or blood pressure problems or take certain medications that affect the heart, such as beta blockers or digoxin (Lanoxin), ask your eye specialist if Upneeq (oxymetazoline) is safe for you. If you get severe headaches, nosebleeds, difficulty breathing, irregular heartbeat, dizziness, feeling faint, or chest pain while taking Upneeq (oxymetazoline), stop taking it and get medical attention right away. These can be signs that your heart or blood pressure conditions have worsened.
Worsening blood flow problems
Risk factors: Conditions that cause poor blood flow to brain or heart | Sjogren's syndrome
Upneeq (oxymetazoline) should be used with caution in people with blood flow problems, such as poor blood flow to the brain (e.g., stroke, "mini strokes") or heart (e.g., coronary artery disease or CAD), or Sjögren's syndrome. Upneeq (oxymetazoline) can affect blood flow and worsen these conditions. Make sure the prescribing specialist knows about all medical conditions you have or have had in the past before starting Upneeq (oxymetazoline). If your symptoms of any of these conditions worsen, stop using Upneeq (oxymetazoline) and contact your care team right away.
Glaucoma
Risk factors: Untreated glaucoma
Upneeq (oxymetazoline) can raise your risk of angle closure glaucoma because of the way it works in your eye. Stop using Upneeq (oxymetazoline) and contact your care team right away if you notice symptoms of glaucoma, such as severe eye and head pain, red eye, and blurry vision.
Risk of infection
Don't touch the tip of your Upneeq (oxymetazoline) bottle to your eyes or any other surface. Doing so can result in eye injury or eye infection.
Upneeq (oxymetazoline) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 0.3ml pouch of 0.1% | 1 carton | $212.40 | $212.40 |
Typical dosing for Upneeq (oxymetazoline)
People ages 13 years and older: The typical dose is 1 drop into the affected eye(s) once per day.
How much does Upneeq (oxymetazoline) cost?
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References
Best studies we foundAmerican Association of Neurological Surgeons. (2024). Cerebrovascular disease.
Bacharach, J., et al. (2021). Rapid and sustained eyelid elevation in acquired blepharoptosis with oxymetazoline 0.1%: Randomized phase 3 trial results. Clinical Ophthalmology.
Morris, C. L., et al. (2005). Acquired ptosis: Evaluation and management. EyeNet Magazine.
National Organization for Rare Disorders. (2008). Horner’s syndrome.
RVL Pharmaceuticals, Inc. (2023). Upneeq- oxymetazoline hydrochloride ophthalmic solution/ drops [package insert]. DailyMed.
Shoji, M. K., et al. (2023). The effects of topical oxymetazoline on eyelid position, eye redness, and patient-reported eye appearance: A randomized controlled trial. Journal of Plastic, Reconstructive & Aesthetic Surgery.
Wirta, D. L., et al. (2021). Safety of once-daily oxymetazoline HCl ophthalmic solution, 0.1% in patients with acquired blepharoptosis: Results from four randomized, double-masked clinical trials. Clinical Ophthalmology.
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