Dipivefrin
Dipivefrin is a prodrug of epinephrine, formed by the diesterification of epinephrine and pivalic acid. The addition of two ester groups (pivaloyl) to the epinephrine molecule enhances its lipophilic character, which helps easy penetration into the anterior chamber. Since it penetrates more easily across the cornea, lesser doses are required. The IOP reduction with dipivefrin is comparable with that of epinephrine. The liberated epinephrine exerts its action by decreasing aqueous production and by enhancing outflow facility. The onset of action with dipivefrin occurs about 30 minutes after treatment, with maximum effect seen at about one hour.
Dipivefrin is more effective than epinephrine; it penetrates the cornea approximately 17 times more than epinephrine.[16] It is indicated for initial therapy or as an adjunct with other ocular hypotensive agents. It produces 20-24% reduction in IOP. Topical dipivefrin 0.1% is useful for lowering IOP in patients intolerant to epinephrine.[17] The most frequent side effects reported with dipivefrin include burning, stinging, follicular conjunctivitis, blurry vision, headache, and allergic reaction.