List of drugs reported to cause IFIS (Intraoperative Floppy Iris Syndrome): potentially

List of all drugs reported to be able to cause IFIS, Intraoperative Floppy Iris Syndrome

Any drug that is an  α-1a receptor blocker can cause IFIS which causes the iris to become “floppy” during surgery and can increase the risk of capsular rupture, iris prolapse through wound, iris chaffing, iris damage.

  • tamsulosin (Flomax)
  • alfuzosin (Uroxatral)
  • terazosin (Hytrin)
  • doxazosin (Cardura)
  • Finasteride (Proscar)
  • Saw palmetto
  • duloxetine (Cymbalta)
  • Silodosin (trade names Rapaflo (USA), Silodyx (Europe and South Africa), Rapilif (India), Silodal (India), Urief (Japan),Urorec (Russia))

  • quetiapine (Seroquel)

  • Risperidone ( Risperdal)

Great article about IFIS, Intraoperative Floppy Iris Syndrome:

Review and Update of Intraoperative Floppy Iris Syndrome

Ahmed Sallam, Hany El-Defrawy, Adam Ross, Samer J Bashir, Hamish MA Towler


Expert Rev Ophthalmol. 2011;6(4):469-476. 

Abstract and Introduction


Intraoperative floppy iris syndrome is a well-known risk factor for complications during cataract extraction in patients who are on or who have previously used tamsulosin, the most commonly prescribed α-1 adrenergic blocker for the treatment of benign prostatic hyperplasia. It is important that both ophthalmologists and physicians appreciate the association as it occurs in a significant number of patients, and favorable visual outcome can be achieved if tamsulosin use is known before surgery and the operation is undertaken by an experienced surgeon. This article evaluates the current literature on intraoperative floppy iris syndrome and includes discussion on epidemiology, underlying mechanisms and management strategies.


Tamsulosin is the most commonly prescribed α-1 adrenergic receptor blocker for the management of benign prostatic hyperplasia (BPH) in aging males.[1,2] The drug has a selective action on the bladder and the prostate, thus relieving lower urinary tract symptoms (LUTS) while having minimal side effects on the cardiovascular system.[2] Three types of α-1 adrenergic receptors have been described; namely α-1a, α-1b and α-1d.[3] The main α-1 receptor subtype in the prostate, bladder, neck and urethra is α-1a, while α-1b receptors predominate in peripheral blood vessels.[4,5] In vitro studies have shown that tamsulosin has a 20-fold higher affinity for the α-1a receptors than for α-1b receptors and a threefold higher affinity for α-1a receptors than for α-1d receptors.[6–8] As tamsulosin is mainly an α-1a receptor blocker, it is more uroselective than other α-1 receptor blockers used for LUTS, such as alfuzosin, terazosin and doxazosin.[4,5] A long-term, open-label, multicenter study confirmed that once-daily tamsulosin (0.4 or 0.8 mg) is effective and safe for long-term treatment of BPH and that it represents a good therapeutic alternative to surgical intervention.[5]

Other references:

Finasteride is associated with intraoperative floppy iris syndrome and cataract formation.[4][5]

Saw palmetto inhibits cyclooxygenase and increases bleeding with warfarin (). In addition, its unsupervised use can result in cholestatic hepatitis, acute pancreatitis (), and intraoperative floppy iris syndrome during cataract removal because of loss of iris tone (). Ophthalmologists should be aware of this important association so that they can take the necessary steps to prevent surgical complications.



5.  2013 May;27(5):673. doi: 10.1038/eye.2013.40. Epub 2013 Mar 15.

Intraoperative floppy iris syndrome associated with quetiapine.

6.  2011 Mar-Apr;21(2):210-1.

Intraoperative floppy iris syndrome associated with risperidone intake.



Intraoperative floppy iris syndrome (IFIS) has been strongly associated with intake of selective a1 adrenergic blockers, particularly tamsulosin. Intraoperative floppy iris syndrome has also been linked to the use of other drugs with some a antagonist activity.


We identified patients on long-term treatment with the antipsychotic agent risperidone who showed typical features of IFIS during cataract surgery.


We report 3 eyes in 2 patients taking risperidone in which typical features of IFIS were noted during cataract surgery.


Risperidone is a widely prescribed drug in psychiatric practice and has a-blocking actions as well as strong affinity for serotonin 2A receptors. Ophthalmologists should be aware of the possible association with IFIS when performing cataract surgery on patients taking risperidone.




[PubMed – indexed for MEDLINE]
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