Mydcombi

Generic name: phenylephrine hydrochloride and tropicamide
Dosage form: Ophthalmic Spray
Drug class: Mydriatics

Medically reviewed by Carmen Pope, BPharm. Last updated on May 19, 2023.

What is Mydcombi?

Mydcombi is a combination eye spray that contains phenylephrine hydrochloride and tropicamide and may be used to dilate the pupils before an eye examination or when short-term pupil dilation is required.

Mydcombi contains two common medications routinely used for pupil dilation before a comprehensive eye examination. It uses the Optejet dispenser which allows the medication to be delivered horizontally in microdroplets while standing or sitting, unlike traditional eye droppers that rely on gravity, and require a person to have their head tilted back or lying down.

Who should not receive Mydcombi?

Mydcombi should not be used by people who are hypersensitive to any of the ingredients contained in the spray.

What is Mydcombi used to treat?

Mydcombi dilates the pupils in preparation for a diagnostic eye examination or when short-term pupil dilation is required. It has been designed to improve the efficiency of office-based comprehensive eye exams and pre-surgery mydriasis (pupil dilation) before cataract surgery. Previously, healthcare providers have had to use two separate eye drop preparations.

Mydcombi was FDA approved on May 5th, 2023.

Warnings

Mydcombi is not for injection and is only for topical use in the eye.

Other warnings and precautions associated with Mydcombi include:

Rarely, significant elevations in blood pressure may occur. Be cautious when using in children less than 5 years of age, and in patients with cardiovascular disease or hyperthyroidism. Blood pressure should be monitored post-treatment
Rare incidences of central nervous system disturbances have been reported in children
May produce a transient increase in intraocular pressure
Rebound Miosis (small or constricted pupils) has been reported 1 day after administration.

Dosing information

Adults and children over the age of 1 year: Administer one metered spray to the cornea of each eye to be dilated, and repeat after 5 minutes.
Children younger than 1 year of age: Administer one metered spray to the cornea of each eye to be dilated, up to a maximum of 3 sprays per eye per day.

The Optejet® dispenser uses high-precision piezo-print technology to deliver 0.008 mL of solution, which is less than 20% of that delivered using conventional eyedroppers, thus reducing overdosing and exposure to drugs and preservatives. The solution is dispensed to the ocular surface in approximately 80 milliseconds, which is faster than the ocular blink reflex.

How should I use Mydcombi?

The Mydcombi dispenser should be held upright during use.

Firmly press the fill button down until the light turns blue, then, slowly release, while counting to three.
Bring the MydCombi dispenser close to the patient's eye with the mirror facing the eye. Gently pull the lower lid down with your other hand to prevent blinking.
Aim mist opening toward the center of the eye.
Ask the patient to confirm when their eye is centered on the blue mirror.
Press the mist button firmly then release. The drug solution should gently wet the eye. Repeat if needed.

What are the side effects of Mydcombi?

Common side effects of Mydcombi include temporarily blurred vision and eyesight, sensitivity to light, disturbances to the cells on the surface of the eye (superficial punctate keratitis), and mild eye discomfort. Increased pressure within the eye (intraocular pressure) has been reported following the use of mydriatics.

Common systemic adverse reactions may include mouth dryness, tachycardia, headache, allergic reactions, nausea, vomiting, pallor, central nervous system disturbances, and muscle rigidity.

You may experience sensitivity to light and blurred vision while your pupils are dilated.

Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.

How does Mydcombi work?

Mydcombi contains a fixed combination of tropicamide and phenylephrine.

Tropicamide is an anticholinergic that dilates the pupil by blocking the response of the sphincter muscle of the iris and the ciliary muscle to cholinergic stimulation.
Phenylephrine hydrochloride is an alpha-1 adrenergic receptor agonist which at prescription strength contracts specific eye muscles which causes dilation of the pupils. It also reduces redness and irritation.

The Optejet dispenser administers medication horizontally in microdroplets as a directional mist that has a low velocity which minimizes the impact of the drops on the surface of the eye. Traditional eye droppers rely on gravity and require a person to have their head tilted back or lying down. The Optejet can be administered while the person is seated or standing.

Traditional eye drops also administer drops that are approximately 40 microliters in volume. These can lead to drug overflow and exposure to excess drugs and preservatives because they exceed the overflow capacity of the eye which is approximately 8 microliters. The Optijet dispenser delivers 8 microliters of drug that is misted onto the cornea which can reduce the risk of drug absorption into the bloodstream and side effects.

What other drugs will affect Mydcombi?

Mydcombi may interact with:

Atropine-like medications: May exaggerate the adrenergic pressor response
Cholinergic agonists and ophthalmic cholinesterase inhibitors: may interfere with the antihypertensive action of carbachol, pilocarpine, or ophthalmic cholinesterase inhibitors
Potent inhalation anesthetic agents: These may potentiate the cardiovascular depressant effects of these agents.

Pregnancy and breastfeeding

There are no human or animal data regarding the use of Mydcombi during pregnancy. It should only be used if the potential benefits outweigh the potential risk to the unborn child.

There are no data for the use of Mydcombi during breastfeeding.

What are the ingredients in Mydcombi?

Mydcombi contains phenylephrine hydrochloride 2.5% and tropicamide 1% which is administered via the Optejet® dispenser as a micro-mist that coats the eye.

Each metered spray delivers 0.008 mL which contains 0.08 mg tropicamide and 0.2 mg phenylephrine HCl. Each Mydcombi cartridge contains approximately 180 sprays.