Hydroxyamphetamine Hydrobromide / Tropicamide

Pronunciation: hye-DROX-ee-am-FET-a-meen HYE-droe-BROE-mide/troe-PIK-a-mide
Class: Mydriatic combination

Trade Names

Paremyd
- Solution, ophthalmic hydroxyamphetamine hydrobromide 1%/tropicamide 0.25%

Pharmacology

Hydroxyamphetamine

An indirect-acting sympathomimetic agent that causes the release of norepinephrine from adrenergic nerve terminals, resulting in mydriasis.

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Tropicamide

A parasympatholytic agent that produces mydriasis and paralysis by blocking the sphincter muscle in the iris and the ciliary muscle.

Indications and Usage

For mydriasis in routine diagnostic procedures and in conditions in which short-term pupil dilation is desired; provides clinically significant mydriasis with partial cycloplegia.

Contraindications

Hypersensitivity to hydroxyamphetamine, tropicamide, or any component of the formulation; angle-closure glaucoma or those with narrow angles in whom dilation of the pupil may precipitate an attack of angle-closure glaucoma.

Dosage and Administration

Adults

Ophthalmic Instill 1 to 2 drops in the conjunctival sac(s).

General Advice

• Do not allow tip of dropper bottle to touch eye, eyelid, fingers, or any other surface.

Storage/Stability

Store between 68° and 77°F. Protect from light.

Drug Interactions

None well documented.

Adverse Reactions

Cardiovascular

Cardiorespiratory collapse; hypotensive episodes; MI; tachycardia; vasomotor collapse; ventricular fibrillation.

CNS

Behavioral disturbances; headache; psychotic reactions.

EENT

Blurred vision; increased IOP; photophobia with or without corneal staining; transient stinging.

GI

Dryness of mouth; nausea; vomiting.

Musculoskeletal

Muscle rigidity.

Miscellaneous

Allergic reactions; pallor.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy have not been established. Rarely, CNS disturbances, which may be dangerous in infants and children, may occur. Psychotic reactions, behavioral disturbances, and vasomotor or cardiorespiratory collapse in children have been reported.

Special Risk Patients

Patients with hypertension, hyperthyroidism, diabetes, or cardiac disease (eg, arrhythmias or chronic ischemic heart disease); elderly patients. Monitor patients with glaucoma or increased IOP closely following instillation.

Angle-closure glaucoma

To avoid inducing angle-closure glaucoma, make an estimation of the depth of the angle of the anterior chamber.

Overdosage

Symptoms

Cardiac arrhythmias, dilation of pupils, GI irritation, headache, hypertension, nausea, substernal discomfort, sweating, vomiting.

Patient Information

• Teach patient proper technique for instilling eye drops: Wash hands; do not allow tip of dropper bottle to touch eye, eyelid, fingers, or any other surface. Tilt head back, look up; pull lower eyelid down to form pocket; place prescribed number of drops in the pocket. Look downward before closing eye; apply pressure to lacrimal sac for 2 to 3 min. Do not rub eye. Wash hands (and child's hands) after instillation.
• Advise parent or guardian to discontinue therapy and notify health care provider immediately if any CNS disturbances, psychotic reactions, changes in thinking or behavior, or rapid heart rate occur.
• Warn patients that they may experience sensitivity to light, and to therefore protect their eyes in bright illumination while their pupils are dilated.
• Caution patients to avoid driving or engaging in hazardous activities while their pupils are dilated.
• Inform patients that blurred vision and sensitivity to light are the most common adverse reactions, and to contact their health care provider if these occur and are bothersome.

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