• All presentations are currently available
  

• • Akorn had Paremyd on shortage due to manufacturing delays.
  • No clinical trial data were found to support the use of Paremyd in the diagnosis of Horner Syndrome.

• Paremyd ophthalmic solution, Akorn
  1% hydroxyamphetamine hydrobromide and 0.25% tropicamide, 15 mL bottle, 1 count (NDC 17478-0704-12)

Estimated Resupply Dates

• Akorn has Paremyd ophthalmic solution available.

Implications for Patient Care

• Hydroxyamphetamine is an indirect-acting adrenergic agonist and causes pupil dilation.3 Topical hydroxyamphetamine is not commercially available in the US.¹

Alternative Agents & Management

• • Topical hydroxyamphetamine has been used to aid in localizing specific ophthalmic lesions associated with Horner syndrome. Because of difficulties with obtaining hydroxyamphetamine, other pharmacologic agents such as phenylephrine 1% have also been used.4 Additionally, some authors recommend alternative clinical and radiological protocols to diagnosis Horner syndrome because of the difficulties in obtaining hydroxyamphetamine hydrobromide.^5,6
  • No clinical trial data were found to support the use of Paremyd (a combination hydroxyamphetamine hydrobromide and tropicamide ophthalmic solution) in the diagnosis of Horner Syndrome.

References

• 1. Anon, ed. Red Book Online. via Micromedex 2.0 [internet database]. Greenwood Village, CO: Truven Health Analytics; 2015.
  2. Professional Compounding Centers of America (personal communication). December 15, 2010.
  3. Hydroxyamphetamine/Tropicamide. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. July 2015.
  4. Danesh-Meyer HV, Savino P, Sergott R. The correlation of phenylephrine 1% with hydroxyamphetamine 1% in Horner’s syndrome. Br J Ophthalmol 2004; 88(4):592-3.
  5. Chen Y, Morgan ML, Barros Palau AE, Yalamachili S, Lee AG. Evaluation and neuroimaging of the Horner Syndrome. Can J Ophthalmol 2015; 50(2):107-11.
  6. Davagnanam I, Fraser, CL, Miskiel K, Daniel CS, Plant GT. Adult Horner’s syndrome: a combined clinical, pharmacological and imaging algorithm. Eye 2013; 27: 291-8.