Pronunciation: mide-com-bi
Generic name: phenylephrine hydrochloride and tropicamide
Dosage form: metered-dose eye spray
Drug class: Mydriatics

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 21, 2024.

What is Mydcombi?

Mydcombi is the first combination eye spray to gain FDA approval for dilating the pupils before an eye examination or when short-term pupil dilation is required. The medical term for pupil dilation is mydriasis.

• Mydcombi contains 2 ingredients: phenylephrine hydrochloride 2.5% (dilates the pupil) and tropicamide 1% (dilates the pupil).

Mydcombi uses the Optejet dispenser which allows the medications in Mydcombi to be easily delivered horizontally in microdroplets into the eye while a person is standing or sitting, unlike traditional eye drops that rely on gravity, and require a person to have their head tilted back or lying down. Mydcombi works by dilating the pupils (opening them up) which helps an eye doctor check for many common eye problems, including diabetic retinopathy, glaucoma, and age-related macular degeneration (AMD).

Mydcombi gained FDA approval on May 5, 2023.

Mydcombi uses

Mydcombi dilates the pupils in preparation for a diagnostic eye examination or when short-term pupil dilation is required.

• It improves the efficiency of office-based comprehensive eye exams and pre-surgery pupil dilation before surgery.
• Previously, healthcare providers have had to use two separate eye drop preparations.

How does Mydcombi work?

Mydcombi contains a fixed combination of tropicamide 1% and phenylephrine 2.5%.

• 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.

Mydcombi side effects

The most common side effects of Mydcombi that affect the eye are:

• temporarily blurred vision and eyesight
• sensitivity to light
• disturbances to the cells on the surface of the eye (superficial punctate keratitis)
• mild eye discomfort.

Other side effects of Mydcombi that affect the whole body include:

• mouth dryness
• fast heartbeat
• headache
• allergic reactions
• nausea or vomiting
• pale skin
• central nervous system disturbances, such as psychosis or behavioral disturbances
• stiff muscles.

Serious side effects and warnings

You should not receive Mydcombi if you are allergic to phenylephrine, tropicamide, Mydcombi, or any of the inactive ingredients contained in the spray.

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

Mydcombi may rarely cause high blood pressure. Be cautious when using in children less than 5 years of age, and in patients with cardiovascular disease or high thyroid levels. In patients at high risk, monitor blood pressure
after application.

Central nervous system disturbances have rarely been reported with Mydcombi, such as psychotic reactions and behavioral disturbances due to hypersensitivity to anticholinergic drugs such as phenylephrine. Be cautious when using Mydcombi in children.

Mydcombi may cause a short-lasting increase in pressure inside the eye (intraocular pressure).

Rebound miosis (small or constricted pupils) has been reported 1 day following administration of Mydcombi.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Related/similar drugs

Before taking

Before taking Mydcombi, tell your healthcare provider about all your medical conditions including if you:

• have high blood pressure
• have an eye condition such as glaucoma, AMD, or cataracts
• have a behavioral disturbance or experience psychotic thoughts
• are pregnant or intend to become pregnant
• are breastfeeding.

Pregnancy

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 risks to the unborn child.

Breastfeeding

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

How is Mydcombi administered?

Mydcombi is usually administered by a healthcare provider just before your eye examination.

• The Mydcombi dispenser is held upright during use.
• Your healthcare provider will press the fill button down until the light turns blue, then, slowly release, while counting to three.
• They will bring the MydCombi dispenser close to your eye with the mirror facing the eye, then gently pull your lower eyelid down with the other hand to prevent blinking, aiming the mist opening toward the center of the eye.
• Tell your healthcare provider when your eye is centered on the blue mirror.
• They will then press the mist button firmly and then release it. The drug solution should gently wet the eye. They may repeat if needed.

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 a conventional eyedropper.

• This reduces 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.

Mydcombi dosing information

Mydcombi dosing for adults and children over the age of 1 year

• Administer 1 metered spray to the cornea of each eye to be dilated, and repeat after 5 minutes.

Mydcombi dosing for children younger than 1 year of age

• Administer 1 metered spray to the cornea of each eye to be dilated, up to a maximum of 3 sprays per eye per day.

What should I avoid while taking Mydcombi?

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

• Do not drive, use machinery, or do any activity requiring clear vision until you can safely perform such activities.

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.

This is not a complete list of interactions. See the Mydcombi Prescribing Information for a full list.

Mydcombi ingredients

Active ingredients: phenylephrine hydrochloride 2.5% and tropicamide 1%.

Inactive ingredients: hydrochloric acid, sodium hydroxide, water, benzalkonium chloride.

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

Manufacturer

Mydcombi is manufactured by Eyenovia, Inc.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer