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Hydroxyamphetamine and Tropicamide

Medically reviewed by Last updated on Nov 22, 2021.


(hye droks ee am FET a meen & troe PIK a mide)

Index Terms

  • Hydroxyamphetamine Hydrobromide and Tropicamide
  • Tropicamide and Hydroxyamphetamine

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, ophthalmic:

Paremyd: Hydroxyamphetamine hydrobromide 1% and tropicamide 0.25% (15 mL) [contains benzalkonium chloride]

Brand Names: U.S.

  • Paremyd

Pharmacologic Category

  • Adrenergic Agonist Agent, Ophthalmic


Hydroxyamphetamine hydrobromide is an indirect acting sympathomimetic agent which causes the release of norepinephrine from adrenergic nerve terminals, resulting in mydriasis. Tropicamide is a parasympatholytic agent which produces mydriasis and paralysis by blocking the sphincter muscle in the iris and the ciliary muscle.

Onset of Action

15 minutes

Time to Peak

60 minutes

Duration of Action

3 hours; complete recovery usually occurs in 6-8 hours, but may take up to 24 hours

Use: Labeled Indications

Mydriasis: Short-term pupil dilation for diagnostic procedures


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

Dosing: Adult

Mydriasis: Ophthalmic: Instill 1 to 2 drops into conjunctival sac(s)

Dosing: Geriatric

Refer to adult dosing.


For topical ophthalmic use only. To avoid excessive systemic absorption, apply gentle finger pressure to lacrimal sac for 2 to 3 minutes following application. Do not touch dropper tip to eyelids or other surfaces when placing drops in eyes. Wash hands following administration.


Store between 20°C and 25°C (68°F and 77°F). Protect from light. Protect from light.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined. Reported with Paremyd or similar medications.

Cardiovascular: Hypotension, myocardial infarction, tachycardia, ventricular fibrillation

Central nervous system: Behavioral problems, headache, psychosis

Dermatologic: Pallor

Gastrointestinal: Nausea, vomiting, xerostomia

Hypersensitivity: Hypersensitivity reaction

Neuromuscular & skeletal: Muscle rigidity

Ophthalmic: Blurred vision, increased intraocular pressure, photophobia, stinging of eyes (transient)


Concerns related to adverse effects:

• CNS effects: May cause drowsiness and/or blurred vision, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery, driving).

• Increased intraocular pressure: May cause a transient increase in intraocular pressure; use with caution in patients with glaucoma.

Disease-related concerns:

• Cardiovascular disease: Use caution in patients with hypertension, arrhythmias, or ischemic disease; monitor following administration.

• Diabetes: Use caution in patients with diabetes; monitor following administration.

• Thyroid disease: Use caution in patients with hyperthyroidism; monitor following administration.

Special populations:

• Contact lens wearers: May contain benzalkonium chloride, which may be adsorbed by contact lenses; remove contacts prior to administration and wait 15 minutes before reinserting.

• Elderly: Use with caution in the elderly; monitor closely for increased intraocular pressure following use.

• Pediatric: Use with caution in infants and children; may cause potentially dangerous CNS disturbances. Psychotic reactions, behavioral disturbances, and vasomotor or cardiorespiratory collapse in children have been reported with the use of anticholinergic drugs.

Other warnings/precautions:

• Appropriate use: For topical ophthalmic use only. To avoid excessive systemic absorption, apply gentle finger pressure to lacrimal sac for 2 to 3 minutes following application. Do not touch dropper tip to eyelids or any surface.

Monitoring Parameters

Ophthalmic exam, intraocular pressure, CNS reactions (especially in pediatric patients).

Pregnancy Risk Factor C Pregnancy Considerations

Animal reproduction studies have not been conducted with this combination. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the fetus (Samples, 1988).

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Further information

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