Mydriasis: Ophthalmic: Instill 1 to 2 drops into conjunctival sac(s).
There are no dosage adjustments provided in manufacturer’s labeling.
There are no dosage adjustments provided in manufacturer’s labeling.
Refer to adult dosing.
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]
No
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.
Mydriasis: Short-term pupil dilation for diagnostic procedures
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)
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
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.
• Older adult: 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.
None known.
There are no known significant interactions.
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).
It is not known if hydroxyamphetamine or tropicamide is excreted in breast milk. The manufacturer recommends that caution be exercised when administering hydroxyamphetamine/tropicamide to nursing women.
Ophthalmic exam, intraocular pressure, CNS reactions (especially in pediatric patients).
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
Duration: 3 hours; complete recovery usually occurs in 6-8 hours, but may take up to 24 hours
Time to peak: 60 minutes
Solution (Paremyd Ophthalmic)
1-0.25% (per mL): $5.66
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