Tropicamide

Tropicamide
Systematic (IUPAC) name
(RS)-N-ethyl-3-hydroxy-2-phenyl-N-(pyridin-4-ylmethyl)propanamide
Clinical data
Trade names Mydriacyl
AHFS/Drugs.com monograph
Pregnancy
category
  • C
Routes of
administration		 topical eye drops
Pharmacokinetic data
Protein binding 45%
Identifiers
CAS Number 1508-75-4 YesY
ATC code S01FA06
PubChem CID 5593
IUPHAR/BPS 7319
DrugBank DB00809 N
ChemSpider 5391 N
UNII N0A3Z5XTC6 N
KEGG D00397 YesY
ChEMBL CHEMBL1200604 N
Chemical data
Formula C17H20N2O2
Molar mass 284.353 g/mol
 NYesY (what is this?)  (verify)

Tropicamide (Mydriacyl) is an anticholinergic used as a mydriatic.[1]

Uses

Tropicamide is an antimuscarinic drug that produces short acting mydriasis (dilation of the pupil) and cycloplegia[2] when applied as eye drops. It is used to allow better examination of the lens, vitreous humor, and retina. Due to its relatively short duration of effect (4–8 hours), it is typically used during eye examinations such as the dilated fundus examination, but it may also be used before or after eye surgery. Cycloplegic drops are often also used to treat anterior uveitis, decreasing risk of posterior synechiae and decreasing inflammation in the anterior chamber of the eye.

Right eye was instilled with tropicamide, leading to mydriasis and therefore anisocoria (unequal pupil size)
Anisocoria caused by Tropicamide instilled into the right eye only.

Tropicamide is occasionally administered in combination with p-hydroxyamphetamine (brand name Paremyd), which is a sympathomimetic. The use of the sympathomimetic drug causes the iris dilator muscle to be directly stimulated, causing increased dilation. In the United States, the sympathomimetic drop most commonly used along with tropicamide, is 2.5% phenylephrine hydrochloride (brand name AK-Dilate).

Side effects

Tropicamide induces transient stinging and a slight and transient rise in intraocular pressure in the majority of patients. It may cause redness or conjunctivitis (inflammation) and also blurs near vision for a short while after instillation (care must be taken, and the patient must only drive when vision returns to normal). Tropicamide may, in very rare cases , cause an attack of acute angle-closure glaucoma. This tends to be in patients with narrow anterior chamber angles, and closure risk must be assessed by the practitioner prior to instillation.

Tropicamide is often preferred to atropine because atropine has a longer half-life, causing prolonged dilation and blurry vision for up to a week. Atropine has less sting effect, but can be toxic or fatal if ingested in large quantities by children or adults.

Systemic side effects are very rare.

Illicit use

According to the researchers of the European Commission-funded ReDNet Project, in Russia tropicamide is currently abused (injected intravenously) as an inexpensive recreational deliriant drug.[3] It is usually mixed with heroin, methadone, and other opioid drugs to potentiate the "rush" when injected intravenously.[4]

References

  1. ↑ Makoto Ukai, Ami Okuda, Takayoshi Mamiya (2004). "Effects of anticholinergic drugs selective for muscarinic receptor subtypes on prepulse inhibition in mice". European Journal of Pharmacology 492 (2–3): 183–187. doi:10.1016/j.ejphar.2004.03.066.
  2. ↑ Manny RE, Hussein M, Scheiman M, Kurtz D, Niemann K, Zinzer K (July 2001). "Tropicamide (1%): an effective cycloplegic agent for myopic children". Investigative Ophthalmology & Visual Science 42 (8): 1728–35. PMID 11431435.
  3. ↑ Bersani, F. S.; Corazza, O.; Simonato, P.; Mylokosta, A.; Levari, E.; Lovaste, R.; Schifano, F. (2013). "Drops of madness? Recreational misuse of tropicamide collyrium; early warning alerts from Russia and Italy". General Hospital Psychiatry 35 (5): 571–3. doi:10.1016/j.genhosppsych.2013.04.013. PMID 23706777.
  4. ↑ Krokodil: The drug that eats junkies
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