hydroxyamphetamine/tropicamide (Rx)

Brand and Other Names:Paremyd
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

hydroxyamphetamine/tropicamide

ophthalmic solution

  • 1%/0.25%
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Mydriasis/Cycloplegia

Indicated for mydriasis in routine diagnostic procedures and in conditions where short-term pupil dilation is desired

Provides clinically significant mydriasis with partial cycloplegia

Dose: 1-2 gtt in the conjunctival sac

Administration

Onset of action occurs within 15 minutes

Maximum effect within 60 minutes

Clinically significant dilation, inhibition of pupillary light response, and partial cycloplegia last 3 hours

Mydriasis will reverse spontaneously with time, typically in 6 to 8 hours

In some cases, complete recovery may take up to 24 hours

Safety and efficacy not established

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Adverse Effects

Frequency Not Defined

Tachycardia

Pallor

Headache

Parasympathetic stimulation

Transient stinging

Dry mouth

Nausea

Vomiting

Allergic reactions

Blurred vision

Photophobia with or without corneal staining

Increased IOP

Muscle rigidity

Rare

  • Psychotic reactions, behavioral disturbances, and vasomotor or cardiorespiratory collapse have been reported with the use of anticholinergic drugs
  • Rare but serious cardiovascular events, including death due to myocardial infarction, ventricular fibrillation and significant hypotensive episodes have occurred shortly following instillation
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Warnings

Contraindications

Hypersensitivity to product components

Known or suspected angle-closure glaucoma, presence of a shallow anterior chamber unless gonioscopic observation of the chamber angle is possible; presence of narrow angle where pupil dilation may precipitate angle-closure glaucoma

Cautions

Monitor patients with cardiac disorders, diabetes mellitus, hypertension or hyperthyroidism

May cause increased intraocular pressure (use with caution in patients with glaucoma)

Possibility of undiagnosed glaucoma should be considered

The elderly may experience intraocular pressure increase following use; use caution

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Pregnancy & Lactation

Pregnancy Category: C

Lactation: Unknown if excreted in breast milk, use caution

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

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Pharmacology

Mechanism of Action

Indirect acting sympathomimetic agent; causes mydriasis by stimulating the release of norepinephrine from adrenergic nerve terminasl; blocks acetylcholine resulting in relaxation of cholinergically innervated iris sphincter muscle

Adrenergic innervation to radial muscle is therefore unopposed and pupil becomes dilated

Pharmacokinetics

Onset of action: 15 min

Peak effect: 60 min

Duration: 3 hr

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Formulary

FormularyPatient Discounts

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  • View the formulary and any restrictions for each plan.
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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