tropicamide/phenylephrine ophthalmic (Rx)

Brand and Other Names:MydCombi

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tropicamide/phenylephrine

ophthalmic spray

  • 1%/2.5%
  • Each metered spray delivers 0.008 mL (0.08mg/0.2mg)
  • 2-mL vial enclosed in a dispenser cartridge for use with device

Mydriasis for Ophthalmic Exam

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

Administer 1 metered spray to cornea of each eye to be dilated; repeat after 5 minutes

Dosage Forms & Strengths

tropicamide/phenylephrine

ophthalmic spray

  • 1%/2.5%
  • Each metered spray delivers 0.008 mL (0.08mg/0.2mg)

Mydriasis for Ophthalmic Exam

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

≥1 year: Administer 1 metered spray to cornea of each eye to be dilated; repeat after 5 minutes

<1 year

  • Administer 1 metered spray to cornea of each eye to be dilated; repeat after 5 minutes
  • Not to exceed 3 sprays/eye per day
  • 2-mL vial enclosed in a dispenser cartridge for use with device
Next:

Interactions

Interaction Checker

and tropicamide/phenylephrine ophthalmic

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (3)

              • glucagon

                glucagon increases toxicity of tropicamide by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

              • glucagon intranasal

                glucagon intranasal increases toxicity of tropicamide by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of anticholinergic drugs and glucagon increase the risk of gastrointestinal adverse reactions due to additive effects on inhibition of gastrointestinal motility. .

              • macimorelin

                tropicamide, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that may blunt the growth hormone (GH) response to macrimorelin may impact the accuracy of the diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin.

              Monitor Closely (17)

              • amitriptyline

                amitriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • amoxapine

                amoxapine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • clomipramine

                clomipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • desipramine

                desipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • doxepin

                doxepin, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • imipramine

                imipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • isocarboxazid

                isocarboxazid increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

              • linezolid

                linezolid increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

              • lofepramine

                lofepramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • maprotiline

                maprotiline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • nortriptyline

                nortriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • phenelzine

                phenelzine increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

              • procarbazine

                procarbazine increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

              • protriptyline

                protriptyline, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • tranylcypromine

                tranylcypromine increases effects of phenylephrine ophthalmic by pharmacodynamic synergism. Use Caution/Monitor. Some systemic absorption of ophthalmic phenylephrine; reduce dose within 21 days of MAO inhibitors.

              • trazodone

                trazodone, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • trimipramine

                trimipramine, phenylephrine ophthalmic. Other (see comment). Use Caution/Monitor. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              Minor (0)

                Previous
                Next:

                Adverse Effects

                Frequency Not Defined

                Ocular effects

                • Transient blurred vision
                • Reduced visual acuity
                • Photophobia
                • Superficial punctate keratitis
                • Mild eye discomfort
                • Increased intraocular pressure

                Systemic effects

                • Xerostomia
                • Tachycardia
                • Headache
                • Allergic reactions
                • Nausea
                • Vomiting
                • Pallor
                • Central nervous system (CNS) disturbances and muscle rigidity reported with tropicamide
                • Psychotic reactions, behavioral disturbances, and vasomotor or cardiorespiratory collapse in children
                • Increase in blood pressure reported (phenylephrine-related, particularly in, but not limited to, low-weight premature neonates, infants, and hypertensive patients)
                Previous
                Next:

                Warnings

                Contraindications

                Known hypersensitivity

                Cautions

                For ophthalmic use only (not indicated for injection)

                Elevated blood pressure may occur; caution in children aged <5 yr and in patients with hyperthyroidism or cardiovascular disease; monitor post-treatment blood pressure of patients with cardiac and endocrine diseases and any patients who develop symptoms

                CNS disturbances associated with tropicamide, which may be dangerous in pediatric patients; consider possibility of psychotic reactions and behavioral disturbances due to hypersensitivity to anticholinergics

                Mydriatics may transiently elevate intraocular pressure

                Rebound miosis reported 1 day after administering; readministration produced a lesser mydriatic effect

                Drug interaction overview

                • Agents that may exaggerate vasopressor responses
                  • Caution, monitor
                  • Phenylephrine may enhance vasopressor effects of atropine-like drugs and induce tachycardia in some patients
                • Cholinergic agonists and ophthalmic cholinesterase inhibitors
                  • Caution, monitor
                  • Tropicamide may interfere with antihypertensive action of carbachol, pilocarpine, or ophthalmic cholinesterase inhibitors
                • Potent inhalation anesthetic agents
                  • Caution, monitor
                  • Phenylephrine may potentiate cardiovascular depressant effects of some inhalation anesthetic agents
                Previous
                Next:

                Pregnancy & Lactation

                Pregnancy

                There are no available data regarding use in pregnant females or animals to inform any drug-associated risks

                Lactation

                Data are not available regarding presence in human milk, effects on breastfed infants, or effects on milk production

                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.

                Previous
                Next:

                Pharmacology

                Mechanism of Action

                Tropicamide: Anticholinergic that blocks the responses of the sphincter muscle of the iris, dilating the pupil (mydriasis)

                Phenylephrine: Alpha-1 adrenergic agonist component that acts as a mydriatic agent by contracting the dilator muscle of the iris

                Fixed-dose combination mydriatic ophthalmic product that is administered as a touchless microdose mist application

                Absorption

                Onset of action

                • 15-30 minutes
                • 20-90 minutes (maximal mydriasis)
                • Darker irides tend to dilate slower than lightly pigmented irides, and achievement of maximal effect may require more doses

                Duration

                • Mydriasis reverses spontaneously with time, with recovery after 3-8 hr
                • Complete recovery may require 24 hr in some individuals
                Previous
                Next:

                Administration

                Ophthalmic Administration

                For ophthalmic use only

                Touchless, metered spray ophthalmic mist

                See prescribing information for complete instructions and diagrams for use

                Advise patients to avoid driving, using machinery, or engaging in activities that require clear vision until they are sure they can perform such activities safely

                Storage

                Store at room temperature 15-25ºC (59-77ºF)

                Do not tamper with or attempt to open cartridge, as it may damage the dispenser, causing an incorrect medication discharge volume, and/or the dispenser base may not function properly

                Previous
                Next:

                Images

                No images available for this drug.
                Previous
                Next:

                Patient Handout

                A Patient Handout is not currently available for this monograph.
                Previous
                Next:

                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

                To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                Adding plans allows you to:

                • View the formulary and any restrictions for each plan.
                • Manage and view all your plans together – even plans in different states.
                • Compare formulary status to other drugs in the same class.
                • Access your plan list on any device – mobile or desktop.

                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.
                Additional Offers
                Email to Patient

                From:

                To:

                The recipient will receive more details and instructions to access this offer.

                By clicking send, you acknowledge that you have permission to email the recipient with this information.

                Email Forms to Patient

                From:

                To:

                The recipient will receive more details and instructions to access this offer.

                By clicking send, you acknowledge that you have permission to email the recipient with this information.

                Previous
                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.