Tropicamide,sold under the brand nameMydriacylamong others, is a medication used todilate the pupiland help withexamination of the eye.[3]Specifically it is used to help examine theback of the eye.[4]It is applied aseye drops.[3]Effects occur within 40 minutes and last for up to a day.[3]
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| Trade names | Mydriacyl, others |
| AHFS/Drugs | Monograph |
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| Routes of administration | Topicaleye drops |
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| Pharmacokineticdata | |
| Protein binding | 45% |
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| CompTox Dashboard(EPA) | |
| ECHA InfoCard | 100.014.673 |
| Chemical and physical data | |
| Formula | C17H20N2O2 |
| Molar mass | 284.359g·mol−1 |
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Common side effects includeblurry vision,increased intraocular pressure,andsensitivity to light.[3]Another rare but severe side effect ispsychosis,particularly in children.[3]It is unclear if use duringpregnancyis safe for the fetus.[5]Tropicamide is in theantimuscarinicpart of theanticholinergicfamily of medications.[3]It works by making the muscles within the eye unable to respond to nerve signals.[3]
Tropicamide was approved for medical use in the United States in 1960.[3]It is on theWorld Health Organization's List of Essential Medicines.[6]
Medical use
edit
Tropicamide is anantimuscarinicdrug that produces short actingmydriasis(dilation of thepupil) andcycloplegia[7]when applied aseye drops.It is used to allow better examination of thelens,vitreous humor,andretina.Due to its relatively short duration of effect (4–8 hours), it is typically used duringeye examinationssuch as thedilated fundus examination,but it may also be used before or aftereye surgery.Cycloplegic drops are often also used to treat anterioruveitis,decreasing risk of posteriorsynechiaeand decreasing inflammation in the anterior chamber of the eye.
Tropicamide is occasionally administered in combination withp-hydroxyamphetamine(brand nameParemyd), which is asympathomimetic.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%phenylephrinehydrochloride (brand name AK-Dilate).
Side effects
editTropicamide induces transient stinging and a slight and transient rise inintraocular pressurein the majority of patients. It may cause redness orconjunctivitis(inflammation) and alsoblursnear 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,[8]cause an attack ofacute angle-closure glaucoma.This tends to be in patients with narrowanterior chamberangles,and closure risk must be assessed by the practitioner prior to instillation.
Tropicamide is often preferred toatropinebecause atropine has a longerhalf-life,causing prolonged dilation and blurry vision for up to a week. Atropine has lesssting effect,but can be toxic or fatal if ingested in large quantities by children or adults.
Witheye drops,systemic effectsare minimal to nonexistent due to very low absorption into the bloodstream.[9]
Pharmacology
editPharmacodynamics
editTropicamide is ananticholinergic.[10]It is specifically anantimuscarinic,acting as aselectivemuscarinic acetylchlineM1andM4receptorantagonist.[10]However, it has also been reported to be a non-selective antagonist of all five muscarinic acetylcholine receptors.[11]As with other antimuscarinics, tropicamide can producedelirianteffects.[10]
Recreational use
editTropicamide is sometimes abused (injected intravenously e.g. byinsulin syringe) as an inexpensive recreationaldeliriantdrug (along withnaphazoline). This was initially reported in Russia, but has subsequently spread to various other countries in the former Soviet Union and around Europe, and later in the United States.[12][13][14]
Tropicamide severely destroys internal organs when injected.[15][16]
Stereochemistry
editTropicamide has achiral centerand twoenantiomers.Medications areracemates.[17]
| Enantiomers | |
|---|---|
 (R)-Tropicamid CAS: 92934-63-9 |
 (S)-Tropicamid CAS: 92934-64-0 |
References
edit- ^"Summary for ARTG Entry: 25356 Mydriacyl tropicamide 0.5% eye drops bottle".Therapeutic Goods Administration.Archived fromthe originalon 5 June 2023.Retrieved5 June2023.
- ^"Mydriacyl 1% eye drops, solution - Summary of Product Characteristics (SmPC)".Electronic Medicines Compendium.12 February 2020. Archived fromthe originalon 27 June 2022.Retrieved29 July2020.
- ^abcdefgh"Tropicamide".Drugs.American Society of Health-System Pharmacists.Archivedfrom the original on 28 December 2016.Retrieved8 December2016.
- ^World Health Organization(2009). Stuart MC, Kouimtzi M, Hill SR (eds.).WHO Model Formulary 2008.World Health Organization. p. 314.hdl:10665/44053.ISBN9789241547659.
- ^"Tropicamide ophthalmic Use During Pregnancy".Drugs.Archivedfrom the original on 28 December 2016.Retrieved28 December2016.
- ^World Health Organization(2019).World Health Organization model list of essential medicines: 21st list 2019.Geneva: World Health Organization.hdl:10665/325771.WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- ^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.PMID11431435.Archived fromthe originalon 2013-01-12.
- ^Liew G, Mitchell P, Wang JJ, Wong TY (January 2006)."Fundoscopy: to dilate or not to dilate?".BMJ.332(7532): 3.doi:10.1136/bmj.332.7532.3.PMC1325111.PMID16399709.
- ^Vuori ML, Kaila T, Iisalo E, Saari KM (1994-01-01). "Systemic absorption and anticholinergic activity of topically applied tropicamide".Journal of Ocular Pharmacology.10(2): 431–437.doi:10.1089/jop.1994.10.431.PMID8083562.
- ^abcLakstygal AM, Kolesnikova TO, Khatsko SL, Zabegalov KN, Volgin AD, Demin KA, Shevyrin VA, Wappler-Guzzetta EA, Kalueff AV (May 2019). "DARK Classics in Chemical Neuroscience: Atropine, Scopolamine, and Other Anticholinergic Deliriant Hallucinogens".ACS Chem Neurosci.10(5): 2144–2159.doi:10.1021/acschemneuro.8b00615.PMID30566832.
- ^Lavrador M, Cabral AC, Veríssimo MT, Fernandez-Llimos F, Figueiredo IV, Castel-Branco MM (January 2023)."A Universal Pharmacological-Based List of Drugs with Anticholinergic Activity".Pharmaceutics.15(1): 230.doi:10.3390/pharmaceutics15010230.PMC9863833.PMID36678858.
- ^Bersani FS, 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.PMID23706777.
- ^Bersani FS, Imperatori C, Prilutskaya M, Kuliev R, Corazza O (July 2015). "Injecting eye-drops: a mini-review on the non-clinical use of tropicamide".Hum Psychopharmacol.30(4): 262–4.doi:10.1002/hup.2481.PMID26216560.S2CID190289.
- ^Bellman V, Ukolova A, Erovichenkova E, Lam S, Srivastava HK, Bruce J, Burgess DM (November 2022)."Abuse of tropicamide eye drops: review of clinical data".Braz J Psychiatry.44(5): 522–531.doi:10.47626/1516-4446-2021-2446.PMC9561840.PMID35739063.
- ^"Bellman, V., Ukolova, A., Erovichenkova, E., Lam, S., Srivastava, H. K., Bruce, J., & Burgess, D. M. (2022). Abuse of tropicamide eye drops: review of clinical data. Revista brasileira de psiquiatria (Sao Paulo, Brazil: 1999)".Braz J Psychiatry.44.2 Nov 2022.
- ^"Krokodil: Russia's Deadliest Drug (NSFW)".YouTube.17 May 2012.
- ^Rote Liste(in German). Vol. 57. Frankfurt/Main: Rote Liste Service GmbH. 2017. p. 224.ISBN978-3-946057-10-9.
Arzneimittelverzeichnis für Deutschland (einschließlich EU-Zulassungen und bestimmter Medizinprodukte)
External links
edit- "Tropicamide".Drug Information Portal.U.S. National Library of Medicine.
