Paremyd (Hydroxyamphetamine and tropicamide) is a combination of sympathetic nervous system activating drug and parasympatholytic drug. It is used to dilate the pupils as in certain diagnostic procedures.

Hydroxyamphetamine and tropicamide Uses:

• Mydriasis:

  • It is used for the short-term pupillary dilation as in diagnostic procedures.

Hydroxyamphetamine and tropicamide (Paremyd) Dose in Adults

Hydroxyamphetamine and tropicamide (Paremyd) Dose in the treatment of Mydriasis:

• Ophthalmic: Instill 1 to 2 drops into conjunctival sac.

Use in Children:

Not indicated.

Pregnancy Risk Factor C

• This combination has not been used in animal reproduction studies.
• To reduce the risk of exposure to the fetus, it is recommended that pregnant women use the lowest effective dose of ophthalmic solution.

Use of tropicamide and hydroxyamphetamine during breastfeeding:

• It is unknown whether breast milk contains tropicamide or hydroxyamphetamine.
• According to the manufactory, it is important to exercise caution when giving tropicamide or hydroxyamphetamine to nursing mothers.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Side effects of Hydroxyamphetamine and tropicamide (Paremyd):

It is 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)

Contraindications to Hydroxyamphetamine and tropicamide (Paremyd):

• Angle-closure Glaucoma, or those with narrow angles that cause dilation of the pupil, may be the causes.
• Hypersensitive patients to hydroxyamphetaminetropicamide may experience symptoms of angle-closure vision.

Warnings and precautions

• CNS effects

  • It can cause blurred or drowsy vision, which could lead to impairment of mental and physical abilities.
  • Patients should be cautious about driving or operating machinery that requires mental alertness.

• Increased intraocular pressure

  • It can cause an increase in intraocular pressure.
  • It should be used in combination with catuion for patients suffering from glaucoma.

• Cardiovascular disease

  • Hypertension patients should be cautious when using the drug. 
  • Patients who have arrhythmias or underlying ischemic cardiovascular disease should not use the drug.
  • They should also be closely monitored for signs of arrhythmias and angina.

• Diabetes:

  • After administering the drug, monitor blood sugar levels in diabetic patients.

• Thyroid disease:

  • Hyperthyroid patients should not use the drug without caution. They should also be closely monitored for any sympathetic symptoms after administration.

Monitoring parameters:

• Ophthalmic exam,
• Intraocular pressure,
• CNS reactions (especially in children).

How to administer Hydroxyamphetamine and tropicamide (Paremyd)?

• It should be used for topical ophthalmic use only.
• Systemic absorption may be minimized by applying gentle finger pressure to the lacrimal sac for 2 to 3 minutes following the drug's administration.
• Avoid contaminating the solution by not touching the dropper tip to eyelids or other surfaces when placing drops in the eyes.
• Wash hands after administering the drug.

Mechanism of action of Hydroxyamphetamine and tropicamide:

• Hydroxyamphetamine Hydrobromide, an indirect-acting sympathomimetic drug that causes pupillary dilation or mydriasis by releasing norepinephrine via adrenergic nerve termins, is a sympathomimetic agent.
• Tropicamide, a parasympatholytic medication, causes pupillary dilation or paralysis of both the sphincter muscles in the iris (ciliary) and the ciliary muscle.

The beginning of action:

• 15 minutes

Duration:

• 3 hours;
• Complete recovery occurs in 6 to 8 hours but may take 24 hours at times.

Time to peak:

• 60 minutes

International Brand Names of Hydroxyamphetamine and tropicamide:

• Paremyd

Hydroxyamphetamine and tropicamide Brand Names in Pakistan:

No Brands Available in Pakistan.