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Tropicamide
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<h2 id="medical-use">Medical use</h2> <p>Tropicamide is an <a href="/facts/Muscarinic_antagonist/802fuzgC">antimuscarinic</a> drug that produces short acting <a href="/facts/Mydriasis/19r5uMvC">mydriasis</a> (dilation of the <a href="/facts/Pupil/E4ec4lfJ">pupil</a>) and <a href="/facts/Cycloplegia/rehWsGgs">cycloplegia</a><a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> when applied as <a href="/facts/Ophthalmic_drug_administration/VlyFY5Nl">eye drops</a>. It is used to allow better examination of the <a href="/facts/Lens_(anatomy)/yWz7AdHV">lens</a>, <a href="/facts/Vitreous_humor/jBNl5YV5">vitreous humor</a>, and <a href="/facts/Retina/v0ISNX2S">retina</a>. Due to its relatively short duration of effect (4–8 hours), it is typically used during <a href="/facts/Eye_examination/vcIUxDp8">eye examinations</a> such as the <a href="/facts/Dilated_fundus_examination/d5xD5ErQ">dilated fundus examination</a>, but it may also be used before or after <a href="/facts/Eye_surgery/MIBdYG7w">eye surgery</a>. Cycloplegic drops are often also used to treat anterior <a href="/facts/Uveitis/le0Ns1eE">uveitis</a>, decreasing the risk of posterior <a href="/facts/Synechia_(eye)/NCeJYM3n">synechiae</a> and decreasing inflammation in the anterior chamber of the eye. </p><p>Tropicamide is occasionally administered in combination with <a href="/facts/4-Hydroxyamphetamine/Wrh18Ydp"><i>p</i>-hydroxyamphetamine</a> (brand name <a href="/facts/Paremyd/UfVfIhR9">Paremyd</a>), which is a <a href="/facts/Sympathomimetic/IEYU5ERW">sympathomimetic</a>. 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% <a href="/facts/Phenylephrine/sf4DxQws">phenylephrine</a> hydrochloride (brand name AK-Dilate). </p> <h2 id="side-effects">Side effects</h2> <p>Tropicamide induces transient stinging and a slight and transient rise in <a href="/facts/Intraocular_pressure/VVnweTza">intraocular pressure</a> in the majority of patients. It may cause redness or <a href="/facts/Conjunctivitis/u1NJfh3A">conjunctivitis</a> (inflammation) and also <a href="/facts/Defocus_aberration/AuE5r5Wv">blurs</a> 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,<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> cause an attack of <a href="/facts/Glaucoma/MWqWVNz3">acute angle-closure glaucoma</a>. This tends to be in patients with narrow <a href="/facts/Anterior_chamber/c7gN4vpp">anterior chamber</a> <a href="/facts/Trabecular_meshwork/3yHA5g6Q">angles</a>, and closure risk must be assessed by the practitioner prior to instillation. </p><p>Tropicamide is often preferred to <a href="/facts/Atropine/cJQ0gL4o">atropine</a> because atropine has a longer <a href="/facts/Half-life/kGVH8BAB">half-life</a>, 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. </p><p>With <a href="/facts/Ophthalmic_drug_administration/VlyFY5Nl">eye drops</a>, <a href="/facts/Systemic_circulation/WXwudzzc">systemic effects</a> are minimal to nonexistent due to very low absorption into the bloodstream.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> </p> <h2 id="pharmacology">Pharmacology</h2> <h3>Pharmacodynamics</h3> <p>Tropicamide is an <a href="/facts/Anticholinergic/9mDjo23r">anticholinergic</a>.<a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a> It is specifically an <a href="/facts/Antimuscarinic/802fuzgC">antimuscarinic</a>, acting as a <a href="/facts/Binding_selectivity/RryTsdGv">selective</a> <a href="/facts/Muscarinic_acetylcholine_receptor/caIdoqrW">muscarinic acetylcholine</a> <a href="/facts/M1_receptor/ne0YBBqI">M1</a> and <a href="/facts/M4_receptor/7nx6wC3s">M4 receptor</a> <a href="/facts/Receptor_antagonist/PuXHVNdV">antagonist</a>.<a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a> However, it has also been reported to be a non-selective antagonist of all five muscarinic acetylcholine receptors.<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> As with other antimuscarinics, tropicamide can produce <a href="/facts/Deliriant/QVjeDyda">deliriant</a> effects.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a> </p> <h2 id="recreational-use">Recreational use</h2> <p>Tropicamide is sometimes abused (injected intravenously e.g. by <a href="/facts/Insulin_syringe/8m937D8m">insulin syringe</a>) as an inexpensive recreational <a href="/facts/Deliriant/QVjeDyda">deliriant</a> drug (along with <a href="/facts/Naphazoline/8kwVB8ca">naphazoline</a>). 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.<a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a><a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> </p><p>Tropicamide severely destroys internal organs when injected.<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a><a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> </p> <h2 id="stereochemistry">Stereochemistry</h2> <p>Tropicamide has a <a href="/facts/Chiral_center/t3XGwk1Q">chiral center</a> and two <a href="/facts/Enantiomers/wjPv5J3y">enantiomers</a>. Medications are <a href="/facts/Racemates/STEagtrD">racemates</a>.<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> </p> <table><tbody><tr><th colspan="2">Enantiomers</th></tr><tr><td>(<i>R</i>)-TropicamidCAS: 92934-63-9</td><td>(<i>S</i>)-TropicamidCAS: 92934-64-0</td></tr></tbody></table> <h2 id="external-links">External links</h2> <ul><li><a href="https://druginfo.nlm.nih.gov/drugportal/name/tropicamide">"Tropicamide"</a>. <i>Drug Information Portal</i>. U.S. National Library of Medicine.</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>"Tropicamide". Drugs.com. American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. <a href="https://www.drugs.com/monograph/tropicamide.html" target="_blank">https://www.drugs.com/monograph/tropicamide.html</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 314. hdl:10665/44053. ISBN 9789241547659. <a href="9789241547659" target="_blank">9789241547659</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>"Tropicamide". Drugs.com. American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. <a href="https://www.drugs.com/monograph/tropicamide.html" target="_blank">https://www.drugs.com/monograph/tropicamide.html</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>"Tropicamide". Drugs.com. American Society of Health-System Pharmacists. Archived from the original on 28 December 2016. Retrieved 8 December 2016. <a href="https://www.drugs.com/monograph/tropicamide.html" target="_blank">https://www.drugs.com/monograph/tropicamide.html</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>"Tropicamide". 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