Hydroxyamphetamine Hydrobromide and Tropicamide Ophthalmic Solution

[07 February 2017]

Products Affected - Description

Paremyd ophthalmic solution, Akorn
1% hydroxyamphetamine hydrobromide and 0.25% tropicamide, 15 mL bottle, 1 count (NDC 17478-0704-12)

Reason for the Shortage

  • Akorn has Paremyd on shortage due to manufacturing delays.
  • No clinical trial data were found to support the use of Paremyd in the diagnosis of Horner Syndrome.

Available Products

There is no supply available.

Estimated Resupply Dates

Akorn has Paremyd ophthalmic solution on back order and the company estimates a release date of early-March 2017.

Implications for Patient Care

Hydroxyamphetamine is an indirect-acting adrenergic agonist and causes pupil dilation.3 Topical hydroxyamphetamine is not commercially available in the US.1

Alternative Agents & Management

  • Topical hydroxyamphetamine has been used to aid in localizing specific ophthalmic lesions associated with Horner syndrome. Because of difficulties with obtaining hydroxyamphetamine, other pharmacologic agents such as phenylephrine 1% have also been used.4 Additionally, some authors recommend alternative clinical and radiological protocols to diagnosis Horner syndrome because of the difficulties in obtaining hydroxyamphetamine hydrobromide.5,6
  • No clinical trial data were found to support the use of Paremyd (a combination hydroxyamphetamine hydrobromide and tropicamide ophthalmic solution) in the diagnosis of Horner Syndrome.

Related Shortages


  1. Anon, ed. Red Book Online. via Micromedex 2.0 [internet database]. Greenwood Village, CO: Truven Health Analytics; 2015.
  2. Professional Compounding Centers of America (personal communication). December 15, 2010.
  3. Hydroxyamphetamine/Tropicamide. Drug Facts and Comparisons Online. St. Louis, MO: Wolters Kluwer Health Inc. July 2015.
  4. Danesh-Meyer HV, Savino P, Sergott R. The correlation of phenylephrine 1% with hydroxyamphetamine 1% in Horner’s syndrome. Br J Ophthalmol 2004; 88(4):592-3.
  5. Chen Y, Morgan ML, Barros Palau AE, Yalamachili S, Lee AG. Evaluation and neuroimaging of the Horner Syndrome. Can J Ophthalmol 2015; 50(2):107-11.
  6. Davagnanam I, Fraser, CL, Miskiel K, Daniel CS, Plant GT. Adult Horner’s syndrome: a combined clinical, pharmacological and imaging algorithm. Eye 2013; 27: 291-8.


February 7, January 31, 2017; November 9, September 7, August 1, June 2, April 18, March 3, January 25, 2016; November 24, July 13, 2015, University of Utah, Drug Information Service. Copyright 2017, Drug Information Service, University of Utah, Salt Lake City, UT.


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