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Hydroxyamphetamine Hydrobromide and Tropicamide Ophthalmic Solution

[18 April 2016]

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 insufficient supply for usual ordering.

Estimated Resupply Dates

Akorn has Paremyd ophthalmic solution available in limited supply.

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

References

  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.

Updated

April 18, March 3, January 25, 2016; November 24, July 13, 2015, University of Utah, Drug Information Service. Copyright 2016, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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