Version July 2025
Note: Individuals with heavily pigmented eyes may require additional doses. Mydriasis will reverse spontaneously with time, typically in 3 to 8 hours; however, in some cases, complete recovery may take up to 24 hours.
Mydriasis: Ophthalmic: Instill 1 spray into the cornea(s); repeat in 5 minutes.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Tropicamide and phenylephrine: Pediatric drug information")
Mydriasis:
Infants: Ophthalmic: Administer 1 spray to the cornea of each eye to be dilated; may repeat if indicated; time to repeat dosing is not defined; in children and adolescents, a dose may be repeated after 5 minutes; maximum daily dose: 3 sprays per eye/day.
Children and Adolescents: Ophthalmic: Administer 1 spray to the cornea of each eye to be dilated; repeat after 5 minutes.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Also see individual agents.
1% to 10%: Ophthalmic: Decreased visual acuity (<2%), eye discomfort (<2%), photophobia (<2%), transient blurred vision (<2%)
Hypersensitivity to tropicamide, phenylephrine, or any component of the formulation.
Concerns related to adverse effects:
• Increased intraocular pressure: May cause a transient increase in intraocular pressure.
• Rebound miosis: Has been reported 1 day after phenylephrine treatment; reinstallation of the drug produced a lesser effect.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease; may elevate BP.
• Hyperthyroidism: Use with caution in patients with hyperthyroidism; may elevate BP.
Special populations:
• Pediatric: Use with caution in infants and children; may cause potentially dangerous CNS disturbances. Psychotic reactions, behavioral disturbances, and vasomotor or cardiorespiratory collapse in children have been reported with the use of anticholinergic drugs. Use with caution in patients <5 years of age; may elevate BP.
Other warnings/precautions:
• Appropriate use: For topical ophthalmic use only. Not for injection.
May cause a significant increase in blood pressure; the risk is increased in pediatric patients <5 years and in patients with hyperthyroidism or cardiovascular disease. Use with caution in these patient groups and monitor closely.
Mydcombi: FDA approved May 2023; anticipated availability currently unknown.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Cartridge, Ophthalmic:
MydCombi: Tropicamide 1% and phenylephrine hydrochloride 2.5% (1.9 mL) [contains benzalkonium chloride]
No
Solution Cartridge (MydCombi Ophthalmic)
1-2.5% (per mL): $75.66
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Ophthalmic: For topical ophthalmic use only; not for injection. Load the dispenser by depressing the fill button once. Hold the dispenser with thumb over mist button, while wrapping fingers around the base. Bring dispenser to patient's eye with mirror facing the patient; the dispenser should be as close as the patient's nose; gently pull lower eyelid down to prevent blinking. Align the mist opening with the center of the eye then press and release the mist button.
Ophthalmic spray: Topical: For topical ophthalmic use only; not for injection into the eye. If soft contacts are worn, remove ≥10 minutes before administering dose. Do not administer artificial tears within 10 minutes of administration.
Mydcombi: See instructions for use in manufacturer's labeling for details on assembling dispenser, cleaning procedure, and mist test. Wash hands prior to use. The exterior of the dispenser should be cleaned using 70% isopropyl alcohol prior to each use. A mist test should be performed daily before dosing begins. Press the fill button down to load drug solution into the dispenser. Once loaded, position the mist opening at the center of the eye making sure the alignment marks align with the center of the eye and the lower eyelid is positioned to avoid blinking; see manufacturer's labeling for detailed instructions. Once alignment has been confirmed, firmly press and release mist button. Repeat process for contralateral eye if it is to be dilated. If a second dose is indicated, wait 5 minutes and repeat process.
Mydriasis: To induce mydriasis for diagnostic procedures and conditions where short-term pupil dilation is desired.
Refer to individual components.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Atomoxetine: May increase hypertensive effects of Sympathomimetics. Atomoxetine may increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Atropine (Systemic): May increase hypertensive effects of Alpha1-Agonists. Risk C: Monitor
Bornaprine: Sympathomimetics may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Bromocriptine: May increase hypertensive effects of Alpha1-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider Therapy Modification
Cannabinoid-Containing Products: May increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Carbachol: Tropicamide may decrease therapeutic effects of Carbachol. Risk C: Monitor
Cocaine (Topical): May increase hypertensive effects of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider Therapy Modification
Dihydralazine: Sympathomimetics may decrease therapeutic effects of Dihydralazine. Risk C: Monitor
Doxofylline: Sympathomimetics may increase adverse/toxic effects of Doxofylline. Risk C: Monitor
Echothiophate Iodide: Tropicamide may decrease therapeutic effects of Echothiophate Iodide. Risk C: Monitor
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May increase vasoconstricting effects of Alpha1-Agonists. Risk X: Avoid
Esketamine (Injection): May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for elevated heart rate, hypertension, and arrhythmias may be increased. Risk C: Monitor
Guanethidine: May increase hypertensive effects of Sympathomimetics. Guanethidine may increase arrhythmogenic effects of Sympathomimetics. Risk C: Monitor
Inhalational Anesthetics: Phenylephrine (Ophthalmic) may increase adverse/toxic effects of Inhalational Anesthetics. Specifically, the cardiovascular depressant effects of inhalational anesthetics may be increased. Risk C: Monitor
Iobenguane Radiopharmaceutical Products: Alpha1-Agonists may decrease therapeutic effects of Iobenguane Radiopharmaceutical Products. Management: Discontinue all drugs that may inhibit or interfere with catecholamine transport or uptake for at least 5 biological half-lives before iobenguane administration. Do not administer these drugs until at least 7 days after each iobenguane dose. Risk X: Avoid
Kratom: May increase adverse/toxic effects of Sympathomimetics. Risk X: Avoid
Levothyroxine: May increase therapeutic effects of Sympathomimetics. Sympathomimetics may increase therapeutic effects of Levothyroxine. Levothyroxine may increase adverse/toxic effects of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Risk C: Monitor
Linezolid: May increase hypertensive effects of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider Therapy Modification
Lisuride: May increase hypertensive effects of Alpha1-Agonists. Risk X: Avoid
Monoamine Oxidase Inhibitors: May increase hypertensive effects of Alpha1-Agonists. While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Risk X: Avoid
Pergolide: May increase hypertensive effects of Alpha1-Agonists. Risk C: Monitor
Pilocarpine (Ophthalmic): Tropicamide may decrease therapeutic effects of Pilocarpine (Ophthalmic). Risk C: Monitor
Solriamfetol: Sympathomimetics may increase hypertensive effects of Solriamfetol. Sympathomimetics may increase tachycardic effects of Solriamfetol. Risk C: Monitor
Sympathomimetics: May increase adverse/toxic effects of Sympathomimetics. Risk C: Monitor
Tedizolid: May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for increased blood pressure and heart rate may be increased. Risk C: Monitor
Tricyclic Antidepressants: May increase therapeutic effects of Alpha1-Agonists. Tricyclic Antidepressants may decrease therapeutic effects of Alpha1-Agonists. Risk C: Monitor
Animal reproduction studies have not been conducted.
Refer to individual monographs.
It is not known if tropicamide or phenylephrine are present in breast milk following ophthalmic administration.
According to the manufacturer, the decision to breastfeed should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother. Refer to individual monographs.
Ophthalmic exam, intraocular pressure, CNS reactions (especially in pediatric patients); BP post administration in patients with cardiac or endocrine disease or patients who develop symptoms.
Tropicamide: Prevents the sphincter muscle of the iris and the muscle of the ciliary body from responding to cholinergic stimulation; produces dilation and prevents accommodation.
Phenylephrine: Potent, direct-acting alpha-adrenergic agonist with virtually no beta-adrenergic activity; produces local vasoconstriction. When applied topically to the eye, phenylephrine stimulates the dilator muscle of the iris, resulting in mydriasis.
Note: Also see individual agents. Onset of action and duration of effect are partially dependent upon eye pigment; dark eyes have a prolonged onset of action and shorter duration than blue eyes.
Onset: 15 to 30 minutes; maximal mydriasis 20 to 90 minutes.
Duration: 3 to 8 hours.
