Translation of a-t 2024; 55: 16
SIDE EFFECTS
INTRAVENOUS ABUSE OF TROPICAMIDE EYE DROPS (MYDRIATICUM STULLN)
The Drug Commission of German Pharmacists is calling attention to three reports of suspected abuse of tropicamide eye drops (MYDRIATICUM STULLN*). Since mid-2022 forged private prescriptions for large quantities of the anticholinergic drug approved for diagnostic pupil dilation have been presented to pharmacies.1 Tropicamide, which requires a prescription in Germany, can also be obtained relatively easily online.2,3
| * | In addition to the standard single-dose containers of 0.4 ml and 0.5 ml, the tropicamide preparation MYDRIATICUM STULLN is also available in packs of 10 ml and 10 x 10 ml, which could potentially be abused. |
It has been known for more than a decade that tropicamide eye drops are being abused by being injected intravenously to achieve stimulating, euphorigenic and hallucinogenic effects.2 Reports initially came from Russia and other eastern European countries,4 and then for example also from France, Italy and Turkey.3,5,6 Tropicamide is often used together with other drugs such as alcohol, marijuana and opioids,2 and is also used to increase the effect of heroin.7
An average of 3 ml to 5 ml is injected per dose, with quantities of up to 50 ml or even up to 150 ml consumed per day.5,7 The effects are strongest in the first hour and decrease in the subsequent hours.6 Among other things, these effects may be based on tropicamide's high affinity for cholinergic receptors. Abuse is sometimes associated with serious adverse effects of anticholinergic toxicity, such as urinary retention, paralytic ileus, seizures, tachycardia, cardiac arrhythmias, toxic cardiomyopathy or hepatitis, acute psychosis, coma and death. Suicidal thoughts occur.3,5,7
Overall, abuse of tropicamide eye drops appears to be rare but on the increase. Pharmacists are being asked to pay greater attention to anomalies on prescriptions for the eye drops.1
| ! | AMK: Pharm. Ztg. 2024; 169 (Nr. 5): 80 |
| 2 | BERSANI, F.S. et al.: Gen. Hosp. Psych. 2013; 35: 571-3 |
| 3 | van HOUT, M.C.: Heroin Addic. Relat. Clin. Probl. 2018; 20: 51-3 |
| 4 | Bluelight: Tropicamide abuse in Russia, 21. Sept. 2011; https://a-turl.de/nghr |
| 5 | PONTÉ, C. et al.: Br. J. Clin. Pharmacol. 2017; 83: 1791-1800 |
| 6 | BERSANI, F.S. et al.: Hum. Psychopharmacol. Clin. Exp. 2015; 30: 262-4 |
| 7 | BELLMAN, V. et al.: Braz. J. Psychiatry 2022; 44: 522-31 |
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