Topical tropicamide induced delirium and psychosis: case report

Abstract

rESUMoTratamento com drogas anticolinérgicas é uma causa conhecida de alterações agudas do estado mental em idosos. Relata-se o caso de uma paciente de 87 anos de idade com alterações comportamentais agudas, que necessita de internamento imediatamente após início de terapia para glaucoma de ângulo aberto com tropicamida, um agente cicloplégico bloqueador de receptor muscarínico. A relação causa-efeito foi confirmada depois de a droga ter sido reiniciada durante o internamento. É apresentada uma revisão da literatura delineando as manifestações clínicas mais comuns e fatores de risco para essa complicação.

Intravenous Abuse of Tropicamide in Opioid Use Disorder: Presentation of 2 Cases

“…20 Systemic side effects such as anticholinergic intoxication and delirium have been reported after topical administration of approximately 1 mg tropicamide. 21,22 The female patient with tropicamide abuse presented by Spagnolo et al was also diagnosed with anticholinergic syndrome at her first admission but recovered without a need of antidote. 6 Despite consumption of tropicamide in high doses, up to 200 to 250 mg/day, our cases do not have a medical history that suggests an anticholinergic syndrome.…”

Early signal of diverted use of tropicamide eye drops in France

“…Among atropinic drugs, tropicamide is an ophthalmic solution indicated for therapeutic or diagnostic procedures, used for a very short-term exposure period at starting doses of one drop (150 μg of tropicamide) and not exceeding 3 ml of the solution. When it reaches blood circulation, atropine-like effects including confusional state, delirium, acute psychosis, visual hallucinations, hyperexcitability or drowsiness may appear especially at high dosages, in children or elderly people [8,9]. From 2013 in Italy, a diverted use of tropicamide has been suspected by some pharmacists, who have observed an abnormal increase in eye drop sales [10].…”

Pharmacologic Mydriasis and Cycloplegia: A Review of Novel Delivery Devices

“…23,29 Rarely, tropicamide may cause central nervous system disturbances and psychotic reactions in paediatric patients. 39,40 Tropicamide is available at doses of 0.5% and 1%. A common dilation regimen in adults is 1.0% tropicamide used in combination with 2.5% phenylephrine.…”