Mydrane (Lidocaine Hydrochloride Monohydrate, Phenylephrine Hydrochloride, Tropicamide)

• Mydrane is used in ophthalmic procedures that require both anesthesia and pupil dilation.
• Cataract surgery: provides rapid pupil dilation and intra‑ocular anesthesia to facilitate lens removal.
• Intraocular anesthesia during cataract extraction: ensures patient comfort and a motion‑less eye.
• Other anterior segment surgeries: assists in procedures such as trabeculectomy by maintaining a dilated pupil and providing local analgesia.

• Lidocaine blocks voltage‑gated sodium channels in ocular nerves, producing local anesthesia. Phenylephrine acts as an α1‑adrenergic agonist, contracting the dilator pupillae muscle and causing pupil dilation. Tropicamide is a muscarinic antagonist that relaxes the sphincter pupillae muscle, further enhancing mydriasis. The combined actions result in a quiet, dilated eye suitable for intra‑ocular surgery.

Mydrane may cause a range of ocular and systemic reactions.

Common Side Effects

• Transient ocular pain or discomfort.
• Redness or conjunctival hyperemia.
• Temporary increase in intra‑ocular pressure.
• Blurred vision lasting a few hours.
• Mild headache.
• Nausea or mild systemic dizziness.

Serious or Rare Side Effects

• Allergic reaction including rash, itching, or anaphylaxis.
• Sustained mydriasis leading to photophobia.
• Corneal edema or endothelial damage.
• Retinal toxicity.
• Systemic lidocaine toxicity presenting as seizures or cardiac arrhythmia.
• Severe hypotension from systemic phenylephrine absorption.

• When using Mydrane, consider the following safety measures.
• Allergy assessment: verify no hypersensitivity to lidocaine, phenylephrine, or tropicamide.
• Intra‑ocular pressure monitoring: measure IOP before and after injection.
• Cardiovascular stability: avoid in patients with uncontrolled hypertension or severe cardiac disease.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk.
• Concurrent mydriatics: avoid combining with other strong mydriatic agents.
• Store at ambient temperature: keep in the original container, protect from light and moisture.

Mydrane can interact with other medications; awareness of the interaction level is essential.

Major Interactions (Avoid)

• Systemic phenylephrine or other α1‑agonists: may cause severe hypertension.
• Concurrent local anesthetics: risk of additive lidocaine toxicity.
• MAO inhibitors combined with phenylephrine: potential hypertensive crisis.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may blunt the IOP‑lowering effect of phenylephrine.
• Cholinergic agents (e.g., pilocarpine): may reduce the mydriatic effect of tropicamide.
• Anticholinergic drugs: may enhance tropicamide‑related systemic anticholinergic effects.