Mydrane (Lidocaine Hydrochloride Monohydrate, Phenylephrine Hydrochloride, Tropicamide)

• Mydrane is employed in ophthalmic procedures to achieve pupil dilation and intra‑ocular anesthesia.
• Cataract surgery: provides rapid pupil dilation and local anesthesia to facilitate lens removal and intra‑ocular lens implantation.
• Intra‑ocular lens implantation: ensures adequate mydriasis and analgesia for precise positioning of the lens.
• Other intra‑ocular surgeries (e.g., trabeculectomy, vitrectomy): enables sufficient pupil enlargement and anesthesia for safe operative access.

• Mydrane combines three agents that act on distinct ocular targets. Lidocaine hydrochloride monohydrate blocks voltage‑gated sodium channels in nerve membranes, producing rapid local anesthesia. Phenylephrine hydrochloride is an α1‑adrenergic agonist that contracts the dilator pupillae muscle and causes vasoconstriction, enhancing pupil dilation and reducing intra‑ocular bleeding. Tropicamide is an antimuscarinic that blocks muscarinic receptors in the iris sphincter, inducing cycloplegia and sustained mydriasis.

The following ocular and systemic reactions have been reported after intracameral administration of Mydrane.

Common Side Effects

• Transient ocular pain or discomfort.
• Mild conjunctival redness.
• Temporary blurred vision.
• Slight increase in intra‑ocular pressure.

Serious or Rare Side Effects

• Severe allergic reaction (anaphylaxis) with swelling or rash.
• Persistent elevation of intra‑ocular pressure requiring treatment.
• Corneal edema or endothelial toxicity.
• Systemic lidocaine toxicity presenting as CNS disturbances or cardiovascular effects.

Prior to using Mydrane, clinicians should observe the following precautions to ensure patient safety.

• Allergy assessment: verify no known hypersensitivity to lidocaine, phenylephrine, or tropicamide.
• Intra‑ocular pressure monitoring: check baseline IOP and observe for post‑injection spikes.
• Cardiovascular caution: use carefully in patients with uncontrolled hypertension or arrhythmias.
• Glaucoma consideration: avoid or use with caution in narrow‑angle glaucoma.
• Pediatric use: limit administration to adults unless specifically indicated.
• Store at room temperature: keep in original container, protect from light and moisture.

Mydrane may interact with other medications; relevant interactions are categorized below.

Major Interactions (Avoid)

• MAO inhibitors: risk of hypertensive crisis with phenylephrine.
• Concurrent systemic lidocaine products: additive local anesthetic toxicity.
• Anticholinergic agents: excessive mydriasis and cycloplegia.

Moderate Interactions (Monitor Closely)

• Alpha‑adrenergic antagonists (e.g., prazosin): may diminish phenylephrine‑induced dilation.
• Beta‑blockers: can blunt vasoconstrictive response of phenylephrine.