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Cyclopentolate Hydrochloride Eye Drops Addiction A Case Report

Authors:
Aslı Enez Darcin at Kanuni Sultan Süleyman Training and Research Hospital Istanbul
Aslı Enez Darcin
Nesrin Dilbaz at Üsküdar University
Nesrin Dilbaz
Savas Yilmaz
Savas Yilmaz
Savas Yilmaz
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Mustafa Kemal Cetin
Mustafa Kemal Cetin
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CASE REPORT
Cyclopentolate Hydrochloride Eye Drops Addiction
A Case Report
Asli Enez Darcin, MD, Nesrin Dilbaz, MD, Savas Yilmaz, MD, and Mustafa K. Cetin, PhD
Cyclopentolate, a synthetic anticholinergic, has been widely
used as a cycloplegic and mydriatic agent for more than 40
years. Abuse of anticholinergic drugs for their stimulating
and euphoriant effects has been known for a long time
(Pullen, 1984). Anticholinergic drug abuse is observed not
only in psychiatric patients but also in individuals without
psychiatric comorbidities. It is well known that anticholin-
ergic drugs can be abused with alcohol and other drugs
(Pullen, 1984; Crouch et al., 2004).
In this report, a case of anticholinergic addiction due to
anticholinergic eye drops, a physiological dependence on
cyclopentolate hydrochloride, is reported.
CASE REPORT
A 28-year-old male patient was admitted to Ankara
Alcohol and Drug Research, Treatment and Training Center
with complaints of topical cyclopentolate hydrochloride over-
use. Twenty years ago, he had been admitted with a com-
plaint of impaired vision and had been diagnosed with uveitis
by an ophthalmologist. In addition, he had cataract surgery on
both eyes 8 years ago.
He had been examined by an ophthalmologist once a
month or once every 3 months since 1989. In the early years,
because the ophthalmologist was using cyclopentolate hydro-
chloride during eye examinations, he prescribed the cyclo-
pentolate hydrochloride to be used by the patient just before
the examination, so that they would not have to wait for the
mydriatic effect. Initially, the patient used the drops to relieve
the eye floaters. Then, he liked the burning feeling in his eyes
and felt “high” when he used the drops. He described the
effect of the drops as a “tingling sensation.” He had been
increasing the dose during the last 10 years to achieve the
same effect. He had kept the drops in his pocket for the last
8 years. The amount of eye drops that he had used was 3 or
4 bottles of cyclopentolate hydrochloride (100 drops per
bottle) per day for the last 2 years. When he forgot to use
them, he noticed that the cessation of the drops made him
anxious. He also had nausea and sweating when he withdrew
from the drops. After experiencing nausea, he had adminis-
tered cyclopentolate hydrochloride drops orally once or
twice, but it did not relieve him. He could tolerate a maxi-
mum of 3 hours without administering the drops during the
last 8 years. Before the weekends or holidays, he used to buy
several bottles of cyclopentolate hydrochloride to avoid de-
privation. He tried to taper the drops several times within the
last 5 years but could not succeed. As a consequence, he
revealed his experiences to his ophthalmologist and was
referred to our clinic. He also had a history of inhalant abuse
10 years ago.
The patient was consulted in the ophthalmology depart-
ment, and pseudophakia was diagnosed in both eyes. Then,
he underwent a standard physical and psychiatric examina-
tion. Structured Clinical Interview for DSM-IV (SCID)-I and
SCID-II were applied to the patient, and no psychiatric
diagnosis was observed other than anticholinergic addiction
(including a physiological dependence on cyclopentolate hy-
drochloride) (304.90) due to tolerance (marked increase in
amount), characteristic withdrawal symptoms (substance
taken to relieve withdrawal), substance taken in larger
amount and for longer period than intended, persistent desire
or repeated unsuccessful attempt to quit, and much time/
activity spent to obtain and use. He also had some antisocial
personality traits including impulsivity or failure to plan
ahead and substance abuse.
DISCUSSION
Among psychiatric patients, misuse of anticholinergic
drugs was rarely reported before 1980. Since then, the re-
ported prevalence rates have increased from 0% to 18%
(Smith, 1980). On direct questioning, the most commonly
encountered reasons of patients for misusing anticholinergic
drugs have been reported as getting high, increase in pleasure,
decrease in depression, increase in energy, relaxing, going
along with the group, and decrease in the side effects of
neuroleptic medication (Buhrich et al., 2000). Cycloplegic
agents can involve the systemic circulation by absorption
through the cornea, conjunctiva, nasolacrimal mucosa, and
gastrointestinal tract. After their systematic absorption, they
may affect almost all systems. Dimethylated side chain (-N-
[CH
3
]
2
) in cyclopentolate, which is also found in the hallu-
cinogens hordenine and bufotenine, may explain the abuse
potential (Havener, 1983).
From the Ankara Numune Hospital (AED, ND, SY); and Ankara Alcohol
and Drug Research, Treatment and Training Center (MKC), Ankara,
Turkey.
Received for publication January 11, 2010; accepted March 11, 2010.
Send correspondence and reprint requests to Asli Enez Darcin, MD, Ankara
Numune Hospital, Psychiatry Clinic, Talatpasa Bulvari, Sihhiye/Ankara
06100, Turkey. e-mail: aenez5280@yahoo.com.tr
Copyright © 2011 American Society of Addiction Medicine
ISSN: 1921– 0629/11/0501-0084
DOI: 10.1097/ADM.0b013e3181dd4f90
J Addict Med • Volume 5, Number 1, March 201184
Abuse of cyclopentolate eye drops has been rarely re-
ported in the literature. The first case of cyclopentolate abuse
was reported in 1975 (Ostler, 1975), followed by Sato et al.
(1992) who described 2 cases of cyclopentolate hydrochloride
abuse, 1 with chronic alcoholism. In a recent report, a case of
cyclopentolate addiction with bipolar disorder has been reported
(Akkaya et al., 2008), which is the fourth case in the literature
that indicates abuse potential of cyclopentolate.
In this study, the patient could not be followed up.
When we could contact him, we learned that he had not used
the drops for 5 months after discharge. However, he had then
begun to abuse a new mydriatic agent (tropicamide) pre-
scribed by his ophthalmologist.
In the report conducted by Ostler (1975), a case with a
combination of cyclopentolate hydrochloride and tropicamide
abuse has been reported. Our patient was the second case
presenting with tropicamide abuse; tropicamide also has an-
ticholinergic effects. It is known that in the course of depen-
dence, there are lapses and relapses. In this study, a case who
had anticholinergic addiction due to topically used anticho-
linergic eye drops was treated in our center. In conclusion, the
number of cases with cyclopentolate hydrochloride abuse is
increasing. Ophthalmologists should be aware of the potential
risk of abuse and dependence on anticholinergic eye drops,
particularly in those populations at risk for addictive disease.
Consultations with addiction medicine specialists and psychi-
atrists may be appropriate in selected patients.
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Akkaya C, Zorlu Kocagoz S, Sarandol A, et al. Addiction to topically used
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J Addict Med • Volume 5, Number 1, March 2011 Cyclopentolate Hydrochloride Eye Drops Addiction
© 2011 American Society of Addiction Medicine 85
... tropicamide, cyclopentolate) are widely used to induce mydriasis and/or cycloplegia during eye examination. 9,10 The abuse of anticholinergic drugs, which has become well known especially in the 1980s, is related to their effect in causing euphoria and hallucination. The main reported reasons for abuse were: relaxing, getting high, induce pleasure, boosting energy, and eliminating depression. ...
... The main reported reasons for abuse were: relaxing, getting high, induce pleasure, boosting energy, and eliminating depression. [9][10][11] Cycloplegic agents like cyclopentolate and tropicamide can enter the systemic circulation and reach to all systems easily by absorption through cornea and then the ocular drainage system. 9 Because of their dangerous systemic side effects, any small amount of these agents could lead to harm if misuse or abuse happens. ...
... [9][10][11] Cycloplegic agents like cyclopentolate and tropicamide can enter the systemic circulation and reach to all systems easily by absorption through cornea and then the ocular drainage system. 9 Because of their dangerous systemic side effects, any small amount of these agents could lead to harm if misuse or abuse happens. 11 Several other types of ophthalmic drugs were mentioned in literature to be liable for abuse. ...
Ophthalmic drug abuse: An observational study from community pharmacies in Amman-Jordan
Article
  • Aug 2019
  • RES SOC ADMIN PHARM
Background: There has been a trend in the past five years in Jordan for ophthalmic anticholinergic preparations to be misused or abused. This is done mainly to experience mental altering effects such as mood changes, euphoria or hallucinations. Such products are mostly obtained from community pharmacies without a prescription. Objectives: This study aimed to observe the requests of ophthalmic preparations in community pharmacies in Amman, Jordan, and evaluating the most popular and frequently requested ophthalmic drops suspected of abuse. Also, it aimed to describe the current methods that Jordanian community pharmacists use to manage such requests. Methods: A prospective cross-sectional observational study was conducted between November 2016 and January 2017 at sixteen different community pharmacies in Amman. All ophthalmic products requested were observed during this period. Results: A total of 140 ophthalmic product requests for 130 customers were observed. Dry eye was the most common complaint for which the customer requested the medication (n = 30, 23.1%) and direct self-medication (ie-requesting the product by name), was the most frequent method of purchase (n = 63, 48.5%). In 19 cases (14.6%), product requests were suspected to be for non-medical (ie-abuse) purposes. Most of the suspected cases were for Pentolate® (n = 11, 57.9%), whereas 7 were for Prisoline® (36.8%) and 1 for Naphcon-A® (5.3%). The majority of observed cases were for products requested without a prescription (n = 16, 84.2%), and in 12 cases out of which, sale was refused (63.2%). Conclusion: More effort and enforcement of pharmacy regulation for safe dispensing is needed to reduce the abuse of ophthalmic products. Educating pharmacists and ophthalmologists would help raise awareness and control the type of drug abuse.
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... Early warning reports and mini-reviews have highlighted the issue of recreational and self-medicating misuse of these drugs (Kadri et al. 2010;Bersani et al. 2013;Prilutskaya and Kuliev 2014;Bersani et al. 2015). Most commonly reported ophthalmic preparations are those containing anticholinergics, antihistamines, and/or decongestants, such as tropicamide, cyclopentolate, naphazoline, and antazoline (Darcin et al. 2011;Wazaify et al. 2016;Ponté et al. 2017). Other ophthalmic drugs liable for abuse are the topical anesthetic drugs (TADs), such as proparacaine, lidocaine, benoxinate (oxybuprocaine), cocaine and tetracaine, and topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) (Rapuano 1990;Flach 2006;Erdem et al. 2013;Sharifi et al. 2013). ...
... On cessation, keratitis resolved within 4 days but with withdrawal symptoms of excessive salivation, tremors, rigidity, nausea, vomiting, and anxiety. Darcin et al. (2011) reported the case of a 28-year-old male patient who abused cyclopentolate hydrochloride. He said that he liked the burning effect of the eye drop which made him feel Bhigh^and described tolerance and dose escalation on repeated use. ...
... This paper is the first known attempt to scope and map the extant literature on the topic of misuse and abuse of ophthalmic drugs. The abuse of ophthalmic anticholinergic drugs is related to their effect in causing euphoria, relaxation, hallucination, and reduction of depression symptoms (Darcin et al. 2011;Bersani et al. 2013;Bersani et al. 2015). A range of health harms are observed in the literature. ...
The Misuse and Abuse of Ophthalmic Preparations: a Scoping Review of Clinical Case Presentations and Extant Literature
Article
Full-text available
  • Aug 2018
  • Int J Ment Health Addiction
The emergent trend of misuse and abuse of ophthalmic drugs is a public health concern. Common ophthalmic preparations contain anticholinergics, antihistamines, decongestants, anesthetics, and vasoconstrictive and topically applied nonsteroidal anti-inflammatory drugs. Misuse and abuse relates to their effect in causing euphoria, relaxation, hallucination, and reduction of depression symptoms. A scoping review of literature was conducted using Arskey and O’Malley (International Journal of Social Research Methodology 8(1):9–32, 2005) framework for mapping extant literature on the current knowledge of the issue. Four themes emerged: abuse of cycloplegics and mydriatics, misuse and abuse of topical ophthalmic anesthetics, misuse of topical ophthalmic vasoconstrictive and topically applied nonsteroidal anti-inflammatory drugs (NSAIDs), and public and pharmacist views on ophthalmic drug abuse/misuse. The review underscores the complex motives for misuse and abuse, availability of ophthalmic products, self-medication practices, presence of co-morbidities, and low public awareness which harms the important role of health professionals regarding suspected misuse of these common products.
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... The abuse of these drugs became popular especially in the 1980s in response to their effect in causing euphoria and hallucination. The main reported reasons for abuse were reported to be relaxing, increase in pleasure, getting high, increase in energy, and a decrease in depression (Darcin et al. 2011;Bersani et al. 2013Bersani et al. , 2015. ...
... In literature, many studies highlighted the importance of raising awareness of ophthalmologists regarding the risk of ophthalmic drug abuse (Darcin et al. 2011;Bersani et al. 2013;Wazaify et al. 2017a, b) but none had evaluated their knowledge regarding this issue. To the best of our knowledge, this is the first study to provide background about ophthalmologists' knowledge, attitude, and practice of ophthalmic products liable to abuse and where the gaps that need to be filled exactly are. ...
Ophthalmic Drug Abuse: Knowledge, Attitude, and Practice of Ophthalmologists in Jordan
Article
Full-text available
  • Aug 2021
  • Int J Ment Health Addiction
This study was conducted to provide background regarding knowledge, attitude, and practice (KAP) of ophthalmologists in Jordan regarding ophthalmic product abuse and misuse. A cross-sectional self-reported survey was conducted among a sample of ophthalmologists of all ranks who were working at different hospitals, centers, and clinics in Jordan. A total of 137 valid questionnaires were returned (response rate = 69.1%). The majority of respondents were male (73.7%) and between 20 and 40 years old. Only 47.4% of our sample knew the correct difference between the definitions “abuse” and “misuse.” The majority of participating ophthalmologists (87.6%) reported that ophthalmic drugs were liable to abuse. Ophthalmologists 40 years or younger had more knowledge about ophthalmic products abuse than their older counterparts (p < 0.05). Most ophthalmologists (67.2%) reported Pentolate® eye drop (cyclopentolate) as the top ophthalmic product liable to abuse. This study provided, for the first time, background regarding the knowledge, attitude, and practice of ophthalmologists about this relatively uncommon and alerting type of drug abuse. Moreover, it highlighted the importance of increasing awareness of ophthalmologists and community pharmacists who dispense such drugs about the issue.
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... antimuscarinic) drugs for their stimulating and euphoriant effects has been known for some time (Pullen, 1984); this abuse often occurs in combination with other psychoactive compounds, most typically alcohol, marijuana, and opiates (Bersani et al., 2013). This kind of abuse has been observed not only in psychiatric patients but also in individuals without psychiatric comorbidities (Darcin et al., 2011). ...
... Cylopentolate is another mydriatic, cycloplegic drug; its abuse has been reported in the literature only four times between 1975 and 2008 (Akkaya et al., 2008;Ostler et al., 1975;Sato et al., 1992). Cycloplegic agents achieve systemic circulation by absorption through the cornea, conjunctiva, nasolacrimal mucosa, and gastrointestinal tract (Darcin et al., 2011). Thus, cycloplegic agents may affect almost all systems. ...
Ophthalmic drops abuse in community pharmacy setting: A cross-sectional study from Jordan
Article
  • May 2017
Background: The abuse of ophthalmic medications is rare and under-researched worldwide. Ophthalmic antimiscarinic drugs are abused by people who seek to feel euphoria or induce hallucinations. This is the first study of its kind in Jordan to investigate the abuse of ophthalmic drugs. Objectives: This study aims to investigate the abuse of ophthalmic drugs sold with or without a prescription in community pharmacies in Jordan. Methods: A cross-sectional survey using a structured, validated, and piloted questionnaire was used. The questionnaire was delivered by hand to a sample of community pharmacists working in four cities in Jordan. Data were managed and analyzed in SPSS. Results: A total of 220 questionnaires were completed (response rate = 95.8%). A total of 178 respondents (80.9%) reported ophthalmic drug abuse. Respondents indicated that most of the ophthalmic products requests were not accompanied by prescriptions (n = 136; 61.8%). The respondents identified five nonprescription and two prescription-only ophthalmic drugs that they believed to be commonly abused. Conclusions: Abuse of ophthalmic drugs is prevalent and perceived to be possibly escalating in the community pharmacy setting in Jordan. Research into methods to effectively deal with such drug abuse is needed and legislation that would require stricter inspections of pharmacies should be enacted.
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... Individuals struggling with CYC eye drop addiction need to seek professional help and support to overcome it and maintain their overall well-being. [11][12][13][14] A fascinating and unusual association has been found between MCR and high-performance liquid chromatography (HPLC). In liquid chromatography, HPLC takes a new direction. ...
Cutting‐edge HPLC and MCR techniques for synchronically quantifying anticholinergic drugs in the presence of C12 and C14 homologs: Robust application to green and white chemistry
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Full-text available
Green and white chemistry are vital to revolutionizing the chemical industry through their unparalleled potential to enhance sustainability and efficiency. In this study, nine sustainability tools of both green and white metrics, including green analytical procedure index (GAPI), ComplexGAPI, analytical greenness, analytical greenness metric for sample preparation, Analytical Eco‐Scale (ESA), analytical method greenness score, high‐performance liquid chromatography‐ environmental assessment tool (HPLC‐EAT), analytical method volume intensity, and blue applicability grade index (BAGI), have been developed for appraising environmental friendliness for both innovative and straightforward mean centering of ratio spectra (MCR) and reversed‐phase high‐performance liquid chromatography (RP‐HPLC) strategies utilized for concurrent analysis and separation of cyclopentolate (CYC) and C12 and C14 homologs of benzalkonium chloride (BNZ) in pure and ophthalmic solution. The mobile phase, formed of buffer phosphate and acetonitrile (35:65, v/v), was adjusted to pH 6.3, and 215‐nm UV detection was used. The experimental flow rate was 2.0 mL min⁻¹, and the analytical column was L11 Inertsil Ph‐3 (150 mm × 4.6 mm, 5 µm). All sequences were run at 25°C in the column oven. The MCR approach effectively resolved the drug's spectral overlapping. CYC and BNZ employed this approach at 227.5 and 220.4 nm, respectively. As part of the HPLC analysis, an isocratic method was employed with phosphate buffer and acetonitrile in the mobile phase at 35:65. A correlation coefficient greater than 0.999 was observed between the calibration curves for the HPLC and MCR methods in the ranges of 20–320 µg mL⁻¹ and 5–30 µg mL⁻¹ for all drugs. The technique yields excellent primary recovery rates, ranging from 97.2% to 100.5%. The recommended approach has been validated according to International Council for Harmonization guidelines.
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... Withdrawal symptoms on attempts to discontinue use included nausea and sweating. 99 Case 5. A 39-year-old male patient with Behçet's syndrome and a related vision disorder abused cyclopentolate eye drops and alcohol for 15 years and increased the dose to 100 drops per day. As a result, he reported blurred vision, impaired concentration, loss of interest, and increased anxiety when trying to lower or abstain from the dose. ...
Ocular Cyclopentolate: A Mini Review Concerning Its Benefits and Risks
Article
Full-text available
Cycloplegic and mydriatic agents are essential in ophthalmological clinical practice since they provide the means for diagnosing and treating certain eye conditions. In addition, cyclopentolate has proven to possess certain benefits compared to other available cycloplegics and mydriatics. Still, the incidence of some adverse drug reactions related to this drug, especially in susceptible patients, has created interest in reviewing the literature about the benefits and risks of using cyclopentolate. A literature search was conducted in Medline/PubMed and Google Scholar, focusing on identifying cyclopentolate's benefits and risks; the most important benefit was its usefulness for evaluating refractive errors, especially for hyperopic children, pseudomyopia, anterior uveitis, treatment of childhood myopia, idiopathic vision loss, and during examinations before refractive surgery, with particular advantages compared to other cycloplegics. While the risks were divided into local adverse drug reactions such as burning sensation, photophobia, hyperemia, punctate keratitis, synechiae, and blurred vision, which are relatively frequent but mild and temporary; and systemic adverse drug reactions such as language problems, visual or tactile hallucinations and ataxia, but unlike ocular, systemic adverse drug reactions are rare and occur mainly in patients with risk factors. In addition, six cases of abuse were found. The treatment with cyclopentolate is effective and safe in most cases; nevertheless, special care must be taken due to the potential severe ADRs that may occur, especially in susceptible patients like children, geriatrics, patients with neurological disorders or Down's syndrome, patients with a low blood level of pseudocholinesterase, users of substances with CNS effects, and patients with a history of drug addiction. The recommendations are avoiding the use of 2% cyclopentolate and instead employing solutions with lower concentrations, preferably with another mydriatic such as phenylephrine. Likewise, the occlusion of the nasolacrimal duct after instillation limits the drug's absorption, reducing the risk of systemic adverse events.
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... Those medications are not scheduled as drugs of abuse by the JFDA (2014), however they are known to have recreational properties of some controlled drugs due to euphoria and hallucinations produced by high doses especially if used systemically (i.e. injected or ingested) ( Balbani et al., 2000;Darcin, Dilbaz, Yilmaz, & Cetin, 2011). The patients in our study acknowledged using the decongestant eye drops to minimize eye redness resulting from using substances of abuse such as cannabis. ...
Patterns of Substance Use among Patients in Addiction Rehabilitation in Jordan
Article
  • Feb 2020
Background: This study aimed to identify pattern of substance use among patients at two public addiction rehabilitation centers in Amman. It provided a description of substance use career and assessment of addiction severity, quality of life and quality of sleep among participants. Methods: A quantitative cross-sectional study using a structured data collection form consisting of 4 parts: 1. General data including the demographic characteristics, medical history and career of drug abuse. 2. Severity of addiction using the severity of dependence scale (SDS). 3. Quality of life measured by the EQ-5D and 4. Quality of sleep measured by the insomnia severity index (ISI) scale. Results: A total of 93 patients from 2 treatment settings were recruited over 5 months. The total number of actively used substances was 196, with an average of 2 substances per patient. Alcohol and synthetic cannabinoids were the two most commonly used substances (39.8% and 38.7% respectively) followed by benzodiazepines (33.4%). A notable drop in heroin use was observed (5.4%, 5 out of 23 opioid user) compared to the years 2007-2009. The mean SDS score among patients was 11.43 (SD ± 3.48) indicating high dependence. Sleep problems were reported by 45% of patients. Data showed a significant role of community pharmacies in supplying drugs of abuse for users. Conclusion: Pattern of substance use changed significantly in Jordan with synthetic cannabinoids being of the top substances used and heroin use dropping. Actions should be taken to reframe the legalization of dispensing certain drugs by pharmacists without a prescription.
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... These eye drops were prescribed for ophthalmic indications, but the patient began to increase the dosage when not gaining relief. Abuse of cyclopentolate alone by topical and intranasal route was also reported in patients with psychiatric or substance abuse comorbidities [21][22][23][24]. Aside from this, three case reports and a study were recently published, showing tropicamide non-medical use in opioid users among Eastern Europe and Central Asian citizens [25][26][27] (Table 3). ...
Early Signal of Diverted Use of Tropicamide Eye Drops in France
Article
Background: Tropicamide is a mydriatic drug used as eye-drops for diagnostic or therapeutic purposes. From 2013, a diverted use by intravenous route has been suspected in Eastern Europe in opioids users. To recent date, no signal of a misuse has been identified in France. Purpose: To investigate an early signal of a diverted use of tropicamide eye drops and to collect information regarding motives of misusing and tropicamide-induced effects. Methods: Information was obtained at 1/ regional level (Midi-Pyrénées area): reimbursement data and pharmacists' reports on suspicious requests, 2/ national level: reimbursement data and prescriptions suggesting possible abuse from the OSIAP (Ordonnances Suspectes, Indicateur d'Abus Possible) survey and 3/ international level: VigiBase® reports and Web sources. Beta-blockers were used as comparators. Results: In France, in 2014-2015, 17 (0.91%, 95% CI [0.53%-1.46%]) falsified prescriptions involving tropicamide were identified in OSIAP survey (versus 0%, 95% CI [0%-0.19%] with beta-blockers). Besides, 37 other suspicious prescriptions were presented in 2015 (notified in 2016). In Midi-Pyrénées, 7 patients aged 35-49 were reimbursed for 19 to 45 vials of 10 mL, in a year. Since September 2014, the regional Addictovigilance Centre has received 91 notifications of suspicious requests to obtain tropicamide. In VigiBase®, 2 cases were identified but none in France. An increased interest on tropicamide-related Internet searches was observed from Russia and Ukraine. Conclusion: These results represent first early warning of a tropicamide diverted use in France. Tropicamide abusers would seek euphoria or hallucinations. The high doses, as the intravenous administration, could lead to serious complications.
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COMORBIDITY OF CYCLOPENTOLATE ABUSE AND BEHCET DISEASE:A CASE REPORT
Article
Full-text available
  • Dec 2021
  • PSYCHIAT DANUB
Cyclopentolate is a synthetic anticholinergic agent that has been used for mydriasis and cycloplegia as an eye drop in ophthalmologic diseases. It is known that there is abuse of anticholinergic drugs for their euphoric and hallucinogenic properties, but abuse involving cyclopentolates has attracted attention in only a fewcase reports in the literature. Here, we report a case in which a patient with cyclopentolate addiction used the drug to self-medicate for his depressive symptoms and for anger management.
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Drugs Used in Ophthalmology
Chapter
  • Jan 2021
This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses drugs used in ophthalmology including drugs used to treat age-related macular degeneration, drugs used to treat allergies, drugs used to treat glaucoma, anti-infectives, antiviral drugs, carbonic anhydrase inhibitors, decongestants, miotics, mydriatics and cycloplegics, neurotoxins, ophthalmic dyes, ophthalmic implants and injectable gases, ophthalmic preservatives and antiseptics, proteolytic enzymes, surgical adjuncts, topical local anesthetics, topical ocular nonsteroidal anti-inflammatory drugs, topical osmotic drugs, and viscoelastics.
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Cycloplegics and mydriatics. Tolerance, habituation, and addiction to topical administration
Article
  • Jul 1975
  • ARCH OPHTHALMOL-CHIC
A patient had tolerance, habituation, and addiction to the topical use of a combination of cyclopentolate hydrochloride and tropicamide. He also developed a blotchy, diffuse epithelial keratitis that disappeared when the drugs were discontinued.
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Anticholinergic Drug Abuse: A Common Problem?
Article
  • Oct 1984
Patients who are treated with neuroleptics for schizophrenia may abuse anticholinergic drugs prescribed to counteract the extrapyramidal effects. Benzhexol is the drug most frequently abused but others include orphenadrine and biperiden.
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Abuse of the antiparkinson drugs: A review of the literature
Article
  • Nov 1980
A review of the literature indicates that the anticholinergic antiparkinson drugs can be abused by some patients to achieve pleasurable effects ranging from a mild euphoria with increased sociability at the lower doses to a toxic anticholinergic psychosis with disorientation and hallucinations at higher doses. Trihexyphenidyl may have a greater potential for abuse but there has been no systematic data on this issue. While the abuse of these drugs may not be widespread, it is yet another factor arguing for their judicious use.
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Misuse of Anticholinergic Drugsby People With Serious Mental Illness
Article
  • Aug 2000
This study assessed misuse of anticholinergic drugs in a population of 50 patients with serious mental illness who were assertively managed by a community-based outreach team in Sydney, Australia. One-third of the subjects reported having misused anticholinergics over the previous month. All anticholinergics were misused, and trihexyphenidyl (benzhexol) was misused most frequently. Most subjects misused at least one other drug as well. On direct questioning, the reason given most frequently was "to get high"; on indirect questioning, reasons were related more to peer participation and feelings of futility. Marginalized patients living in the community are vulnerable to the misuse of anticholinergic drugs.
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Trends in child and teen nonprescription drug abuse reported to a regional poison control center
Article
  • Jul 2004
Trends in child and teen nonprescription drug abuse reported to a regional poison control center over a 10-year period were examined. Human exposures to toxic substances reported to the Utah Poison Control Center between January 1990 and December 1999 were reviewed. Cases were selected for analysis if the exposure involved a nonprescription drug, the patient was 6-19 years old, and the reason for exposure was intentional abuse. Frequencies and cross-tabulations were calculated to identify trends in nonprescription drug abuse. There were 2214 reports of intentional drug abuse among children and teenagers 6-19 years old. Of those, 844 (38.1%) involved nonprescription drugs. The percentage of exposures Involving nonprescription products varied every year and declined over time. Exposures were slightly more common In males (51.7%). The site of exposure was a residence in 65% of cases and a school in 10% of cases. The majority of patients with exposures (68.4%) were treated In a health care facility. The most common types of nonprescription medications abused were drugs with anticholinergic properties, caffeine, dextromethorphan, and nonprescription stimulants. Reports of the Intentional abuse of nonprescription drugs by children and teenagers were common at a regional poison control center. There was significant variation in the type of nonprescription medication most commonly abused. The knowledge of these trends may assist public health policymakers, physicians, pharmacists, and child educators in their attempts to curb nonprescription drug abuse. drugs.
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Ocular Pharmacology. 5th ed.
  • Jan 1983
  • 233
  • Havener