What are Mydriabid drops?
Mydriabid drops is the common name online for “Mydrapid” eye drops, a 1% eye drop containing tropicamide, and “Mydriacyl” drops have the same active ingredient. Their natural place is the eye doctor’s clinic, where they are instilled to dilate the pupil before an examination.
According to a StatPearls review, tropicamide is considered a safe drug for dilating the pupil before a comprehensive eye examination and before procedures such as cataract surgery and retinal surgery. A clinical review published in 2022 in the Brazilian Journal of Psychiatry notes that its effect on the eye starts within 15 to 30 minutes and lasts 4 to 6 hours, much shorter than atropine, whose effect can last up to 14 days.
We place it on our site under hallucinogens because the purpose of misusing it is usually to alter consciousness and perception, even though it is originally an eye medication.
The medical use of Mydrapid drops
Dilating the pupil so the doctor can see the retina and optic nerve clearly.
Making cataract and retinal surgery easier and reducing complications.
Used in a small amount set by the doctor, and its effect wears off within hours.
How do Mydriabid drops affect the brain?
Tropicamide blocks the muscarinic receptors on which acetylcholine acts. In the eye, this means the pupil widens. But when large amounts reach the brain, blocking these receptors causes what doctors call “central anticholinergic syndrome”: agitation, rapid speech, delirium, and visual or auditory hallucinations.
The 2022 clinical review notes that tropicamide’s addictive properties apparently relate to the interaction between the acetylcholine system and the opioid system in the brain, which may explain why its misuse appeared mainly among opioid users. This mechanism is close to that of Parkinol, another drug from the same group.
Names of the drops and what they look like
The clinical review describes the package as containing 10 ml of a clear, colorless solution at a concentration of 1% or 0.5%. In Egypt, drops containing tropicamide are known by brand names including Mydrapid and Mydriacyl, and many people write the name online as “Mydriabid,” while others search for them as “pupil dilating drops.”
Why are Mydrapid drops misused?
The 2022 clinical review summarizes the reasons researchers have put forward for the spread of their misuse:
- That they strengthen and prolong the effect of heroin, so users describe a “second wave” minutes after injection.
- That they reduce or delay opioid withdrawal symptoms, according to some users.
- The speed and strength of their effect after injection.
- Their low price and availability without a prescription in many parts of the world.
- That they dilate the pupil and so hide the “pinpoint pupil” that reveals opioid use.
- What is said about them online and in the media.
But they can turn from an “add-on” into a problem in their own right; some patients in the Russian reports described moving on to using them alone despite frightening hallucinations, with a large increase in the number of injections per day.
Mydriabid drops compared with similar substances
| Mydriatic eye drops | Parkinol | Heroin | |
|---|---|---|---|
| How it acts | Block acetylcholine receptors | Blocks acetylcholine receptors | Activates opioid receptors |
| Medical use | Dilating the pupil for eye examination | Tremor and the movement effects of antipsychotics | Not used medically in Egypt |
| Common misuse | Injection, often together with heroin | Swallowing large numbers of tablets | Injection, sniffing or smoking |
| Pupils | Dilated | Dilated | Very small |
| Main risk | Delirium, and harm from injecting and to the liver and kidneys | Delirium, high temperature and a racing heart | Overdose and respiratory depression |
This is why the pupil of a person who combines heroin with the drops may look normal or dilated, so the family misses the sign that would have alerted them. This does not mean the risk of heroin overdose has gone away; the drops do not protect against respiratory depression.
Where has misuse of the drops spread?
According to the clinical review, the first documented cases of injecting tropicamide drops for misuse were published in Russia between 2012 and 2013, after empty drop bottles began appearing in large numbers near pharmacies, and then reports followed from Turkey, Italy, France, Tajikistan and Kazakhstan, while no confirmed cases were recorded in the United States. In France, the pharmacovigilance network recorded 17 forged tropicamide prescriptions in 2014 and 2015.
In our region, the review cites an observational study in 16 pharmacies in Amman which found that one in six requests for eye products was linked to suspected misuse. Doctors at an eye hospital in Khartoum also described a tenfold weekly rise in the drops’ use in outpatient clinics and bottles disappearing from examination rooms, until management put dispensing controls in place that brought use back to normal. We have no published data on the size of the problem in Egypt.
The legal status of Mydrapid drops in Egypt
Mydrapid drops are a registered eye medication, and their place of use is the eye doctor’s clinic or the treatment the doctor prescribes. Buying or circulating them for injection or misuse is misuse of a medication that may expose the person to legal liability, quite apart from the health risk. The Fund for Drug Control and Treatment of Addiction offers free, confidential treatment through hotline 16023.
This is general educational information and not legal advice.
Mydriabid drops in numbers
Sources: review by Bellman et al. (2022) in the Brazilian Journal of Psychiatry, and a letter by Eltom et al. (2020) in the Indian Journal of Pharmacology.
Mydriabid drops guide: everything you need to know
We have gathered everything about Mydriabid drops into 4 pages, each answering one question in detail. Choose what you are looking for:
Harms of Mydriabid eye drops to the body and mind
What are the harms of Mydriabid (Mydrapid) drops outside the eye? Delirium, hallucinations, seizures and heart rhythm disturbance, the harms of injection, reports of liver and kidney failure and anemia, and the complications of mixing them with heroin.
Mydriabid eye drops use symptoms and signs of addiction
How do you know whether someone is using Mydriabid drops? A dilated pupil despite heroin use, dry skin and hallucinations, signs of injection and empty bottles, and when use becomes addiction.
Heroin withdrawal symptoms and how long they last
When do heroin withdrawal symptoms start and how long do they last? The withdrawal timeline, early and late symptoms, long-term withdrawal, and why it needs medical supervision.
Mydriabid eye drops addiction treatment: stages and duration
How is addiction to Mydriabid (Mydrapid) drops treated? Assessment of all substances, heart, liver, kidney and virus tests, withdrawal from opioids and the drops together, and rehabilitation and relapse prevention.
Found empty drop bottles? Start here
- Do not assume the worst right away; ask whether an eye examination or treatment explains their presence.
- Pay attention if the bottles are numerous or appear with syringes or injection marks, or if opioid use was suspected before.
- Do not rely on pupil size to judge; the drops can hide a sign of heroin use.
- Speak calmly and at a time when they are alert, and express your concern rather than accusation.
- Ask for a comprehensive medical assessment that includes the heart, liver, kidneys and mental state.
- Save the ambulance number, 123, and learn the overdose signs.
The drops’ harms, symptoms, withdrawal and treatment in brief
Harms: delirium, seizures and heart rhythm disturbance during poisoning, and reports of damage to the liver, kidneys and veins with repeated use. Details are in the harms of Mydriabid drops.
Symptoms: a dilated pupil, hot dry skin and hallucinations, with signs of injection and empty bottles. Details are in symptoms of Mydriabid drop use.
Withdrawal: reports described anxiety, sweating, nausea, stiffness, tremor and sharp mood swings lasting on average 5 to 7 days, with longer cravings. Because the drops are usually used with opioids, their withdrawal overlaps with and prolongs heroin withdrawal.
Treatment: assessment of all substances, medical withdrawal that treats the opioids and the drops together, then psychological rehabilitation to prevent relapse. Details are in treatment of Mydriabid drop addiction.
Danger signs after using Mydriabid drops: call an ambulance (123) immediately
- Seizures, loss of consciousness, or no response to calling
- Slow or weak breathing, especially if the drops were mixed with heroin or other opioids
- Severe palpitations, an irregular pulse or chest pain
- High fever with hot, dry skin and very wide pupils
- Delirium or severe agitation with a risk of harming themselves or others
Call an ambulance on 123 immediately. If the person is unconscious but breathing, place them on their side so they do not choke on vomit. Stay with them and do not leave them alone, keep syringes and sharp objects away from them, give them no medication or other substance, and tell the paramedics that they used eye drops and everything else they took with them.
Call the ambulance 123