nasal exposure to methamfetamine on the same side as the nasal drug exposure.

Hertle et al (2001) reported a case of ‘paradoxically’ improved nystagmus, binocular function and visual acuity in a child with retinal dystrophy and congenital nystagmus while taking ­Dexedrine (dextroamfetamine sulfate).

References and Further Reading

Acute drug abuse reactions. Med Lett Drugs Ther 27: 77, 1985.

Chuck RS, Williams JM, Goldberg MA, Lubniewski AJ. Recurrent corneal ulcerations associated with smokeable methamphetamine abuse. Am J Ophthalmol 121(5): 571–572, 1996.

D’Souza T, Shraberg D. Intracranial hemorrhage associated with amphetamine use. Neurology 31: 922, 1981.

Hertle RW, Maybodi M, Bauer RM, Walker K. Clinical and oculographic response to Dexedrine in a patient with rod-cone dystrophy, exotropia, and congenital aperiodic alternating nystagmus. Binocul Vis Strabismus Q 16: 259–264, 2001.

Limaye SR, Goldberg MH. Septic submacular choroidal embolus associated with intravenous drug abuse. Ann Ophthalmol 14: 518, 1982.

Lowe T, et al. Stimulant medications precipitate Tourette’s syndrome. JAMA 247: 1729, 1982.

Rouher F, Cantat MA. Anorexic medications and retinal venous thromboses. Bull Soc Ophtalmol France 62: 65–71, 1962.

Shaw HE Jr., Lawson JG, Stulting RG. Amaurosis fugax and retinal vasculitis associated with methamphetamine inhalation J Clin. Neuro- ­ophthalmol 5: 169–176, 1985.

Smart JV, Sneddon JM, Turner P. A comparison of the effects of chlophentermine, diethylpropion, and phenmetrazine on critical flicker frequency. Br J Pharmacol 30: 307–316, 1967.

Spaeth GL, Nelson LB, Beaudoin AR. Ocular teratology. In: Ocular ­Anatomy, Embryology and Teratology, Jakobiec FA (ed), Philadelphia J.B. Lippincott, 1982, pp 955–975.

Vesterhauge S, Peitersen E. The effects of some drugs on the caloric induced nystagmus. Adv Otorhinolaryngol 25: 173, 1979.

Wallace RT, Brown GC, Benson W, Sivalingham A. Sudden retinal ­manifestations of intranasal cocaine and methamphetamine abuse. Am. J Ophthalmol 114: 158–160, 1992.

Wijaya J, Salu P, Leblanc A, Bervoets S. Acute unilateral visual loss due to a single intranasal methamphetamine abuse. Bull Soc Belge Opthalmol 271: 19–25, 1999.

Yung A, Agnew K, Snow J, Oliver F. Two unusual cases of toxic epidermal necrolysis. Australas. J Dermatol 43: 35–38, 2002.

Generic names: 1. Benzfetamine hydrochloride; 2. amfepramone hydrochloride (diethylpropion); 3. phendimetrazine tartrate; 4. phentermine.

Proprietary names: 1. Didrex; 2. Tenuate, Tenuate Dospan; 3. Bontril, Bontril PDM, X-Trozine, X-Trozine L.A.; 4. Adipex-p, Ionamin.

Primary use

These sympathomimetic amines are used in the treatment of exogenous obesity.

Ocular side effects

Systemic administration

Certain

1. Decreased vision

2. Decreased accommodation

3. Diplopia

4. Visual hallucinations

5. Non-specific ocular irritation

a.Photophobia

b.Ocular pain

c.Burning sensation 6. Eyelids or conjunctiva

a.Allergic reactions

b.Erythema

c.Urticaria

7. Increased critical flicker fusion frequency (amfepramone)

Conditional/Unclassified

1. Optic neuritis (phentermine)

2. Posterior subcapsular cataracts (phentermine, amfepramone)

3. Vasoplastic amairosis fugax (amfepramone)

Clinical significance

Ocular side effects due to these sympathomimetic amines are rare and seldom of clinical significance. All proven side effects are reversible or resolve even while remaining on the drug. Posterior subcapsular cataracts have been reported in patients receiving phentermine or amfepramone, but a cause-and-effect relationship has not been proven. There are 11 cases of optic neuritis in patients on phentermine in the National Registry, but most occurred during the age that multiple sclerosis may occur. Evans (2000) reported a unilateral reversible ocular migraine type aura with a positive dechallenge but no rechallenge in a patient on amfepramone.

A female adult had ‘paradoxical’ improvement of her congenital nystagmus and binocular function while taking amfepramone (Hertle et al 2002).

References and Further Reading

Chan JW. Acute nonarteritic ischaemic optic neuropathy after phentermine. Eye 19: 1238–1239, 2005.

Evans RW. Monocular visual aura with headache: retinal migraine? Headache 40: 603–604, 2000.

Hertle RW, Maybodi M, Mellow SD, Yang D. Clinical and oculographic response to tenuate dospan (diethylpropionate) in a

patient with congenital nystagmus. Am J Ophthalmol 133: 159–160, 2002.

Smart JV, Sneddon JM, Turner P. A comparison of the effects of ­chlorphentermine, diethylpropion, and phenmetrazine on critical flicker frequency. Br J Pharmacol 30: 307–316, 1967.

Class: Antianxiety Agents

Generic names: 1. Alprazolam; 2. chlordiazepoxide; 3. clonazepam; 4. clorazepate dipotassium; 5. diazepam; 6. flurazepam; 7. lorazepam; 8. midazolam; 9. oxazepam; 10. temazepam; 11. triazolam.

Proprietary names: 1. Niravam, Xanax; 2. Librium;

3. Klonopin; 4. Gen-xene, Tranxene, Tranxene SD; 5. Acudial, Diastat, Valium; 6. Dalmane; 7. Ativan; 8. Generic only;

10. Generic only; 11. Restoril; 12. Halcion.

Primary use

These benzodiazepine derivatives are effective in the management of psychoneurotic states manifested by anxiety, tension or agitation. They are also used as adjunctive therapy in the relief of skeletal muscle spasms and as preoperative medications.

CNS the affecting Agents • 2 Section