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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

Panic-like symptoms associated with ophthalmic tetryzoline: a case report and clinical pharmacokinetic assessment

SO286A - PANIC-LIKE SYMPTOMS ASSOCIATED WITH OPHTHALMIC TETRYZOLINE: A CASE REPORT AND CLINICAL PHARMACOKINETIC CONSIDERATIONS (ID 3499)

Topical ophthalmic tetryzoline use caused systemic sympathomimetic symptoms resembling panic attacks, confirmed by drug withdrawal and rechallenge.

The aim of this case report is to describe the systemic psychiatric effects of ophthalmic tetryzoline and to highlight that topical eye drops can trigger panic-like symptoms. Tetryzoline hydrochloride is an alpha-adrenergic agonist used for conjunctival hyperemia; although its known systemic effects include hypertension, tachycardia, tremor, headache, and nervousness, psychiatric presentations resembling panic attacks remain underrecognized. This single-patient case report is based on a structured psychiatric assessment, a review of medical records, an analysis of medication history, and two years of longitudinal follow-up; causality was assessed using the temporal relationship, drug withdrawal and controlled re-exposure (dechallenge and rechallenge), and the Naranjo Adverse Drug Reaction Probability Scale. A 59-year-old man presented with recurrent, sudden-onset episodes of intense anxiety accompanied by palpitations, shortness of breath, chest discomfort, nausea, paresthesia, and fear of dying; a comprehensive medical evaluation, complete blood count, liver and kidney function tests, thyroid profile, urinalysis, and ECG were normal. Chronic use of ophthalmic tetryzoline (0.5 mg/mL) was identified, and symptoms resolved completely after the drug was discontinued, recurring within 48 hours of rechallenge; bromazepam was used as needed for a short period. Following permanent discontinuation of the drug, the patient remained symptom-free for two years without maintenance psychotropic treatment, and his daily functioning remained normal; the reaction was classified as probable according to the Naranjo scale. In conclusion, the report emphasizes the importance of including topical sympathomimetic medications in the psychiatric assessment when panic-like symptoms occur without an apparent cause, the pharmacokinetic significance of conjunctival and nasal absorption that bypasses first-pass metabolism, and the potential for this approach to prevent misdiagnosis and unnecessary pharmacological treatment.

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