Tetryzoline eye drops may cause blurred vision, eye irritation and dilated pupils. Tetryzoline is not suitable for prolonged use as its vasoconstrictive effects within the eye eventually decrease or stop. If tolerance to the drug has developed, ceasing its use may cause a rebound effect and increase redness of the eyes — a vasodilatory effect. Intranasal use of tetryzoline may cause transient burning, stinging, or dryness of the mucosa and sneezing. Prolonged intranasal use often causes opposite effects in the form of rebound congestion with effects such as chronic redness, swelling and rhinitis. Prolonged use thus may result in overuse of the drug. Overdose most often causes slow heart rate. Respiratory depression, low blood pressure, constricted pupils, hypothermia, brief episodes of high blood pressure, drowsiness, headaches and vomiting may also occur. In serious cases some of these effects may result in circulatory shock. Most often overdoses occur in children who have ingested the drug. There is no antidote for tetryzoline or other similar imidazoline analogue poisoning, but the symptoms can be alleviated and with treatment, death is rare.
Pharmacokinetics
of tetryzoline in healthy people is about 6 hours and it is excreted unchanged in urine, at least in part. In one study 10 people were given 2 drops of 0.5 mg/ml tetryzoline eye drops at 0, 4, 8 and 12 h. Within 24 h time window since the last dose, tetryzoline blood serum concentration of the subjects was 13.0–210.0 ng/ml and urine concentration was 11–400 ng/ml. Both reached their maximum about 9 h post last dose. These levels correspond to normal ocular use of tetryzoline. Higher concentrations may indicate misuse of the drug or poisoning.
An urban legend suggests that tetryzoline can cause violent diarrhea if given orally, such as by putting a few drops of Visine in an unsuspecting person's beverage. However, the actual results of the prank may be worse, varying from severe nausea and vomiting to seizures or a coma. Diarrhea is not a side effect.
Criminal use
In late August 2018, a South Carolina woman was charged with murdering her husband by putting eye drops containing tetryzoline in his drinking water. An autopsy found high concentrations of tetryzoline in his body. Tetryzoline has been used as a date rape drug in a number of cases due to its ability to cause dizziness and unconsciousness.
