Truths and Tales about Tetrahydrozoline Toxicity
By: Jen, Tony, Carol and Mike (aka Moe, Larry, Curley and Shemp)
We bet this is a new one for you armchair, quasi-forensic toxicologists and pseudo-crime detectives to pontificate. Something as seemingly simple as a small bottle of non-prescription eye drops can pack a big wallop to small kids and unsuspecting victims of malicious poisoning.
Were you able to catch the drug of choice in these two entertainment venues when they were first released? “Revenge is Best Served Cold,” a CSI: Crime Scene Investigation episode first aired in 2002 involved a case of the murder of a high stakes poker player. Investigators concluded that the death was triggered by the malicious administration of tetrahydrozoline eye drops, but was ultimately caused by lead poisoning from tainted chocolate candy and/or a lead bullet imbedded in his leg. In the 2005 movie Wedding Crashers, two main characters John and Jeremy collaborate to spike the drink of their rival Sack with eye drops in order to sicken him. Jeremy schemes, “Put a few drops of these in his drink and he’ll be going down on a toilet seat for the next 24-hours” so that his date would be more easily approachable.
Scenarios such as these in high profile entertainment, seen by millions of viewers, have initiated a number of “copy cat” crimes where victims are intended to be injured, killed, assaulted or have a practical joke played on them. Examples of headline stories depicting tetrahydrozoline eye drop misuse include:
“Accused of Trying to Kill with Visine®” Miami Herald. 20 Jan 2006.
“Visine® Prank Leads to Day in Court” Milwaukee Journal Sentinel. 15 Nov 2006.
“Visine®-laced Drinks Lead to Charges” Southern Oregon Mail Tribune. 26 May 2007.
“Substitute’s Coffee Spiked with Substance” Cheyenne Star-Tribune. 14 Dec 2007.
“Gal’s Toxic Visine® Tea” New York Post. 16 Sept 2008.
Urban myth misinforms many pranksters with the idea that Visine®-spiked beverages would result in only diarrhea. Legends passed on by bartenders and prostitutes speak of the malicious spiking of drinks to punish those who fail to tip or to incapacitate unruly, harassing customers.
So is all this reporting of tetrahydrozoline toxicity fact or fiction? How can this teeny tiny ½ ounce bottle of eye drops whose active ingredient is in a teeny weenie concentration of 0.05% cause such mayhem?
When used, “only as directed,” tetrahydrozoline is an effective medication which shrinks blood vessels thus alleviating reddened “bloodshot” eyes. If taken internally, however, this drug acts like a potent high blood pressure medicine. Symptoms reported in both children and adults who have swallowed some of these eye care products either by accident or via malicious activity include marked drowsiness, low blood pressure, slowed heart rate, and possibly even coma and impaired breathing. Quantities as low as ½ to 1½ teaspoonfuls (approximately 1/6 to ½ of a half ounce bottle) have caused pronounced reactions in small children. Toxic affects following tetrahydrozoline ingestion can be serious and at times require close observation and treatment in an intensive care setting. Fortunately, no deaths have been reported.
It is important to point out that tetrahydrozoline is the active ingredient not only in Visine®, but also found in a variety of brand name products including Murine®, Opti-Clear®, Altazine®, Optigene 3®, Redness Reliever® and other generic products. Other drugs which are similar to tetrahydrozoline used in eye drops and nasal decongestants include xylometazoline, oxymetazoline and naphazoline.
The take home message is that when used and stored properly, tetrahydrozoline eye drops are safe and effective. But everyone should be mindful of the potential for toxicity from accidental poisoning in children or malicious misuse by adolescents and adults. Additionally, parents and caregivers of small children should be encouraged to keep these products (usually not in child resistant packaging) out-of-reach as they would safely store other prescription and over-the-counter medications. Anyone who becomes aware of a known or suspected tetrahydrozoline eye drop ingestion, regardless if intentional or unintentional in nature, should immediately consult the Illinois Poison Center by calling 1-800-222-1222.