What are the uses of Tromethamine (THAM) drops in medical treatment?

Tromethamine (THAM) Drops: Clinical Uses in Medical Treatment

Tromethamine (THAM) is primarily used as an intravenous buffering agent to treat metabolic acidosis in critically ill patients, particularly during liver transplantation and in ARDS management, but it is NOT available or indicated as topical drops for routine clinical use. 1, 2

Critical Distinction: THAM vs. Trometamol Salt Formulations

The term "trometamol drops" in clinical practice refers to tromethamine salt formulations of NSAIDs or antibiotics, not pure THAM solution. These are entirely different medications:

Actual Topical "Trometamol" Drop Formulations

Ketorolac Tromethamine Ophthalmic Solution:

• Used for postoperative ocular inflammation and pain following cataract surgery 3
• The tromethamine salt improves solubility and stability of ketorolac for topical delivery 3
• This is an NSAID formulation, not a buffering agent 3

Dexketoprofen Trometamol (Oral, Not Drops):

• Rapid-onset NSAID for acute pain conditions including migraine, postoperative pain, and musculoskeletal pain 4, 5
• Onset of action within 30 minutes with significant pain reduction 4, 5
• Not formulated as drops; available as oral tablets 5

Fosfomycin Tromethamine (Oral, Not Drops):

• Single-dose oral antibiotic for acute uncomplicated urinary tract infections 6
• Achieves bacteriological eradication rates of 75-90% 6
• Not a topical formulation 6

Intravenous THAM: The Only True "Tromethamine" Medical Use

Primary Indication - Metabolic Acidosis Management:

• THAM buffers acid loads and raises pH without producing CO₂ or increasing sodium levels, unlike sodium bicarbonate 2
• Particularly valuable during liver transplantation where rising sodium levels increase risk of osmotic demyelination syndrome (ODS) 1
• The American Association for the Study of Liver Diseases states that tromethamine may reduce the risk of ODS in patients with severe hyponatremia undergoing liver transplant 1

ARDS and Critical Care Applications:

• Used to manage acid-base derangements in acute respiratory distress syndrome where CO₂ production from bicarbonate would be problematic 2
• Efficacy equivalent to sodium bicarbonate but with less hypercarbia and hypernatremia 2

Dosing and Administration (IV Only):

• Administered intravenously in critically ill surgical and nonsurgical patients 2
• No standardized drop or topical formulation exists for THAM 2

Safety Profile and Adverse Effects

THAM-Specific Risks:

• Hyperkalemia, hypoglycemia, and ventilatory depression are documented adverse effects 2
• Tissue damage with extravasation requires careful IV administration 2
• Not approved for topical or ophthalmic use 2

Common Pitfall: Confusing tromethamine (THAM buffer) with trometamol salt formulations of other drugs. The trometamol component in NSAIDs and antibiotics serves only as a salt form to improve drug solubility—it does not provide buffering effects 3, 6.

Clinical Decision Algorithm

If seeking topical ophthalmic anti-inflammatory drops:

• Use ketorolac tromethamine ophthalmic solution for postoperative ocular inflammation 3

If seeking rapid-onset oral analgesia for acute pain:

• Consider dexketoprofen trometamol 25 mg orally with onset within 30 minutes 4, 5

If managing metabolic acidosis in liver transplant or ARDS:

• Use intravenous THAM under intensive monitoring for pH correction without sodium elevation 1, 2

If treating urinary tract infection:

• Use fosfomycin tromethamine 3g single oral dose 6