Version May 2024
Amblyopia, healthy eye penalization: Ophthalmic: Solution: Instill 1 drop in the conjunctiva of the sound eye (nonamblyopic eye) once daily on weekends or daily (Ref).
Mydriasis, cycloplegia: Ophthalmic:
Solution: Instill 1 drop in the conjunctiva 40 minutes prior to intended maximal dilation time; may repeat up to twice daily as needed.
Ointment: Apply a small amount in the conjunctival sac 1 to 2 times daily.
Palliative care of respiratory secretions (off-label use): Sublingual (using 1% ophthalmic solution): Initial: 1 to 2 drops every 2 to 4 hours; usual dose range: 2 to 4 drops every 2 to 4 hours (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Use caution; dosage adjustment may be required.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Atropine (ophthalmic): Pediatric drug information")
Amblyopia, healthy eye penalization: Solution (1%):
Infants ≥3 months and Children <3 years: Ophthalmic: Instill 1 drop once daily to healthy eye
Children ≥3 years and Adolescents: Ophthalmic: Solution (1%): Instill 1 drop once daily to healthy eye; dose may be repeated up to twice daily if needed
Mydriasis, cycloplegia:
Solution (1%):
Infants ≥3 months and Children <3 years: Ophthalmic: Instill 1 drop 40 minutes prior to intended maximal dilation time; maximum dose: 1 drop per eye per day
Children ≥3 years and Adolescents: Ophthalmic: Instill 1 drop 40 minutes prior to intended maximal dilation time; may repeat up to twice daily as needed
Ointment: Infants, Children, and Adolescents: Ophthalmic: Apply a small amount in the conjunctival sac 1 to 2 times daily
Infla mmatory conditions of iris and uveal tract: Infants, Children, and Adolescents: Ophthalmic: Ointment: Apply a small amount in the conjunctival sac 1 to 2 times daily
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Severity and frequency of adverse reactions are dose related.
Frequency not defined:
Cardiovascular: Flushing, hypotension, increased blood pressure, tachycardia
Dermatologic: Contact dermatitis, xeroderma
Gastrointestinal: Xerostomia
Nervous system: Delirium, irritability, restlessness
Ophthalmic: Blurred vision, decreased lacrimation, decreased visual acuity (reversible, healthy eye) (Scheiman 2008), eye irritation, eye pain, eyelid edema, papillary conjunctivitis, photophobia, stinging of eyes, superficial keratitis
Respiratory: Dry throat, respiratory depression
Miscellaneous: Fever
Hypersensitivity to atropine or any component of the formulation; primary glaucoma or tendency toward angle-closure glaucoma (narrowing or closure of the anterior chamber angle).
Concerns related to adverse effects:
• Elevated BP: May occur due to systemic absorption following conjunctival instillation.
• Photophobia/blurred vision: May last up to 2 weeks due to pupil unresponsiveness and cycloplegia.
Disease-related concerns:
• Brain damage: Use with caution in patients with brain damage; these patients are particularly susceptible to CNS disturbances and cardiopulmonary and GI toxicity from systemic absorption of atropine.
• Down syndrome: Use with caution in patients with Down syndrome; these patients are particularly susceptible to CNS disturbances and cardiopulmonary and GI toxicity from systemic absorption of atropine.
• Spastic paralysis: Use with caution in patients with spastic paralysis; these patients are particularly susceptible to CNS disturbances and cardiopulmonary and GI toxicity from systemic absorption of atropine.
Dosage form specific issues:
• Benzalkonium chloride: Some products may contain benzalkonium chloride which may be absorbed by soft contact lenses; avoid contact use during treatment.
Other warnings/precautions:
• Appropriate use: To avoid precipitating angle closure glaucoma, an estimation of the depth of the anterior chamber angle should be made prior to use.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Ointment, Ophthalmic, as sulfate:
Generic: 1% (3.5 g [DSC])
Ointment, Ophthalmic, as sulfate [preservative free]:
Generic: 1% (3.5 g)
Solution, Ophthalmic, as sulfate:
Isopto Atropine: 1% (5 mL [DSC]) [contains benzalkonium chloride]
Generic: 1% (2 mL, 5 mL, 15 mL)
Solution, Ophthalmic, as sulfate [preservative free]:
Generic: 1% (10 ea)
Yes
Ointment (Atropine Sulfate Ophthalmic)
1% (per gram): $10.67
Solution (Atropine Sulfate Ophthalmic)
1% (per mL): $21.00 - $23.93
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Ophthalmic:
Generic: 1% (0.3 mL, 0.5 mL)
Solution, Ophthalmic, as sulfate:
Alcon Atropine: 1% (5 mL) [contains benzalkonium chloride]
Generic: 1% (5 mL)
Ophthalmic: For topical ophthalmic use only. Wash hands before and after use. Avoid touching tip of applicator to eye or other surfaces. Finger pressure should be applied to lacrimal sac for 1 to 3 minutes after instillation to decrease risk of absorption and systemic reactions.
Ophthalmic: Wash hands prior to use.
Solution: Instill solution into conjunctival sac of affected eye(s); Avoid contact of bottle tip with eye or skin; apply gentle pressure to lacrimal sac during and immediately following instillation (1 minute) or instruct patient to gently close eyelid after administration, to decrease systemic absorption of ophthalmic drops (Ref)
Ointment: Place a small amount of ointment into the conjunctival sac of the affected eye(s)
Amblyopia, healthy eye penalization (solution only): Penalization of the healthy eye in the treatment of amblyopia.
Mydriasis, Cycloplegia: Produce mydriasis and/or cycloplegia.
Terminal respiratory secretions
Atropt [Australia and New Zealand] may be confused with Azopt brand name for brinzolamide [US, Canada, and multiple international markets]
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Risk C: Monitor therapy
Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Amantadine: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Risk C: Monitor therapy
Botulinum Toxin-Containing Products: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Risk C: Monitor therapy
Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Risk C: Monitor therapy
Chlorprothixene: Anticholinergic Agents may enhance the anticholinergic effect of Chlorprothixene. Risk C: Monitor therapy
Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Risk X: Avoid combination
CloZAPine: Anticholinergic Agents may enhance the constipating effect of CloZAPine. Management: Consider alternatives to this combination whenever possible. If combined, monitor closely for signs and symptoms of gastrointestinal hypomotility and consider prophylactic laxative treatment. Risk D: Consider therapy modification
Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Risk X: Avoid combination
Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Risk C: Monitor therapy
Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Risk C: Monitor therapy
Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Risk X: Avoid combination
Glycopyrronium (Topical): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Risk C: Monitor therapy
Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Risk X: Avoid combination
Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Risk C: Monitor therapy
Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Risk C: Monitor therapy
Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of Atropine (Ophthalmic). Risk X: Avoid combination
Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Risk C: Monitor therapy
Opioid Agonists: Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Agonists. Specifically, the risk for constipation and urinary retention may be increased with this combination. Risk C: Monitor therapy
Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Risk X: Avoid combination
Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid combination
Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Risk X: Avoid combination
Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Risk C: Monitor therapy
Revefenacin: Anticholinergic Agents may enhance the anticholinergic effect of Revefenacin. Risk X: Avoid combination
Rivastigmine: Anticholinergic Agents may diminish the therapeutic effect of Rivastigmine. Rivastigmine may diminish the therapeutic effect of Anticholinergic Agents. Management: Use of rivastigmine with an anticholinergic agent is not recommended unless clinically necessary. If the combination is necessary, monitor for reduced anticholinergic effects. Risk D: Consider therapy modification
Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Risk D: Consider therapy modification
Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy
Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Risk X: Avoid combination
Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Risk C: Monitor therapy
Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Risk X: Avoid combination
Atropine crosses the placenta following systemic maternal use (Shutt 1979). Atropine is systemically available following ophthalmic administration. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the fetus (Samples 1988).
It is not known if atropine is excreted in breast milk following ophthalmic administration; however, systemic absorption occurs. According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
Reduction in visual acuity; local and systemic toxicity. Gonioscopy exam to assess ocular drainage angle.
Blocks the action of acetylcholine that induces mydriasis and allows the radial pupillary dilator muscle to contract resulting in dilation of the pupil; induces cycloplegia by paralysis of the ciliary muscle. In amblyopia, use temporarily blurs sight in the healthy eye and encourages the use of the amblyopic eye.
Onset of action: Ophthalmic solution: Within minutes; maximum effect: within hours (3 hours [Matta 2013]).
Duration: Multiple days; visual acuity near normal at 4 days postadministration (Matta 2013).
Absorption: Well absorbed from all dosage forms.
Metabolism: Hepatic via enzymatic hydrolysis.
Bioavailability: Ophthalmic solution: 64% ± 29% (range: 19% to 95%).
Half-life elimination: 2.5 ± 0.8 hours.
Time to peak: 28 ± 27 minutes (range: 3 to 60 minutes).
Excretion: Urine (13% to 50% as unchanged drug and metabolites).
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