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Atropine (Ophthalmic)

Pronunciation

Pronunciation

(A troe peen)

Index Terms

  • Atropine Sulfate

Dosage Forms

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)

Solution, Ophthalmic, as sulfate:

Atropine-Care: 1% (2 mL [DSC], 5 mL [DSC], 15 mL [DSC]) [contains benzalkonium chloride, edetate disodium]

Isopto Atropine: 1% (5 mL [DSC], 15 mL [DSC])

Generic: 1% (2 mL, 5 mL, 15 mL)

Brand Names: U.S.

  • Atropine-Care [DSC]
  • Isopto Atropine [DSC]

Pharmacologic Category

  • Anticholinergic Agent, Ophthalmic
  • Ophthalmic Agent, Mydriatic

Pharmacology

Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS

Absorption

Well absorbed from all dosage forms

Metabolism

Hepatic via enzymatic hydrolysis

Excretion

Urine (13% to 50% as unchanged drug and metabolites)

Onset of Action

Ophthalmic solution: Within 40 minutes; maximum effect: 2 hours

Time to Peak

28 ± 27 minutes

Duration of Action

Up to 2 weeks in a normal eye

Half-Life Elimination

2.5 ± 0.8 hours

Use: Labeled Indications

Produce mydriasis and cycloplegia for examination of the retina and optic disc and accurate measurement of refractive errors; produce papillary dilation in inflammatory conditions of the iris and uveal tract (eg, uveitis); penalization of the healthy eye in the treatment of amblyopia

Contraindications

Hypersensitivity to atropine or any component of the formulation

Dosing: Adult

Mydriasis, cycloplegia (preprocedure): Ophthalmic: Solution (1%): Instill 1 to 2 drops 1 hour before procedure.

Uveitis: Ophthalmic:

Ointment: Apply a small amount in the conjunctival sac 1 to 2 times/day; compress the lacrimal sac by digital pressure for 1 to 3 minutes after instillation

Solution (1%): Instill 1 to 2 drops up to 4 times/day

Terminal 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 (Protus 2013)

Dosing: Pediatric

Amblyopia, healthy eye penalization: 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 (Repka 2014; Scheiman 2008)

Mydriasis, cycloplegia (preprocedure):

Infants ≥3 months and Children <3 years: Ophthalmic: Solution (1%): 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: Solution (1%): Instill 1 to 2 drops 40 minutes prior to intended maximal dilation time (Nelson 1996)

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Administration

Solution: Instill solution into conjunctival sac of affected eye(s); compress lacrimal sac with digital pressure for 2 to 3 minutes after instillation; avoid contact of bottle tip with eye or skin

Storage

Ophthalmic products: Store at 20°C to 25°C (68°F to 77°F); keep tightly closed.

Drug Interactions

AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy

Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy

Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Analgesics (Opioid): Anticholinergic Agents may enhance the adverse/toxic effect of Analgesics (Opioid). Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy

Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy

Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy

Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination

Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination

Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy

Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Avoid combination

Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination

Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy

Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination

MAO Inhibitors: May enhance the hypertensive effect of Atropine (Ophthalmic). Avoid combination

Mianserin: May enhance the anticholinergic effect of Anticholinergic Agents. Monitor therapy

Mirabegron: Anticholinergic Agents may enhance the adverse/toxic effect of Mirabegron. Monitor therapy

OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy

Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. 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. Avoid combination

Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification

Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy

RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy

Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid using drugs with substantial anticholinergic effects in patients receiving secretin whenever possible. If such agents must be used in combination, monitor closely for a diminished response to secretin. Consider therapy modification

Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy

Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination

Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy

Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination

Adverse Reactions

Frequency not defined. Severity and frequency of adverse reactions are dose related.

Cardiovascular: Delirium, flushing, hypotension, increased blood pressure

Central nervous system: Irritability, restlessness

Dermatologic: Contact dermatitis, xeroderma

Gastrointestinal: Xerostomia

Ophthalmic: Blurred vision, decreased lacrimation, eye irritation, eyelid edema, eye pain, papillary conjunctivitis, photophobia, stinging of eyes, superficial keratitis

Respiratory: Dry throat, respiratory depression

Warnings/Precautions

Concerns related to adverse effects:

• Elevated blood pressure: May occur due to systemic absorption following conjunctival instillation.

• Photophobia/blurred vision: May last up to 2 weeks due to pupil unresponsiveness and cycloplegia.

Pregnancy Considerations

Animal reproduction studies have not been conducted. Atropine is absorbed systemically following ophthalmic administration (variable concentrations). Atropine has been found to cross the human placenta.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience blurred vision or stinging. Have patient report immediately to prescriber severe headache, dizziness, passing out, vision changes, tachycardia, abnormal heartbeat, flushing, irritability, agitation, dry mouth, dry skin, severe eye irritation, or eye pain (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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