Atropine  (U.S.N.L.M.)
(Myopia prevention) 1 drop 0.02% to 0.05%1, 8 qhs
(0.5% starting dose used weekly may be appropriate for high rates of progression. 2)
(1% starting dose used monthly in alternating eyes has shown good results in one study.7)
Chem Specs atropine sulfate,  common prepared concentrations: 0.01%, 0.25%, 0.50%
(standard commercial availability 1%)  
Quantities Standard commercial quantities: 2,5,15ml
Cost $45.00 3.5ml compounded 0.05% at  OSRX®
Class anticholinergic
Action Competitive antagonist for the muscarinic acetylcholine receptor.
Usage Indicated for cycloplegia, mydriasis, amblyopia penalization.
Used off label to prevent myopic progression.
(Myopia prevention) Reduction in myopia progression is age and dose dependent.  (The younger the age the
lower the response to given dosage.)3 The 0.05% concentration provides about twice the
protective effect as the 0.01% solution1.    Rebound after cessation can be avoided with
a  taper  regardless  of dosage used4.    Although  slight  mydriasis  is  present  with  low
dosages5(0.01% to 0.05%),  problematic photophobia and cycloplegia is generally absent1, 8.
With higher concentrations (0.5% or 1%)  these side effects should be addressed with
progressive and photochromic lenses.
Warnings Increased susceptibility in infants, young children, and in children with blond hair, blue eyes, Down's
syndrome, spastic paralysis, or brain damage. Ointment form thought to reduce systemic absorption.
Elevated blood pressure reported following conjunctival instillation of 1% solution.
Contraindications Hypersensitivity to the product.
Adverse Reactions Pain on instillation, superficial keratitis, dry eye, skin, mouth, and throat. Restlessness, irritability,
delirium, tachycardia.
Pediatric use Avoid under 3 months of age. Limit 1% solution to once daily under age 3.
Pregnancy Category C. No adequate studies in pregnant women.
 
    N.L.M. DailyMed page for Atropine          PDR page for Atropine 1. Jason C. Yam, et.al., LAMP II December 2019
2. Polling JR, Tan E, Driessen S, et al. Eye (Lond). 2020 Sep 21.
3. JAMA Ophthalmol; 2021 Jan 14; EPub Ahead of Print; J Wang, Y Li, DC Musch, et. al.
4. Zhu et. al., Efficacy and Safety of 1% Atropine... Int J Med Sci. 2020; 17(2): 176–181.
5. Joachimsen L, Böhringer D, Gross NJ, et al. Ophthalmol Ther. 2019 Jun 12.
6. Risacher, McDonald, Tallman, et al. JAMA April 18, 2016.
7. Zhu Q, Tang Y, Guo L, et al. Int J Med Sci. 2020 Jan;17:176-181
8. Cooper et. al., Optometry and Vision Science: December 2013 - Volume 90 - Issue 12 - p 1467-1472