| Atropine (U.S.N.L.M.) | |
|---|---|
| (Myopia prevention) | 1 drop 0.025% to 0.05%1, 9 qhs |
| Chem Specs | atropine sulfate, common prepared concentrations: 0.01%, 0.025%, 0.050%, 0.1% (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) | Atropine therapy is dose dependent so the magnitude and rate of change of myopia should determine the dosage. 0.5% to 1% has been used for high rates of progression.2, 7, 14 Combine with ortho-k to enhance results13. The 0.01% concentration is no better than placebo in two studies7, 11and fails to prevent axial elongation15. Rebound after cessation can be reduced or avoided with a taper regardless of dosage used4, . Binocular function may be affected and so should be monitored. |
| 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 | No adequate studies in pregnant women. |
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.
9. Jason C. Yam, et.al.,https://jamanetwork.com/journals/jama/article-abstract/2801319, February, 2023
10. Breliant, et al., Optom Vis Sci. 2023 August doi: 10.1097/OPX.02031.
11. Repka, Weise, Chandler; et al JAMA Ophthalmol. Published online July 13, 2023. doi:10.1001/jamaophthalmol.2023.2855
12. Zadnick et. al.,JAMA Ophthalmol. 2023 Oct; 141(10): 990–999. Published online 2023 Jun 1. doi: 10.1001/jamaophthalmol.2023.2097
13. Shengsong Xu, et al., Br J Ophthalmol. 2023 Nov 22;107(12):1812-1817. doi: 10.1136/bjo-2022-321272.
14. Du L, Ding L, Chen J, et al. Br J Ophthalmol. Published online August 9, 2024. doi:10.1136/bjo-2023-324615
15. Jason Yam, et al., I.O.V.S., June 2025, Vol 66, Issue 8.
16. Bullimore MA, Berntsen DA. Low‐dose atropine for myopia control. JAMA Ophthalmol 2018; 136: 303.