Atropine

Registered South African indications: 

• Mydriatic
• Cycloplegic

Contraindications 

• Hypersensitivity to the active ingredient or any of its excipients
• Narrow angle glaucoma
• Suspected latent narrow angle glaucoma

Cautions

• Pregnancy
• Breastfeeding
• Elderly

Forms avail. in SA and covered in this monograph: opd

Uveitis
Painful blind eyes
Trauma - blunt, non-penetrating, chemical injuries

• Ophthalmic (opd): 1 drop into affected eye(s), 8-12hrly

Atropine is not used as a diagnostic mydriatic due to its long duration of action

Care should be taken to avoid contact between the dropper tip and the eye, eyelashes or any other surface

See additional prescribing points

Paed. forms avail. in SA and covered in this monograph: opd

Hyphaema - in combination with topical steroid drops

• Ophthalmic (opd): 1 drop into affected eye(s), 12hrly; Treatment duration: 5 days

Atropine penalization of healthy eye for selected cases of amblyopia

• Treatment regimens are specialist dependent and may be tailored based on individual assessment

Diagnostic - cycloplegic refraction/retinoscopy

Younger than 1 year

• Ophthalmic (opd): 0.5% sol. 1 drop into affected eye(s), 12hrly for 3 days prior to refraction

Older than 1 year

• Ophthalmic (opd): 1% sol. 1 drop into affected eye(s), 12hrly for 3 days prior to refraction

Care should be taken to avoid contact between the dropper tip and the eye, eyelashes or any other surface

See additional prescribing points

Pregnancy

• Caution
• The safety for use during pregnancy has not been established. Use with caution, if benefits outweigh risks

Breastfeeding

• Caution
• The safety for use in breastfeeding has not been established. Use with caution, if benefits outweigh risks

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended 

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Irritability
• Restlessness
• Delirium

Cardiovascular Disorders

• Flushing
• Hypotension
• Hypertension
• Tachycardia

Respiratory Disorders

• Dry throat
• Respiratory depression

Gastrointestinal Disorders

• Xerostomia

Genitourinary Disorders

• Urinary symptoms

Skin and Subcutaneous Tissue Disorders

• Contact dermatitis
• Xeroderma
• Dry skin

Sensory Disorders

• Blurred vision
• Decreased lacrimation
• Eye irritation
• Eyelid oedema
• Eye pain
• Papillary conjunctivitis
• Photophobia
• Stinging of eyes
• Superficial keratitis

Others

• Increased body temperature

• Monoamine oxidase inhibitors

Intraocular pressure

Systemic absorption may be reduced by compressing the lacrimal sac at the medial canthus for a minute during and following the instillation of the drops.

Atropine sulphate is a competitive antagonist of acetylcholine at postganglionic cholinergic (parasympathetic) nerve endings. Atropine blocks the pupillary constrictor muscle, which depends on muscarinic receptor activation. This results in sympathetic dilator activity and mydriasis.  Atropine also weakens the contraction of the ciliary muscle (cycloplegia). Cycloplegia results in loss of the ability to accommodate such that the eye cannot focus for near vision.

Eye drops (per ml) 10mg

• Atropine eye drops (Adcock) originator
• Isopto Atropine 1% (Alcon) originator

Also available in the following form: injection.