atropine ophthalmic (Rx)

Frequency Not Defined

Local irritation

Hyperemia

Edema

Dry eyes

Exudate

Follicular conjunctivitis

Vascular congestion

Dermatitis

Blurred vision

Hyperreactive response in Down's syndrome children (atropine)

Drowsiness

Increased intraocular pressure

Physostigmine

Contraindications

Hypersensitivity or known allergic reaction to any ingredient of the formulation

Cautions

Elevation in blood pressure from systemic absorption reported following conjunctival instillation of recommended doses of this medication

Although mydriatic/cycloplegic effects last for up to 2 wk in an uninflamed eye, an inflamed eye may require 2-4 times DAILY dosing to see an effective pharmacologic effect

Nor for injection; topical use only

While pupils are dilated patients are advised not to engage in hazardous activities like driving

Administration to infants requires caution; may produce systemic symptoms (discontinue medication if this occurs

Pregnancy

There are no adequate and well-controlled studies in pregnant women to inform a drug-associated risk; adequate animal development and reproduction studies have not been conducted with atropine sulfate; in humans, 1% atropine sulfate is systemically bioavailable following topical ocular administration; the drug should only be used during pregnancy if the potential benefit justifies potential risk to fetus

Lactation

There is no information to inform risk regarding presence of drug in human milk following ocular administrations of the drug to the mother; effects on breastfed infants and effects on milk production are also unknown

Developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on breastfed child from the drug

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Absorption: transconjunctivally

Excretion: urine

Mechanism of Action

Blocks the action of acetylcholine resulting in relaxation of the cholinergically innervated sphincter muscle of the iris

Cholinergic stimulation of the accommodative ciliary muscle of the lens is also blocked

Anticholinergic effects of atropine sulfate in the eye produce dilation of the pupil (mydriasis) and paralysis of accommodation (cycloplegia)

Pharmacokinetics

Absorption: Transconjunctival

Excretion: Urine