What to Know About Ophthalmic Isopto Atropine (Atropine Sulfate)

Isopto Atropine (atropine sulfate) is a muscarinic antagonist that works to both widen the pupil and relax the eye's focusing muscles. It does this by blocking the nerve transmitter acetylcholine from working. There are receptors for acetylcholine around the muscle encircling the pupil as well as the one that focuses the lens. It can be used either as a drop or an ointment.

Uses

Atropine is FDA-approved for expanding the pupil and temporarily paralyzing the muscle of the eye that adapts the lens to sharp vision at different distances.

It is commonly used to treat lazy eye, otherwise known as amblyopia. This can be put into the normal eye of someone with this condition to blur vision and make the "lazy eye" work harder to compensate.

It can be used for dilated eye examinations, but other medications that wear off faster are more common for this purpose.

Off-Label Uses

Eye practitioners also commonly prescribe atropine drops off label to combat eye inflammation and even to help keep nearsightedness, where distant objects appear blurry, from progressing.

Nearsightedness occurs when the eye grows too long from front to back. There's some thinking that when the eye's focusing mechanism becomes fatigued, this causes nearsightedness. Atropine drops, which disable this focusing mechanism, can interrupt the development of this condition.

Before Taking

For most, atropine is well-tolerated. However, it's important to ensure that whoever takes the medication has no allergic issues here. If you have glaucoma, be sure to discuss this with your practitioner. If so, you may not be prescribed the atropine ointment formulation.

It's important to discuss with your healthcare provider any allergic reactions you or maybe your child may have had previously, whether this is due to medications like atropine or even to foods. Also, be sure to mention if you've had any prior problems with atropine medication.

Precautions and Contraindications

While in most cases atropine can be used without issue, some conditions that can conflict should first be ruled out.

Be sure to alert your practitioner beforehand about any of the following:

• Glaucoma
• High blood pressure
• Pregnancy: It's currently unknown whether this may affect a developing fetus.
• Breastfeeding: Since atropine can be transferred through breast milk, if you are breastfeeding, talk to your practitioner about this.

Also, if the medication is meant for your child, keep in mind these are not to be given to anyone under 3 months of age.

Be sure to discuss with your healthcare provider all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration of whether the pros of treatment outweigh the cons in your case.

Other Antimuscarinics

Besides atropine, some other antimuscarinic agents commonly used in the eye to widen the pupil and temporarily paralyze accommodative muscles include:

• Cyclopentolate
• Homatropine
• Scopolamine
• Tropicamide

Keep in mind that atropine is the most potent of all of these agents.

Dosage

One drop of atropine is usually placed in the eye. When treating a condition such as lazy eye, this can be given as often as twice a day in children age 3 or older.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you.

Modifications

If given to children under the age of 3, one drop should be given no more than once a day.

How to Take and Store

Atropine drops can be stored at temperatures between 36 to 77 degrees F. Atropine eye ointment should be stored between 59 and 86 degrees F.

You can administer the atropine drops as follows:

• Remove any contact lenses.
• Tip your head back and place one drop in the eye.
• While keeping your eye closed, press lightly on the inside corner of the eye for one to two minutes.

To administer the atropine ointment:

• Use a clean index finger to pull down the lower lid; squeeze in as long a ribbon of ointment as the healthcare provider prescribes.
• After releasing the lower lid, keep it closed for one to two minutes.

If you inadvertently miss a dose of the atropine, consider when you're supposed to take the next dose. If it's still relatively close to when you should have taken the missed dose, go ahead and take this now.

However, if it's almost time for a second dose, take the medication but don't take any extra.

Atropine should only be used topically. If too much is used, contact emergency services, who can administer supportive care. If mistakenly taken orally, call poison control at 1-800-222-1222.

Side Effects

Atropine may at times cause some side effects. Many are relatively minor and may be expected.

Common

Some common side effects you may encounter include:

• Some mild stinging when the medication is first placed in the eye
• Slight eye pain
• Sensitivity to light
• Blurred vision
• Tearing or puffiness
• Dryness of the nose, mouth or throat

Severe

In some cases, patients may have more severe reactions that may warrant discontinuation of the medication or possibly some intervention. Children, in particular, may be vulnerable here. Some more serious side effects include:

• Extreme stinging or burning sensation
• Severely red eyes
• Feeling of flushing
• Increased heart rate and irritability
• Raised blood pressure, with signs such as extreme headache, pounding in the ears or neck, blurry vision, feelings of anxiety, or sudden nosebleed

In the event you experience any of these symptoms, be sure to contact your healthcare provider. Also, reach out for emergency help if you or your child show any signs of an anaphylactic allergic reaction such as difficulty breathing; swelling of your tongue, lips, throat, or face; or even hives.

Warnings and Interactions

Keep in mind that vision may be somewhat blurred for up to two weeks after taking this medication. Don't drive or engage in other hazardous activities while your vision is blurred.

Also, atropine use is not recommended with monoamine oxidase inhibitors (MAOI), since this may cause a severe increase in blood pressure. Some drugs that may conflict include:

• Isocarboxazid
• Phenelzine
• Tranylcypromine
• Selegiline
• Rasagiline

Don't stop any of these on your own. Be sure to consult the prescribing healthcare provider on this to discuss options.