Atropine low-dose (compounded)
Myopia · Rx (compounded in the US)
Trade namesCompounded 0.01% / 0.025% / 0.05%, (Ryjunea / SYD-101 pending)
Drug classLow-concentration antimuscarinic, myopia control
Strength0.01%, 0.025%, 0.05%
AvailabilityRx (compounded in the US)
Mechanism of actionNon-selective muscarinic antagonist; slows axial elongation through a receptor-mediated effect on the retina/sclera that is largely independent of accommodation. Low concentrations retain most of the treatment effect with minimal pupil and accommodation impact.
Indication / reason for useSlowing myopia progression in children (typically ~4-12 years at onset, progressing ≥0.5 D/year); used alone or combined with optical methods (ortho-K, myopia-control soft lenses, spectacles).
Usual adult dosing1 drop in each eye once nightly. Often continued for 2-3 years with a slow taper; watch for a rebound spurt on abrupt cessation, especially with higher concentrations.
PreservativeVaries by compounding pharmacy (BAK or preservative-free); request preservative-free where possible , a preservative-free option exists
Contact lensesInstil at night with lenses out; compatible with daytime ortho-K or soft myopia-control lens wear.
Common / important adverse effectsDose-dependent: 0.01%, minimal photophobia or near blur; 0.025-0.05%, some photophobia, ~1-2 mm extra pupil size, slight loss of accommodative amplitude (occasionally needing progressive/photochromic spectacles); allergic/contact dermatitis of the lids; rare systemic anticholinergic effects.
Contraindications & cautionsAtropine hypersensitivity; caution in Down syndrome and in children with a history of anticholinergic sensitivity; untreated narrow angles (rare in this age group).
Pregnancy / lactationNot applicable (pediatric use).
Practice notesLAMP study: 0.05% gave the best efficacy-to-side-effect balance; 0.01% is better tolerated but less effective and showed no benefit over placebo in the US-based CHAMP trial for the 0.01% arm on some endpoints. Photochromic lenses help with the photophobia. Confirm concentration and beyond-use date with the compounding pharmacy at every refill.
Chair-side reference only. Dosing, contraindications and pregnancy guidance here are not exhaustive. Confirm against the current prescribing information and the patient’s full history before prescribing or advising.