Atropine sulfate
Dilation & diagnostic · Rx
Trade namesIsopto Atropine, Atropine Care
Drug classLong-acting anticholinergic cycloplegic
Strength1% (also 0.5%, 2%; ointment 1%)
AvailabilityRx
Mechanism of actionPotent, long-lasting muscarinic antagonist; complete cycloplegia and mydriasis.
Indication / reason for useFull cycloplegic refraction in young children with accommodative esotropia or dense hyperopia; penalization therapy for amblyopia; cycloplegia and pain relief in significant anterior uveitis / after anterior segment trauma or surgery; prevention of synechiae.
Usual adult dosingRefraction (child): 1% ointment or drop 2-3×/day for 1-3 days before the exam. Uveitis: 1% 1-2×/day. Effects last 1-2 weeks.
PreservativeBAK
Contact lensesRemove lenses; reinsert after 15 minutes.
Common / important adverse effectsSystemic anticholinergic toxicity, more likely in children and the elderly: flushing ("red as a beet"), dry mouth/skin, fever, tachycardia, urinary retention, delirium/hallucinations ("mad as a hatter"); photophobia and blur for 1-2 weeks. Contact dermatitis of the lids.
Contraindications & cautionsUntreated narrow angles / angle-closure risk; Down syndrome and children with brain damage or spastic paralysis (exaggerated response); infants (use 0.5%, ointment preferred, punctal occlusion, wipe lids).
Pregnancy / lactationLimited data; avoid repeated dosing.
Practice notesOintment gives more controllable dosing than drops in small children. Warn parents about facial flushing and to press the tear duct.
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.