Atropine, homatropine, and scopolamine (ophthalmic route)

Brand Name

US Brand Name

AK-Dilate

AK-Pentolate

Altafrin

Atropine Care

Cyclogyl

Cyclomydril

Eye Cool

Homatropaire

Isopto Atropine

Isopto Homatropine

Isopto Hyoscine

Mydcombi

Mydfrin

Mydral

Mydriacyl

Neofrin

Neo-Synephrine

Omidria

Paremyd

Canadian Brand Name

Ak-Dilate

Ak-Pentolate

Atropine

Atropine-Ak

Atropine Eye Ointment

Atropine Ointment

Atropisol

Minims Phenylephrine Hydrochloride

Description

Ophthalmic atropine, homatropine, and scopolamine are used to dilate (enlarge) the pupil of the eye. They are used before eye examinations, before and after eye surgery, and to treat certain eye conditions, such as uveitis or posterior synechiae.

These medicines are available only with your doctor's prescription.

This product is available in the following dosage forms:

Solution
Ointment

Before Using

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Infants and young children and children with blond hair or blue eyes may be especially sensitive to the effects of atropine, homatropine, or scopolamine. This may increase the chance of side effects during treatment . Children should use a lower strength of this medicine.

Geriatric

Elderly people are especially sensitive to the effects of atropine, homatropine, or scopolamine. This may increase the chance of side effects during treatment.

Pregnancy

Studies on effects in pregnancy have not been done in either humans or animals. However, these medicines may be absorbed into the body.

Breastfeeding

These medicines may be absorbed into the body. Atropine passes into the breast milk in very small amounts and may cause side effects, such as fast pulse, fever, or dry skin, in babies of nursing mothers using ophthalmic atropine. It is not known whether homatropine or scopolamine passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are using one of these medicines and who wish to breast-feed should discuss this with their doctor.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

Aceclofenac
Acemetacin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Celecoxib
Choline Salicylate
Clonixin
Clorgyline
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Dihydroergotamine
Dipyrone
Droxicam
Etodolac
Etofenamate
Etoricoxib
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine
Flufenamic Acid
Flurbiprofen
Ibuprofen
Indomethacin
Iproniazid
Isocarboxazid
Ketoprofen
Linezolid
Lornoxicam
Loxoprofen
Lumiracoxib
Meclofenamate
Mefenamic Acid
Meloxicam
Morniflumate

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abciximab
Acenocoumarol
Amantadine
Amifampridine
Amiloride
Amineptine
Amitriptyline
Amitriptylinoxide
Amoxapine
Amphetamine
Anagrelide
Apixaban
Ardeparin
Argatroban
Bemetizide
Bemiparin
Bendroflumethiazide
Benzhydrocodone
Benzthiazide
Betrixaban
Bivalirudin
Budesonide
Bumetanide
Buprenorphine
Bupropion
Cangrelor
Certoparin
Chlorothiazide
Chlorthalidone
Cilostazol
Citalopram
Clomipramine
Clopamide
Clopidogrel
Clozapine
Codeine
Cyclopenthiazide
Cyclosporine
Cyclothiazide
Dabigatran Etexilate

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use

To use the ophthalmic solution (eye drops) form of this medicine:

First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Drop the medicine into this space. Let go of the eyelid and gently close the eyes. Do not blink. Keep the eyes closed and apply pressure to the inner corner of the eye with your finger for 2 or 3 minutes to allow the medicine to be absorbed by the eye.
Immediately after using the eye drops, wash your hands to remove any medicine that may be on them. If you are using the eye drops for an infant or child, be sure to wash his or her hands immediately afterwards also, and do not let any of the medicine get in his or her mouth. In addition, wipe off any medicine that may have accidentally gotten on the infant or child, including his or her face or eyelids.
To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). Also, keep the container tightly closed.

To use the ointment form of this medicine:

First, wash your hands. Tilt the head back and, pressing your finger gently on the skin just beneath the lower eyelid, pull the lower eyelid away from the eye to make a space. Squeeze a thin strip of ointment into this space. A 1/3- to ½;-cm (approximately ⅛-inch in infants and young children and ¼-inch in older children and adults) strip of ointment is usually enough, unless you have been told by your doctor to use a different amount. Let go of the eyelid and gently close the eyes. Keep the eyes closed for 1 or 2 minutes to allow the medicine to be absorbed by the eye.
Immediately after using the eye ointment, wash your hands to remove any medicine that may be on them. If you are using the eye ointment for an infant or child, be sure to wash his or her hands immediately afterwards also, and do not let any of the medicine get in his or her mouth. In addition, wipe off any medicine that may have accidentally gotten on the infant or child, including his or her face or eyelids.
To keep the medicine as germ-free as possible, do not touch the applicator tip to any surface (including the eye). After using the eye ointment, wipe the tip of the ointment tube with a clean tissue and keep the tube tightly closed.

Use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of too much medicine being absorbed into the body and the chance of side effects. This is especially important when this medicine is used in infants and children, since overdose is very dangerous in infants and children.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For atropine

For ophthalmic ointment dosage form:
- For uveitis:
  - Adults—Use a thin strip of the ointment in the eye one or two times a day.
  - Children—Use a thin strip of the ointment in the eye one to three times a day.
- For eye examinations:
  - Adults—Use and dose must be determined by your doctor.
  - Children—Use a thin strip of the ointment in the eye three times a day for one to three days before the examination.
For ophthalmic solution (eye drops) dosage form:
- For uveitis:
  - Adults—Use one drop in the eye one or two times a day.
  - Children—Use one drop in the eye one to three times a day.
- For eye examinations:
  - Adults—Use and dose must be determined by your doctor.
  - Children—Use one drop in the eye two times a day for one to three days before the examination.

For homatropine

For ophthalmic solution (eye drops) dosage form:
- For uveitis:
  - Adults and children—Use 1 or 2 drops in the eye two or three times a day.
- For eye examinations:
  - Adults—Use 1 or 2 drops in the eye. May be repeated every five to ten minutes for two or three doses.
  - Children—Use 1 or 2 drops in the eye every ten minutes for two or three doses.

For scopolamine

For ophthalmic solution (eye drops) dosage form:
- For uveitis:
  - Adults and children—Use one drop in the eye up to four times a day.
- For eye examinations:
  - Adults—Use one drop in the eye one hour before the examination.
  - Children—Use one drop in the eye two times a day for two days before the examination.
- For posterior synechiae:
  - Adults—Use one drop in the eye every ten minutes for three doses.
  - Children—Use and dose must be determined by your doctor.
- For use before and after surgery:
  - Adults and children—Use one drop in the eye one to four times a day.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose of this medicine and your dosing schedule is:

One dose a day—Apply the missed dose as soon as possible. However, if you do not remember the missed dose until the next day, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
More than one dose a day—Apply the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions

After you apply this medicine to your eyes:

Your pupils will become unusually large and you will have blurring of vision, especially for close objects. Make sure your vision is clear before you drive, use machines, or do anything else that could be dangerous if you are not able to see well.
Your eyes will become more sensitive to light than they are normally. Wear sunglasses to protect your eyes from sunlight and other bright lights.

These effects may continue for several days after you stop using this medicine. However, check with your doctor if they continue longer than:

14 days if you are using atropine.
3 days if you are using homatropine.
7 days if you are using scopolamine.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Symptoms of too much medicine being absorbed into the body

Clumsiness or unsteadiness
confusion or unusual behavior
dryness of skin
fast or irregular heartbeat
fever
flushing or redness of face
seeing, hearing, or feeling things that are not there
skin rash
slurred speech
swollen stomach in infants
thirst or unusual dryness of mouth
unusual drowsiness, tiredness, or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Blurred vision
brief burning or stinging of the eyes
eye irritation not present before use of this medicine
increased sensitivity of eyes to light
swelling of the eyelids

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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