ATROPINE,HOMATROPINE, AND SCOPOLAMINE (Ophthalmic)

Some commonly used brand names are:

In the U.S.?

• AK-Homatropine ²
• Atropair ¹
• Atropine Care ¹
• Atropine Sulfate S.O.P. ¹
• Atropisol ¹
• Atrosulf ¹
• I-Homatrine ²
• Isopto Atropine ¹
• Isopto Homatropine ²
• Isopto Hyoscine ³
• I-Tropine ¹
• Ocu-Tropine ¹
• Spectro-Homatropine ²

In Canada?

• Atropisol ¹
• Isopto Atropine ¹
• Isopto Homatropine ²
• Minims Atropine ¹
• Minims Homatropine ²

Another commonly used name for scopolamine is hyoscine.

Category

• Cycloplegic?Atropine; Homatropine; Scopolamine
• mydriatic?Atropine; Homatropine; Scopolamine

Description

Ophthalmic atropine, homatropine, and scopolamineare used to dilate (enlarge) the pupil of the eye. They are used before eyeexaminations, 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, inthe following dosage forms:

Ophthalmic
• Atropine
  • Ophthalmic ointment (U.S. and Canada)
  • Ophthalmic solution (eye drops) (U.S. and Canada)
• Homatropine
  • Ophthalmic solution (eye drops) (U.S. and Canada)
• Scopolamine
  • Ophthalmic solution (eye drops) (U.S.)

Before Using This Medicine

In deciding to use a medicine,the risks of using the medicine must be weighed against the good it will do.This is a decision you and your doctor will make. For ophthalmic atropine,homatropine, and scopolamine, the following should be considered:

Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to atropine, homatropine, or scopolamine. Also tell yourhealth care professional if you are allergic to any other substances, suchas certain preservatives.

Pregnancy?Studies on effects in pregnancy have not been donein either humans or animals. However, these medicines may be absorbed intothe body.

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

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

Older adults?Elderly people are especially sensitive to the effectsof atropine, homatropine, or scopolamine. This may increase the chance ofside effects during treatment.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. Tell your health careprofessional if you are using any other prescription or nonprescription (over-the-counter[OTC]) medicine.

Other medical problems?The presence of other medicalproblems may affect the use of ophthalmic atropine, homatropine, or scopolamine.Make sure you tell your doctor if you have any other medical problems, especially:

• Brain damage (in children) or
• Down's syndrome (mongolism) (in children and adults) or
• Glaucoma or
• Other eye diseases or problems or
• Spastic paralysis (in children)?Use of ophthalmic atropine,homatropine, or scopolamine may make the condition worse

Proper Use of This Medicine

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

• First, wash your hands. Tilt the head back and, pressing your fingergently on the skin just beneath the lower eyelid, pull the lower eyelid awayfrom the eye to make a space. Drop the medicine into this space. Let go ofthe eyelid and gently close the eyes. Do not blink. Keep the eyes closed andapply pressure to the inner corner of the eye with your finger for 2 or 3minutes to allow the medicine to be absorbed by the eye.
• Immediately after using the eye drops, wash your hands to removeany medicine that may be on them. If you are using the eye drops for an infantor child, be sure to wash his or her hands immediately afterwards also, anddo not let any of the medicine get in his or her mouth. In addition, wipeoff 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 applicatortip 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 fingergently on the skin just beneath the lower eyelid, pull the lower eyelid awayfrom the eye to make a space. Squeeze a thin strip of ointment into this space.A 1/3- to 1/2-cm (approximately 1/8-inch in infants and youngchildren and 1/4-inch in older children and adults) strip of ointmentis usually enough, unless you have been told by your doctor to use a differentamount. Let go of the eyelid and gently close the eyes. Keep the eyes closedfor 1 or 2 minutes to allow the medicine to be absorbed by the eye.
• Immediately after using the eye ointment, wash your hands to removeany medicine that may be on them. If you are using the eye ointment for aninfant 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, wipeoff 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 applicatortip to any surface (including the eye). After using the eye ointment, wipethe tip of the ointment tube with a clean tissue and keep the tube tightlyclosed.

Use this medicine only as directed. Do not usemore of it and do not use it more often than your doctor ordered. To do somay increase the chance of too much medicine being absorbed into the bodyand the chance of side effects. This is especially importantwhen this medicine is used in infants and children, since overdose is verydangerous in infants and children.

Dosing?The doses of these medicines will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of these medicines. If your dose isdifferent, do not change it unless your doctor tells you to do so.

The number of doses you use each day, the time allowed between doses, andthe length of time you use the medicine depend on the medical problem forwhich you are using atropine, homatropine, or scopolamine.

For atropine
• For ophthalmic ointment dosage form:
  • For uveitis:
    • Adults?Use a thin strip of the ointment in the eye one or twotimes a day.
    • Children?Use a thin strip of the ointment in the eye one tothree 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 threetimes a day for one to three days before the examination.
• For ophthalmic solution (eye drops) dosageform:
  • 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 tothree days before the examination.

For homatropine
• For ophthalmic solution (eye drops) dosageform:
  • For uveitis:
    • Adults and children?Use 1 or 2 drops in the eye two or threetimes a day.
  • For eye examinations:
    • Adults?Use 1 or 2 drops in the eye. May be repeated every fiveto ten minutes for two or three doses.
    • Children?Use 1 or 2 drops in the eye every ten minutes fortwo or three doses.

For scopolamine
• For ophthalmic solution (eye drops) dosageform:
  • For uveitis:
    • Adults and children?Use one drop in the eye up to four timesa 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 daysbefore the examination.
  • For posterior synechiae:
    • Adults?Use one drop in the eye every ten minutes for threedoses.
    • 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 timesa day.

Missed dose?If you miss a dose of this medicine and your dosingschedule 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 misseddose 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 andgo back to your regular dosing schedule. Do not double doses.

Storage?To store this medicine:

• Keep out of the reach of children. Overdose of this medicine is verydangerous for infants and children.
• Store away from heat and direct light.
• Keep this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Afteryou apply this medicine to your eyes:

• Your pupils will become unusually large and you will have blurringof vision, especially for close objects. Make sure yourvision is clear before you drive, use machines, or do anything else that couldbe 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 andother 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 of This Medicine

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 mayneed medical attention.

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

Symptoms of too much medicine being absorbed into the body

Clumsiness or unsteadiness; confusionor unusual behavior; dryness of skin; fast or irregular heartbeat; fever; flushing or redness of face; seeing,hearing, or feeling things that are not there; skinrash; slurred speech; swollenstomach in infants; thirst or unusual dryness ofmouth; unusual drowsiness, tiredness, or weakness

Other side effects may occur that usually do not need medical attention.These side effects may go away during treatment as your body adjusts to themedicine. However, check with your doctor if any of the following side effectscontinue or are bothersome:

Blurred vision; brief burning or stingingof the eyes; eye irritation not present before useof this medicine; increased sensitivity of eyes tolight; swelling of the eyelids

Other side effects not listed above may also occur in some patients. Ifyou notice any other effects, check with your doctor.