Compounded 0.01% Atropine—What's in the Bottle?

Abstract

Objective: To describe the labeling, packaging practices, and characteristics of compounded 0.01% ophthalmic atropine. Methods: A convenience sample of parents of children who had previously been prescribed low-concentration atropine for myopia management were randomized to obtain 0.01% atropine ophthalmic solution from one of nine compounding pharmacies. The products were analyzed for various important quality attributes. The main outcomes were labeling practices, concentration of atropine and degradant product tropic acid, pH, osmolarity, viscosity, and excipients in 0.01% atropine samples obtained from nine US compounding pharmacies. Results: Twenty-four samples from nine pharmacies were analyzed. The median bottle size was 10 mL (range 3.5–15 mL), and eight of nine pharmacies used clear plastic bottles. Storage recommendations varied and were evenly split between refrigeration (33%), room temperature (33%), and cool, dark, dry location (33%). Beyond use dates ranged from 7 to 175 days (median, 91 days). Median pH of samples was 7.1 (range, 5.5–7.8). Median measured concentration relative to the prescribed concentration was 93.3% (70.4%–104.1%). One quarter of samples were under the 90% minimum target concentration of 0.01%. Conclusions: An inconsistent and wide variety of formulation and labeling practices exist for compounding 0.01% atropine prescribed to slow pediatric myopia progression.