‘Atropt 1% should not be supplied.’


close up of green eye

Despite previously warning its pharmacist members about an error with atropine eye drops, PDL says it continues to receive incident reports about the problem

In its latest practice alert for members, PDL has reminded pharmacists that “Atropine 0.01% eye drops are not commercially available and Atropt 1% should not be supplied”.

“Despite warning its pharmacist members against this error in 2018, PDL continues to receive incident reports relating to the dispensing of Atropine eye drops 1%, when 0.01% was prescribed,” the organisation says.

“The weaker form of atropine eye drops (0.01%) is typically prescribed to children to treat myopia and these eye drops must be compounded by a pharmacy that is equipped to provide sterile compounding services.

“Using the full strength atropine in the eye of a child will naturally result in extreme discomfort in the treated eye and an aversion to bright light which will often require a period of absence from school.

“PDL has warned of this.”

In the 2018 warning, PDL suggested that the error could be occurring due to a lack of awareness of the indication for this strength, or a misinterpretation of the prescription by pharmacists and dispensary technicians.

Now, it has offered a new case scenario for pharmacists in which an ophthalmologist prescribed “0.01% atropine eye drops in each eye daily for myopic control” for a 13-year-old.

“It is assumed the prescribing software used by the doctor did not accommodate the writing of a strength of 0.01%, so the 1% standard script was computer generated, with an alteration to 0.01% by hand,” PDL notes.

“This alteration may have confused the dispensing pharmacist who provided Atropt 1%, which caused a ‘loss of vision’ as reported by the mother of the patient.

“If a changed or altered script is presented to a pharmacist, and the intended order is unclear, the prescriber should always be contacted for clarification.”

PDL points out that as myopia – nearsightedness which results in distant objects appearing to be blurred – does not generally stabilize until the age of 18 to 20, children are treated with low dose atropine in any attempt to stop or slow the progression to established myopia.

“Children aged between five and 15 years are typically treated for at least six months,” it says.

“If improvement is noted, treatment can last for up to two years or until age of 15 is reached. There are no reported side effects and accommodation is not affected, unlike the full strength atropine.”

PDL encourages members to get in touch on 1300 854 838 if this topic raises any concerns for readers.

PDL membership includes 24/7 access to speak with a Professional Officer for immediate advice and incident support, Australia wide; members can also use their member login to the portal at www.pdl.org.au to leave a comment or question for its Professional Officers via the blog (via login to the portal).

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3 Comments

  1. Jarrod McMaugh
    10/09/2019

    In this instance, the prescription may not actually be invalid – depending on regulations

    From NSW Regulations: g) the prescription produced in accordance with these criteria to be issued
    without alteration, and especially NOT altered by hand after printing

    From Vic Regulations: • Alterations must not be made to computer-generated prescriptions. Where an alteration is required, a new prescription must be generated and the other prescription immediately destroyed.

    etc…..

  2. Ai Nguyen
    10/09/2019

    It seems like myopia is a common condition globally and Atropine 0.01% is the treatment. Can Atropine 0.01% be commercially available? If Aspen Pharma can manufacture Atropt 1%, can Aspen manufacture Atropine 0.01% as well? Is there any reason why this Atropine 0.01% is not available on the market? This product would save money to patient to get it done at compounding chemists every 4 weeks and it also prevent this mistake from happening.

  3. vixeyv
    10/09/2019

    The wrong atropine is being prescribed, and also incorrectly dispensed, to treat myopia… sounds like a case of the blind treating the blind

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