Atropine

What is Atropine?

• Atropine (Atropen) is a muscarinic antagonist used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery.
• Eye drops are also available which are used to treat uveitis and early amblyopia.

Atropine

Atropine-D-and-L-isomers-from-DL-xtal-2004-3D-balls

Atropine3d

What are the uses of this medicine?

• Atropine (Atropen) is used for temporary blockade of severe or life threatening muscarinic effects.

• Atropine is used as an antisialagogue, an antivagal agent (preanesthesia and during surgery) , an antidote for organophosphorus, carbamate, or muscarinic mushroom poisoning, and to treat symptomatic bradycardia.

How does this medicine work?

• Atropine (at' roe peen) is a natural alkaloid that is the prototypic anticholinergic agent found as a secondary metabolite in plants of the Solanaceae family, including deadly nightshade (atropa belladonna) for which it is named.
• Atropine has potent and broad, nonspecific antimuscarinic activity.
• Because of its rapid onset of action and short half-life, atropine is used parenterally in management of medical emergencies including cardiac bradyarrhythmias, during anesthesia to prevent vagal reflexes and to decrease secretions, for acute bronchospasm, and for anticholinesterase overdose or poisoning.

Who Should Not Use this medicine ?

• This medicine have no usage limitations.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• mexiletine

Is this medicine FDA approved?

• Atropine has been in use in medicine for decades, but has not been formally approved for many of its broadly accepted indications.
• Atropine is used in low doses (1 mg or less) and usually for short periods of time.
• Homatropine (hoe mat' roe peen) is a synthetic derivative of Atropine and is less potent and has a shorter half-life, which makes it appropriate as a cycloplegic eye drops to dilate the pupils.
• It is also used in combination with opiate drugs for its aversive side effects to prevent abuse of high doses.

How should this medicine be used?

Recommended dosage:

Adult Dosage: In Antisialagogue or other antivagal (preanesthesia and during surgery):

• 0.5 to 1 mg IV/IM/SC 30-60 minutes preoperatively.
• Repeat as needed every 4-6 hours.
• Maximum Total Dose: 3 mg

In Organophosphorus, carbamate or muscarinic mushroom poisoning:

• 1 to 6 mg IV/IM/ET depending on severity of symptoms.
• Repeat as needed every 3 to 5 minutes.
• Dose may be doubled with each administration until response (reduced bronchospasm, improved oxygenation and drying of pulmonary secretions).

Maintenance Dose: Administer 10% to 20% of the loading dose required for response as a continuous infusion per hour and titrate. Maximum Total Dose: No maximum total dose.

In Symptomatic bradycardia:

• 0.5 mg IV/IM or 1 to 2 mg ET by diluting in no more than 10 mL sterile water for injection or 0.9% sodium chloride.
• As needed every 3 to 5 minutes
• Maximum Total Dose: 3 mg

Pediatric Dosage: In Antisialagogue or other antivagal (preanesthesia and during surgery):

• 0.02 mg/kg IV/IM/SC 30-60 minutes preoperatively.
• Repeat as needed every 4-6 hours.

In Organophosphorus, carbamate or muscarinic mushroom poisoning:

• 0.02 to 0.06 mg/kg IV/IM/IO/ET.
• Repeat as needed every 5 minutes.
• Dose may be doubled with each administration until response (reduced bronchospasm, improved oxygenation and drying of pulmonary secretions).

Maintenance Dose:

• Administer 10% to 20% of the loading dose required for response as a continuous infusion per hour and titrate as needed.

Maximum Total Dose: No maximum total dose.

In Symptomatic bradycardia due to increased vagal tone or primary AV conduction block (not secondary to hypoxia):

• 0.02 mg/kg IV/IO or 0.04 to 0.06 mg/kg via endotracheal tube followed by 1 to 5 mL flush of normal saline followed by 5 ventilations.
• Repeat as needed every 5 minutes.

Maximum Single Dose:

• Less than12 years old: 0.5 mg
• 12 years and older: 1 mg

Dosing in Patients with Ischemic Heart Disease:

• Do not exceed 0.04 mg/kg.

Administration:

• Intravenous administration is usually preferred, but subcutaneous, intramuscular, endotracheal, and intraosseous administration are possible.
• Inspect parenteral drug products for particulate matter and discoloration prior to administration, whenever solution and container permit.
• Do not administer unless solution is clear and seal is intact.
• After initial use, discard unused portion within 24 hours.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Injection: 8 mg per 20 mL (0.4 mg per mL) multiple dose glass vial

This medicine is available in fallowing brand namesː

• Atropen

What side effects can this medication cause?

The most common side effects of this medicine include:

• Dryness of the mouth
• blurred vision
• photophobia
• tachycardia
• Anhidrosis
• Constipation and difficulty in micturition
• hypersensitivity reactions have been observed, including serious skin rashes
• Paralytic ileus

Less common, but serious side effects may include:

• Hypersensitivity
• Worsening of Ischemic Heart Disease
• Acute Glaucoma
• Pyloric Obstruction
• Complete Urinary Retention
• Viscid Plugs

What special precautions should I follow?

• Atropine may cause anaphylaxis.
• In patients with ischemic heart disease, the total dose should be restricted to 2 to 3 mg (maximum 0.03 to 0.04 mg/kg) to avoid atropine-induced tachycardia, increased myocardial oxygen demand and the potential for worsening cardiac ischemia or increasing infarction size.
• Atropine may precipitate acute glaucoma.
• Atropine may convert partial organic pyloric stenosis into complete obstruction.
• Atropine may lead to complete urinary retention in patients with prostatic hypertrophy.
• Atropine may cause thickening of bronchial secretions and formation of viscid plugs in patients with chronic lung disease.
• The preservative benzyl alcohol has been associated with serious adverse events and death in neonates. Premature and low-birth weight infants may be more likely to develop toxicity. Practitioners administering this and other medications containing benzyl alcohol should consider the combined daily metabolic load of benzyl alcohol from all sources.
• Trace amounts of atropine have been reported in human milk after oral intake. There are no available data on atropine levels in human milk after intravenous injection, the effects on the breastfed infant, or the effects on milk production.
• Atropine has not been implicated in causing liver enzyme elevations or clinically apparent acute liver injury.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• palpitation, dilated pupils, difficulty in swallowing, hot dry skin, thirst, dizziness, restlessness, tremor, fatigue, ataxia, locomotor difficulties, delirium, followed by hallucinations, depression, and ultimately, medullary paralysis and death.
• Large doses can also lead to circulatory collapse.
• In such cases, blood pressure declines and death due to respiratory failure may ensue following paralysis and coma.

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• In the event of toxic overdosage, a short acting barbiturate or diazepam may be given as needed to control marked excitement and convulsions.
• Large doses for sedation should be avoided because central depressant action may coincide with the depression occurring late in atropine poisoning.
• Central stimulants are not recommended.
• Physostigmine, given as an atropine antidote by slow intravenous injection of 1 to 4 mg (0.5 to 1 mg in pediatric populations), rapidly abolishes delirium and coma caused by large doses of atropine.
• Since physostigmine is rapidly destroyed, the patient may again lapse into coma after one to two hours, and repeated doses may be required.
• Artificial respiration with oxygen may be necessary.
• Ice bags and alcohol sponges help to reduce fever, especially in pediatric populations.
• Atropine is not removed by dialysis.

Can this medicine be used in pregnancy?

• Limited available data with Atropine Sulfate Injection use in pregnant women are insufficient to inform a drug associated risk of adverse developmental outcomes.
• Severe or life-threatening muscarinic events such as acute organophosphate poisoning and symptomatic bradycardia are medical emergencies in pregnancy which can be fatal if left untreated.
• Life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of atropine on the fetus.

Can this medicine be used in children?

• Safety and effectiveness in pediatric patients have been established.

What are the active and inactive ingredients in this medicine?

• The active ingredient is ATROPINE SULFATE

The inactive ingredients include:

• SODIUM CHLORIDE
• BENZYL ALCOHOL
• SULFURIC ACID
• WATER

Who manufactures and distributes this medicine?

• Fresenius Kabi USA, LLC

What should I know about storage and disposal of this medication?

• Store at 20° to 25°C (68° to 77°F).
• After initial use, store between 20° to 25°C (68° to 77°F) and discard within 24 hours.

anticholinergic agents

• Aclidinium
• Atropine
• Homatropine
• Darifenacin
• Dicyclomine
• Fesoterodine
• Flavoxate
• Glycopyrrolate
• Hyoscyamine
• Ipratropium
• Mepenzolate
• Methscopolamine
• Oxybutynin
• Propantheline
• Scopolamine
• Solifenacin
• Tiotropium
• Tolterodine
• Trospium

• Dailymed label info on Atropine
• FDA Atropine

Atropine Resources
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