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Atropine information from DrugsUpdate  

See Available Brands of Atropine in India

P - Caution when used during pregnancy
L - Caution when used during pregnancy

Atropine is a tropane alkaloid extracted from deadly nightshade (Atropa belladonna), jimsonweed (Datura stramonium), mandrake (Mandragora officinarum) and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects. It is a competitive antagonist for the muscarinic acetylcholine receptor.

It is classified as an anticholinergic drug. Being potentially deadly, it derives its name from Atropos, one of the three Fates who, according to Greek mythology, chose how a person was to die. Atropine is a core medicine in the World Health Organization's "Essential Drugs List", which is a list of minimum medical needs for a basic health care system.

Pharmacodynamics

Pharmacokinetics

Atropine is an anticholinergic agent which competitively blocks the muscarinic receptors in peripheral tissues such as the heart, intestines, bronchial muscles, iris and secretory glands. Some central stimulation may occur. Atropine abolishes bradycardia and reduces heart block due to vagal activity. Smooth muscles in the bronchi and gut are relaxed while glandular secretions are reduced. It also has mydriatic and cycloplegic effect.

Absorption
Readily absorbed from the GI tract; also absorbed from mucous membranes, eye, and through intact skin.

Distribution
Distributes throughout the body and crosses the blood-brain barrier and placenta.

Metabolism
Incomplete metabolism in the liver.

Excretion
Excreted in urine as unchanged drug and metabolites. Half-life reported to be 4 hours.

Atropine Indications / Atropine Uses

Information Not Available

Atropine Adverse Reactions / Atropine Side Effects

Dry mouth, dysphagia, constipation, flushing and dryness of skin, tachycardia, palpitations, arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness, confusion, excitement, hallucinations, delirium and may progress to circulatory failure and resp depression.


Eye drops: Systemic toxicity esp in children, on prolonged use may lead to irritation, hyperaemia, oedema and conjunctivitis. Increased intraocular pressure.
Inhalation: Dryness of mouth, throat.

Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular ectopics.

Precautions

Monitor
Baseline signs and symptoms
Identify baseline signs and symptoms, and monitor patients response to therapy according to indications for use: increased heart rate when used for bradycardia; decreased secretions for preanesthesia; decreased GI motility or decreased abdominal pain in GI disorders; pupil dilation in eye disorders; decreased tremor, rigidity and drooling in Parkinson disease. Notify health care provider if signs or symptoms do not improve or worsen.

Eyelid inflammation
Monitor patient's response to therapy. Notify health care provider if eye or eyelid inflammation is noted or if symptoms do not improve or worsen (ophthalmic).

Poisoning
Ensure that patient with moderate to severe poisoning is closely monitored for at least 48 h after emergency treatment has been provided (auto-injector).

Respiratory status
Monitor patients respiratory status. Be prepared to provide artificial respiration if severe breathing difficulty is noted (auto-injector).

Special Precautions

Reflux oesophagitis, elderly, infants and children. Pregnancy.

Other Drug Interactions

Additive anticholinergic effects with quinidine, antidepressants and some antihistamines.

Other Interactions

Information Not Available

Dosage

Intravenous
Bradycardia
Adult: 500 mcg every 3-5 minutes. Total: 3 mg.
Max Dosage: 0.04 mg/kg body weight.

Parenteral
Premedication in balanced anaesthesia
Adult: 300-600 mcg IM/SC 30-60 minutes before anaesthesia. Alternatively, 300-600 mcg IV immediately before induction of anaesthesia.
Child: >20 kg: 300-600 mcg; 12-16 kg: 300 mcg; 7-9 kg: 200 mcg; >3 kg: 100 mcg. Doses to be given via IM/SC admin 30-60 minutes before anaesthesia.

Parenteral
Organophosphorus poisoning
Adult: 2 mg IV/IM, every 10-30 minutes until muscarinic effects disappear or atropine toxicity appears. In severe cases, dose can be given as often as every 5 minutes. In moderate to severe poisoning, a state of atropinisation is maintained for at least 2 days and continued for as long as symptoms are present.
Child: 20 mcg/kg given every 5-10 minutes.

Parenteral
Poisoning or overdosage with compounds having muscarinic actions
Adult: 0.6-1 mg IV/IM/SC, repeated every 2 hour.

Ophthalmic
Ophthalmic inflammation
Adult: Instill 1-2 drops of a 0.5-1% solution up to 4 times daily.
Child: As sulfate: Instill 1-2 drops of a 0.5% soln (or 1 drop of a 1% solution) up to tid.

Ophthalmic
Eye refraction
Adult: Instill 1 drop of a 1% solution bid for 1-2 days before the procedure, or on a single occasion 1 hr before the procedure.
Child: As sulfate: Instill 1 or 2 drops of a 0.5% soln (or 1 drop of a 1% solution) bid for 1-3 days before the procedure, with a further dose given 1 hour before the procedure.


Incompatibility
Incompatible with hydroxybenzoate preservatives.

Food(before/after)

May be taken with or without food. (Take w/ food or water.)

List of Contraindications

Atropine and Pregnancy

Caution when used during pregnancy


Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Atropine and Lactation

Excreted in breast milk. If possible, do not use

Atropine and Children

Use cautiously in infants

Atropine and Geriatic

Information Not Available

Atropine and Other Contraindications

Glaucoma, chronic respiratory disease, sick sinus syndrome, thyrotoxicosis, cardiac failure, pyloric stenosis, prostatic hypertrophy.

Storage

Intravenous
Store at 15-30°C.

Ophthalmic
Store at 15-30°C.

Parenteral
Store at 15-30°C.

Lab interference

Intravenous
Store at 15-30°C.

Ophthalmic
Store at 15-30°C.

Parenteral
Store at 15-30°C.

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