atropine sulfate

atropine sulfate,

an antispasmodic and anticholinergic.

indications It may be prescribed in the treatment of GI hypermotility to decrease the tone of the detrusor muscle of the urinary bladder in urinary tract disorders, for cycloplegic refraction and dilation of the pupil in inflammation of the iris or the uvea, cardiac arrhythmias, and certain kinds of poisoning and as an adjunct to anesthesia.

contraindications GI obstruction, glaucoma, hepatitis, liver or kidney dysfunction, porphyria, or known hypersensitivity to this drug or other anticholinergics prohibits its use.

adverse effects Among the more serious adverse reactions are tachycardia, angina, loss of taste, nausea, diarrhea, skin rash, blurred vision, and eye pain. Dry mouth and constipation are common effects.

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atropine (at´rōpēn),

n an alkaloid that annuls parasympathetic effects and antagonizes the effects of pilocarpine. It acts directly on the effector cells, preventing the action but not the liberation of acetylcholine. It suppresses sweat and other glandular sections.

atropine sulfate,

n brand name: Sal-Tropine;
drug class: anticholinergic;
action: inhibits muscarinic actions of acetylcholine at postganglionic parasympathetic neuroeffector sites;
uses: reduction of salivary and bronchial secretions.

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atropine

an anticholinergic alkaloid occurring in belladonna, hyoscyamus and stramonium. It acts as a competitive antagonist of acetylcholine at muscarinic receptors, blocking stimulation of muscles and glands by parasympathetic and cholinergic sympathetic nerves; used as a smooth muscle relaxant, as a preanesthetic to reduce secretions, and as an antidote to organophosphate poisoning. Has been used as a spasmolytic in many cases of gut hypermotility, e.g. equine spasmodic colic. Has the disadvantage of causing prolonged pupillary dilatation.

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atropine challenge test

used in the diagnosis of narcolepsy in dogs; pretreatment with atropine reduces the number of cataleptic attacks with exposure to food.

atropine methobromide

a synthetic muscarinic blocking agent used as a smooth muscle relaxant but less effective against poisoning with organophosphorus insecticides than atropine. Called also methylatropine.

atropine poisoning

severe toxic reaction due to overdosage of atropine. Signs include dilated pupils, absent pupillary light reflex, dry mouth, high heart rate, excitement, muscle tremor. In animals usually results from atropine overdose.

atropine sulfate

the pharmaceutical preparation in common use.

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atropine sulfate

AtroPen

Pharmacologic class: Anticholinergic (antimuscarinic)

Therapeutic class: Antiarrhythmic

Pregnancy risk category C

Action

Inhibits acetylcholine at parasympathetic neuroeffector junction of smooth muscle and cardiac muscle, blocking sinoatrial (SA) and atrioventricular (AV) nodes. These actions increase impulse conduction and raise heart rate. In ophthalmic use, blocks cholinergic stimulation to iris and ciliary bodies, causing pupillary dilation and accommodation paralysis.

Availability

Injection: 0.05 mg/ml, 0.1 mg/ml, 0.3 mg/ml, 0.4 mg/ml, 0.5 mg/ml, 0.8 mg/ml, 1 mg/ml

Ophthalmic solution: 0.5%, 1%, 2%

Tablets: 0.4 mg

⊘Indications and dosages

➣ Bradyarrhythmias, symptomatic bradycardia

Adults: 0.5 to 1 mg by I.V. push repeated q 3 to 5 minutes as needed, to a maximum dosage of 2 mg

Children: 0.01 mg/kg I.V. to a maximum dosage of 0.4 mg or 0.3 mg/m². May repeat I.V. dose q 4 to 6 hours.

➣ Antidote for anticholinesterase insecticide poisoning

Adults: 2 to 3 mg I.V. repeated q 5 to 10 minutes until symptoms disappear or a toxic level is reached. For severe poisoning, 6 mg q hour.

Children: 0.05 mg/kg I.M. or I.V. repeated q every 10 to 30 minutes until symptoms disappear or a toxic level is reached

➣ Preoperatively to diminish secretions and block cardiac vagal reflexes

Adults and children weighing more than 40.8 kg (90 lb): 0.4 to 0.6 mg I.M., I.V., or subcutaneously 30 to 60 minutes before anesthesia

Children weighing 29.5 to 40.8 kg (65 to 90 lb): 0.4 mg I.M., I.V., or subcutaneously 30 to 60 minutes before anesthesia

Children weighing 18.1 to 29.5 kg (40 to 65 lb): 0.3 mg I.M., I.V., or subcutaneously 30 to 60 minutes before anesthesia

Children weighing 10.9 to 18.1 kg (24 to 40 lb): 0.2 mg I.M., I.V., or subcutaneously 30 to 60 minutes before anesthesia

Children weighing 7.3 to 10.9 kg (16 to 24 lb): 0.15 mg I.M., I.V., or subcutaneously 30 to 60 minutes before anesthesia

Children weighing 3.2 to 7.3 kg (7 to 16 lb): 0.1 mg I.M., I.V., or subcutaneously 30 to 60 minutes before anesthesia

➣ Peptic ulcer disease, functional GI disorders (such as hypersecretory states)

Adults: 0.4 to 0.6 mg P.O. q 4 to 6 hours

Children: 0.01 mg/kg or 0.3/m² P.O. q 4 to 6 hours

➣ Parkinsonism

Adults: 0.1 to 0.25 mg P.O. q.i.d.

➣ Antidote for muscarine-induced mushroom toxicity

Adults: 1 to 2 mg/hour I.M. or I.V. until respiratory function improves

➣ Pupillary dilation in acute inflammatory conditions of iris and uveal tract

Adults: Instill one or two drops of 0.5% or 1% solution into eye(s) up to q.i.d.

Children: Instill one or two drops of 0.5% solution into eye(s) up to t.i.d.

➣ To produce mydriasis and cycloplegia for refraction

Adults: Instill one or two drops of 1% solution into eye(s) 1 hour before refraction.

Children: Instill one or two drops of 0.5% solution into eye(s) b.i.d. for 1 to 3 days before examination.

Off-label uses

• Cholinergic-mediated bronchial asthma

Contraindications

• Hypersensitivity to drug or other belladonna alkaloids
• Acute narrow-angle glaucoma
• Adhesions between iris and lens (ophthalmic form)
• Obstructive GI tract disease
• Unstable cardiovascular status
• Asthma
• Myasthenia gravis
• Thyrotoxicosis
• Infants ages 3 months and younger

Precautions

Use cautiously in:
• chronic renal, hepatic, pulmonary, or cardiac disease
• intra-abdominal infection, prostatic hypertrophy
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• For I.V. dose, infuse directly into large vein or I.V. tubing over at least 1 minute.
• Be aware that slow I.V. infusion may cause slowing of heart rate.
• Don't administer oral dose within 1 hour of giving antacids.
• Be aware that patients with Down syndrome may be unusually sensitive to drug.

Route	Onset	Peak	Duration
P.O.	0.5-2 hr	1-2 hr	4-6 hr
I.V.	Immediate	2-4 min	4-6 hr
I.M., subcut.	Rapid	15-50 min	4-6 hr

Adverse effects

CNS: headache, restlessness, ataxia, disorientation, delirium, insomnia, dizziness, drowsiness, agitation, nervousness, confusion, excitement

CV: palpitations, bradycardia, tachycardia

EENT: photophobia, blurred version, increased intraocular pressure, mydriasis, cycloplegia, nasal congestion

GI: nausea, vomiting, constipation, bloating, dyspepsia, ileus, abdominal distention (in infants), dysphagia, dry mouth

GU: urinary retention, urinary hesitancy, impotence

Skin: decreased sweating, flushing, urticaria, dry skin

Other: thirst, anaphylaxis

Interactions

Drug-drug. Amantadine, antiarrhythmics, anticholinergics, antihistamines, antiparkinsonian drugs, glutethimide, meperidine, muscle relaxants, phenothiazines, tricyclic antidepressants: increased atropine effects

Antacids, antidiarrheals: decreased atropine absorption

Antimyasthenics: decreased intestinal motility

Cyclopropane: ventricular arrhythmias

Haloperidol: decreased antipsychotic effect

Ketoconazole, levodopa: decreased absorption of these drugs

Metoclopramide: decreased effect of atropine on GI motility

Potassium chloride wax-matrix tablets: increased severity of mucosal lesions

Drug-herbs. Jaborandi tree, pill-bearing spurge: decreased drug effect

Jimsonweed: changes in cardiovascular function

Squaw vine: reduced metabolic breakdown of drug

Drug-behaviors. Sun exposure: increased risk of photophobia

Patient monitoring

☞ Watch closely for signs and symptoms of anaphylaxis.
• Monitor heart rate for bradycardia or tachycardia.
• Evaluate fluid intake and output.
• Assess for urine retention or urinary hesitancy.
• Monitor for signs and symptoms of glaucoma.

Patient teaching

☞ Instruct patient to immediately report allergic response.
☞ Inform patient that headache, eye pain, and blurred vision may signal glaucoma. Tell him to report these symptoms at once.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and vision.
• Encourage patient to establish an effective bedtime routine to minimize insomnia.
• Tell patient to apply pressure to inside corner of eye during instillation of ophthalmic solution and for 1 to 2 minutes afterward.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.