Atropine | Anticholinergic drug | uses and side effects

Atropine belongs to a group of medicines known as anticholinergics. An anticholinergic is a substance that blocks the neurotransmitter acetylcholine in the central and peripheral nervous system. It is used in emergency situations when the heart beats too slowly, as an antidote to for example organophosphate insecticide or nerve gas poisoning and in mushroom poisoning. It can be used as part of the premedication before general anaesthesia. It can also be used to prevent side effects of other drugs which are used to reverse the effects of muscle relaxants after surgery.
ATROPINE SULFATE 1 mg/5 ml solution for injection in pre-filled syringe is used to treat adults only.
Atropine belongs to a group of medicines known as anticholinergics.


Class: Anticholinergic Agent, Ophthalmic; Antidote; Antispasmodic Agent, Gastrointestinal; Ophthalmic Agent, Mydriatic




Indications

Injection: Preoperative medication to inhibit salivation and secretions; treatment of symptomatic sinus bradycardia, AV block (nodal level); antidote for anticholinesterase poisoning (carbamate insecticides, nerve agents, organophosphate insecticides); adjuvant use with anticholinesterases (e.g., edrophonium, neostigmine) to decrease their side effects during reversal of neuromuscular blockade
Note: Use is no longer recommended in the management of asystole or pulseless electrical activity (PEA) (ACLS, 2010).

Ophthalmic: Produce mydriasis and cycloplegia for examination of the retina and optic disc and accurate measurement of refractive errors; produce papillary dilation in inflammatory conditions (e.g., uveitis)

Mechanism of action

By blocking parasympathetic (vagal) action of the heart, atropine increases the rate of discharge by the sinus node, enhances conduction through the AV junction, and accelerates the heart rate, thereby improving cardiac output.

Do not use ATROPINE SULFATE if you:

• are allergic (hypersensitive) to atropine or any of the other ingredients of this medicine
• have urinary difficulties,
• have elevated pressure in your eye (glaucoma),
• have oesophagus disease (achalasia of oesophagus), a blockage in your intestine (paralytic ileus), or acute
• Afib / Aflutter with rapid ventricular response (RVR)
• Mobitz Type II AV Blocks
• Wide Complex 3rd degree AV blocks
• Myocardial ischemia form of colonic distension (toxic megacolon).
These contraindications do not apply in case of life-threatening emergencies.

Special consideration

Administration should be rapid IV push to prevent reflex bradycardia. Atropine may result in an increased oxygen demand in patients suffering myocardial ischemia, thus worsening the ischemia or infarction size. Ineffective for bradycardia in heart transplant patients (denervated heart), proceed to pacing.

Warnings and precautions

Talk to your doctor before using ATROPINE SULFATE if you have:
• Hyperthyroidism
• Prostatic disease
• Heart failure
• Liver or kidney disease
• Some cardiac diseases
• Stomach disease, such as pyloric narrowing
• Chronic bronchitis
• Fever
• Myasthenia gravis (severe muscle weakness),
• Heartburn (reflux)
• Or if you are elderly.

Pregnancy

Limited data from the use of atropine in pregnant women indicate no adverse effects on pregnancy or on the health of the fetus. Atropine crosses the placenta. Intravenous administration of atropine during pregnancy or at term may cause a faster heart rate in the fetus and the mother. This medicine should only be administered during pregnancy after careful consideration of the benefits and risks of the treatment.

Breast-feeding

Small amounts of atropine may pass into breast milk and may have effects on the infant. Atropine may inhibit the production of breast milk. Your doctor will consider the benefit of breast-feeding against the benefit of the treatment. Breast-feeding should be discontinued if the decision to use the treatment is maintained. However, if it is decided during treatment to continue breast-feeding, your doctor will perform extra examinations on the infant.
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Driving and using machines

Atropine injection may cause confusion or blurred vision. You should not drive or operate machinery after receiving an injection.

ATROPINE SULFATE contains sodium
This medicinal product contains less than 1 mmol sodium (23 mg) per syringe, i.e. essentially «sodium-free. »

Common side effect

Cardiovascular: Arrhythmia, flushing, hypotension, palpitation, tachycardia. Central nervous system: Ataxia, coma, delirium, disorientation, dizziness, drowsiness, excitement, fever, hallucinations, headache, insomnia, nervousness. Dermatologic: Anhidrosis, urticaria, rash, scarlatiniform rash. Gastrointestinal: Bloating, constipation, delayed gastric emptying, loss of taste, nausea, paralytic ileus, vomiting, xerostomia, dry throat, nasal dryness. Genitourinary: Urinary hesitancy, urinary retention. Neuromuscular and skeletal: Weakness. Ocular: Angle closure glaucoma, blurred vision, cycloplegia, dry eyes, mydriasis, ocular tension increased. Respiratory: Dyspnea, laryngospasm, pulmonary edema. Miscellaneous: Anaphylaxis

Dosage regimen

• Adult
Bradycardia: 0.5 mg rapid IV push every 3-5 minutes (max dose 3 mg)
Cholinergic Poisoning: 2mg IV push every 15 minutes until decreased secretions; 2mg IM every 15 minutes if NO IV
• Pediatric
Bradycardia: 0.02 mg/kg rapid IV push every 5 minutes, minimum dose 0.1 mg
Max dose: 1mg child; 2mg adolescent
Cholinergic Poisoning: 0.05mg/kg IV push every 15 minutes until decreased secretions; 1mg IM every 15 minutes if NO IV



Reference
https://www.rxlist.com/atropine-drug.htm
https://www.drugs.com/mtm/atropine-injection.html
https://reference.medscape.com/drug/atropen-atropine-iv-im-343093
https://www.drugbank.ca/drugs/DB00572
https://www.ncbi.nlm.nih.gov/books/NBK470551/
https://pubchem.ncbi.nlm.nih.gov/compound/Atropine
https://www.cardiosmart.org/Healthwise/d001/74/d00174
https://www.cvpharmacology.com/antiarrhy/atropine
https://www.sciencedirect.com/topics/medicine-and-dentistry/atropine

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