Drug information of Atropine sulfate systemic

Mechanism of effect

Atropine has two actions. The most important therapeutic action is the inhibition of smooth muscle and glands innervated by postganglionic cholinergic nerves. Atropine also has central-nervous-system activity, which may be stimulating or depressing depending upon the dose

Pharmacodynamic

Atropine, a naturally occurring belladonna alkaloid, is a racemic mixture of equal parts of d- and l-hyoscyamine, whose activity is due almost entirely to the levo isomer of the drug. Atropine is commonly classified as an anticholinergic or antiparasympathetic (parasympatholytic) drug. More precisely, however, it is termed an antimuscarinic agent since it antagonizes the muscarine-like actions of acetylcholine and other choline esters. Adequate doses of atropine abolish various types of reflex vagal cardiac slowing or asystole. The drug also prevents or abolishes bradycardia or asystole produced by injection of choline esters, anticholinesterase agents or other parasympathomimetic drugs, and cardiac arrest produced by stimulation of the vagus. Atropine may also lessen the degree of partial heart block when vagal activity is an etiologic factor. Atropine in clinical doses counteracts the peripheral dilatation and abrupt decrease in blood pressure produced by choline esters. However, when given by itself, atropine does not exert a striking or uniform effect on blood vessels or blood pressure.

Pharmacokinetics

Atropine is rapidly and well absorbed after intramuscular administration. Atropine disappears rapidly from the blood and is distributed throughout the various body tissues and fluids The protein binding of atropine is 14 to 22% in plasma Much of the drug is destroyed by enzymatic hydrolysis, particularly in the liver. From 13 to 50% is excreted unchanged in the urine Much of the drug is destroyed by enzymatic hydrolysis, particularly in the liver; from 13 to 50% is excreted unchanged in the urine 3.0 ± 0.9 hours in adults. The half-life of atropine is slightly shorter (approximately 20 minutes) in females than males

Drug indications

pylorospasm , spasm of biliary , hypermotility of the colon , urinary tract disorders , peptic ulcer , Parkinson's Disease , hypertonicity of the small intestine , bronchial spasm , control the crying and laughing episodes in pati

Dosage

Usual Adult Dose for Bradyarrhythmia 0.4 to 1 mg IV one time. Usual Adult Dose for AV Heart Block 0.4 to 1 mg IV one time Usual Adult Dose for Organophosphate Poisoning Mild symptoms of nerve agent (nerve gas) or insecticide exposure: 2 mg/0.7 mL (green) by AtroPen auto-injector into midlateral thigh followed by 2 additional 2 mg/0.7 mL (AtroPen) injections given in rapid succession are recommended 10 minutes after receiving the first injection Severe symptoms of nerve agent (nerve gas) or insecticide exposure: 3 injections of 2 mg/0.7 mL (green) by AtroPen auto-injector into midlateral thigh in rapid succession Usual Adult Dose for Anticholinesterase Poisoning 2 to 3 mg IV one time Usual Pediatric Dose for Bradyarrhythmia 0.01 to 0.03 mg/kg IV every 5 minutes for 2 to 3 doses as needed. Usual Pediatric Dose for AV Heart Block 0.01 to 0.03 mg/kg IV every 5 minutes for 2 to 3 doses as needed Endotracheal: 0.04 to 0.06 mg/kg; may repeat once if needed Usual Pediatric Dose for Organophosphate Poisonin Infants weighing less than 15 lbs. (generally less than six months of age): use 0.25 mg/ 0.3 mL (yellow)AtroPen auto-injector

Drug contraindications

patients with glaucoma , tachycardia , bronchial asthma , Prostatic hypertrophy

Side effects

allergic reaction , irregular or fast heart rate , rash , flushing

Interactions

Galantamine , Donepzil , Ipratropium bromide , Neostigmine

Alerts

This drug is effective in very low dosage and overdose may cause permanent damage or death, especially in children. Doses of 0.5 to 1 mg of Atropine are mildly stimulating to the central nervous system. Larger doses may produce mental disturbances; still larger doses are depressing. Death from Atropine poisoning, though rare, is usually due to paralysis of the medullary centers

Points of recommendation

Do NOT use atropine if: you are allergic to any ingredient in atropine you have adhesions between the iris and lens of the eyes, asthma, blocking of the stomach or bowel, ulcerative colitis, bleeding, angle-closure glaucoma, myasthenia gravis, difficulty urinating due to a blockage, excess acid in the stomach or throat, esophagus problems (difficulty swallowing), or bowel muscle weakness If your symptoms do not get better within a few days or if they get worse, check with your doctor. Atropine may cause drowsiness or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use atropine with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using atropine; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Do not become overheated in hot weather or while you are being active; heatstroke may occur. Report any symptoms of fluid or electrolyte loss to your doctor: dry mouth; thirst; weakness; lethargy; drowsiness; restlessness; muscle pain or cramps; muscle weakness; low blood pressure; infrequent urination; rapid heartbeat; stomach disorders such as nausea and vomiting. Atropine may make your eyes more sensitive to sunlight. It may help to wear sunglasses. Tell your doctor or dentist that you take atropine before you receive any medical or dental care, emergency care, or surgery

Pregnancy level

B