Atropine
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Atropine Dosage
Atropine is given as an injection, taken orally, or administered in the eye with a dropper.
Your dose will depend on your medical condition.
Follow your doctor's instructions carefully when taking atropine. Don't take more or less of the drug than is prescribed.
If you're using the eye dropper, wash your hands before and after use.
If you're using the oral form of atropine, take it with a full glass of water.
Atropine Overdose
If you suspect an overdose, contact a poison control center or emergency room immediately.
You can get in touch with a poison control center at (800) 222-1222.
Missed Dose of Atropine
If you miss a dose of atropine, take it as soon as you remember.
However, if it's almost time for your next dose, skip the missed dose and continue on your regular dosing schedule.
Don't take extra medicine to make up for a missed dose.
Description
Atropine Sulfate Ophthalmic Solution, USP 1% is a sterile topical anticholinergic for ophthalmic use. The active ingredient is represented by the chemical structure:
Chemical Name: Benzeneacetic acid, α-(hydroxymethyl)-, 8-methyl-8-azabicyclo[3.2.1.]oct-3-yl ester, endo –(±)-, sulfate (2:1) (salt), monohydrate.
Molecular Formula: (C17H23NO3) •H2SO4•H2O
Molecular Weight: 694.83 g/mol
Each mL of Atropine Sulfate Ophthalmic Solution USP, 1% contains: Active: atropine sulfate 10 mg equivalent to 8.3 mg of atropine. Inactives: benzalkonium chloride 0.1 mg (0.01%), dibasic sodium phosphate, edetate disodium, hypromellose (2910), monobasic sodium phosphate, hydrochloric acid and/or sodium hydroxide may be added to adjust pH (3.5 to 6. 0), and water for injection USP.
Uses of Atropine
Injectable:
Atropine is a prescription medication used to reduce salivation and bronchial secretions before surgery.
Atropine may also be used to restore cardiac rate and arterial pressure during anesthesia, to lessen the degree of atrioventricular heart block, to restore normal heart rate and rhythm, and as an antidote for the overdose or poisoning of a cholinergic drug.
Topical:
Atropine is also used to dilate the pupil before eye exams and to relieve pain caused by swelling and inflammation in the eye.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Atropine Drug Class
Atropine is part of the drug class:
Opthalmic anticholinergics
Introduction
Antimuscarinic; a naturally occurring tertiary amine.
Cautions for Atropine
Contraindications
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No absolute contraindications to use in life-threatening conditions (e.g., poisoning by organophosphate nerve agents and pesticides).105 200
-
Relative contraindications include:
-
known hypersensitivity to atropine or any ingredient in the formulation105 b
-
angle-closure glaucoma105 b c
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obstructive uropathy (e.g., bladder neck obstruction secondary to prostatic hypertrophy)c
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obstructive GI disease (e.g., pyloroduodenal stenosis, achalasia)c
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paralytic ileusc
-
intestinal atony (especially in geriatric and debilitated patients)c
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severe ulcerative colitisc
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toxic megacolonc
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tachycardia secondary to cardiac insufficiency or thyrotoxicosis
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acute hemorrhage when cardiovascular status is unstablec
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myasthenia gravis (unless used to reduce adverse muscarinic effects of an anticholinesterase agent such as neostigmine)c
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Warnings/Precautions
Warnings
OverdosageAvoid overdosage, especially with IV administration.198
Pediatric patients are particularly susceptible to overdosage.198
Pesticide and Chemical Warfare Agent PoisoningUse in patients with a history of anaphylactic reaction to atropine and mildly symptomatic organophosphate pesticide or nerve agent poisoning only when there is adequate medical supervision.105
Severe breathing difficulty requires artificial respiration because atropine alone is not dependable in reversing respiratory muscle weakness or paralysis.105
Administer with extreme caution when the symptoms of nerve agent poisoning are less severe in patients with disorders of heart rhythm (e.g., atrial flutter), substantial renal insufficiency, or a recent MI.105
No more than 3 doses should be self-administered IM; additional doses require medical supervision.105
Sensitivity Reactions
Parabens present in multiple-dose preparations may cause hypersensitivity reactions.c
Hypersensitivity reactions may occasionally occur; usually skin rashes that may progress to exfoliation.105 200
Major Toxicities
Cardiovascular EffectsCaution in patients with cardiac disease.105 200 Because heart rate is a major determinant of myocardial oxygen requirements, excessive rate acceleration in patients with acute myocardial ischemia or infarction may worsen ischemia or increase extent of infarction.b
CNS DisturbancesLarge or toxic doses or usual doses in patients with excess susceptibility may produce marked CNS disturbances (e.g., ranging from marked excitement, ataxia, hallucination, depression, and/or disorientation to active delirium to coma to death [secondary to respiratory failure]).105 200
Marked somnolence in susceptible patients.c
Mental confusion and/or excitement, especially in geriatric patients.c
GI DisturbancesExtreme caution in known or suspected GI infections because of decreased GI motility and retention of causative organism and/or toxins.c
Extreme caution in mild to moderate ulcerative colitis because of suppressed intestinal motility and resultant paralytic ileus and toxic megacolon.c
Extreme caution in diarrhea (especially in patients with ileostomy or colostomy) because it may be an early sign of intestinal obstruction.c
Caution in gastric ulcer because of delayed gastric emptying and possible antral stasis.c
Caution in esophageal reflux and hiatal hernia because of decreased gastric motility and lower esophageal sphincter pressure leading to gastric retention and reflux aggravation.c
GU DisturbancesExtreme caution in patients with partial obstructive uropathy because of decreased tone and amplitude of contractions of ureters and bladder and resultant urinary retention.c (See Contraindications under Cautions)
Respiratory EffectsCaution with systemically administered atropine in debilitated patients with chronic pulmonary disease because a reduction in bronchial secretions may lead to inspissation and formation of bronchial plugs; however, has been used effectively as bronchodilator when administered via oral inhalation.
Thermoregulatory EffectsExposure to high environmental temperatures may result in heat prostration due to decreased sweating.c Increased risk of hyperthermia in patients who are febrile.c
General Precautions
NeuropathyExtreme caution in patients with autonomic neuropathy.c
Down’s Syndrome, Spastic Paralysis, and Brain DamageIncreased sensitivity to antimuscarinic effects (e.g., mydriasis, positive chronotropic effect).c
HypertensionCaution in hypertensive patients.c
HyperthyroidismCaution in hyperthyroid patients.c
Seizure Management in Anticholinesterase PoisoningUse barbiturates cautiously to manage seizures because the drugs are potentiated by anticholinesterases.105 Diazepam is preferred for seizure control.101
Specific Populations
PregnancyCategory C.105 c
LactationAtropine is found in human milk in trace amounts; use caution when administered to a nursing woman.105
Pediatric UseSafety and efficacy in the setting of organophosphate pesticide poisoning established in children of all ages.105
Increased susceptibility to the effects of atropine.105 c More susceptible than adults to toxic effects; deaths at doses as low as 10 mg.c
Infants, patients with Down’s syndrome (mongolism), and children with spastic paralysis or brain damage may be hypersensitive to antimuscarinic effects (e.g., mydriasis, positive chronotropic effect).c
Geriatric UseIncreased susceptibility to the effects of atropine.105 c Mental confusion and/or excitement are especially likely in geriatric patients.c
Hepatic ImpairmentUse with caution in hepatic disease.c
Renal ImpairmentUse with caution in renal disease.c
Common Adverse Effects
Most adverse effects are manifestations of pharmacologic effects at muscarinic-cholinergic receptors and usually are reversible when therapy is discontinued.c
Severity and frequency of adverse effects are dose related and individual intolerance varies greatly; adverse effects occasionally may be obviated by a reduction in dosage but this also may eliminate potential therapeutic effects.c
Frequent effects include xerostomia (dry mouth), dry skin, blurred vision, cycloplegia, mydriasis, photophobia, anhidrosis, urinary hesitancy and retention, tachycardia, palpitation, xerophthalmia, and constipation,105 200 c which may appear at therapeutic or subtherapeutic doses.c In many patients, xerostomia is the dose-limiting effect.c
Other common effects include increased ocular tension (especially in patients with angle-closure glaucoma), loss of taste, headache, nervousness, restlessness, drowsiness, weakness, dizziness, flushing, insomnia, nausea, vomiting, bloated feeling, anhidrosis (especially in hot environments),105 200 mild to moderate pain at the injection site,105 c loss of libido, and erectile dysfunction (via block of cholinergically mediated vasodilation).105 c
Interactions for Atropine
Drugs with Anticholinergic Effects
Additive adverse effects resulting from cholinergic blockade (e.g., xerostomia, blurred vision, constipation).c Advise of possibility of increased anticholinergic effects and monitor carefully.c
Effects on GI Absorption of Drugs
By inhibiting the motility of the GI tract and prolonging GI transit time, antimuscarinics have the potential to alter GI absorption of various drugs.c
Specific Drugs
Drug | Interaction | Comments |
---|---|---|
Amantadine | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Antacids | Decreased GI absorption of atropinec | Administer oral atropine at least 1 hour before antacidsc |
Anticholinergic drugs | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Antihistamines (anticholinergic) | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Antiparkinsonian (antimuscarinic) agents | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Corticosteroids | Increased IOPc | Caution; monitor IOPc |
Digoxin (slow dissolving) | Increased serum digoxinc | Use digoxin oral solution (elixir) or rapidly dissolving tablets (e.g., Lanoxin)c |
Disopyramide | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Ketoconazole | Increased gastric pH decreases ketoconazole absorptionc | Administer atropine at least 2 hours after ketoconazolec |
Levodopa | Increased GI metabolism of levodopa & decreased systemic concentrationsc | Adjust levodopa dosage if atropine is started or discontinuedc |
Meperidine | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Mexiletine | Decreased GI absorption rate of mexiletine; no effect on bioavailability200 | |
Muscle (anticholinergic) relaxants | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Phenothiazines | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Potassium chloride | Slowed GI transit potentiates adverse GI effects of oral potassium chloride (especially wax-matrix tablets)c | Caution if used concomitantly; monitor for possible GI mucosal lesionsc |
Procainamide | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Pralidoxime | Increased rate of atropinizationc | |
Tricyclic antidepressants | Increased anticholinergic effectsc | Inform patient and monitor carefullyc |
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
---|---|---|---|---|
Bulk | Powder | |||
Parenteral | Injection | equivalent to Atropine Sulfate 0.25 mg/0.3 mL | AtroPen Auto-Injector (“yellow label”) | Meridian |
equivalent to Atropine Sulfate 0.5 mg/0.7 mL | AtroPenAuto-Injector (“blue label”) | Meridian | ||
equivalent to Atropine Sulfate 1 mg/0.7 mL | AtroPenAuto-Injector (“dark red label”) | Meridian | ||
equivalent to Atropine Sulfate 2 mg/0.7 mL | AtroPenAuto-Injector (“green label”) | Meridian |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
---|---|---|---|---|
Bulk | Powder* | |||
Parenteral | Injection | 0.05 mg/mL* | Atropine Sulfate Injection | |
0.1 mg/mL* | Atropine Sulfate Injection | |||
0.4 mg/mL* | Atropine Sulfate Injection | |||
1 mg/mL* | Atropine Sulfate Injection |
Commonly used brand name(s)
In the U.S.
- AK-Dilate
- AK-Pentolate
- Altafrin
- Atropine Care
- Cyclogyl
- Cyclomydril
- Eye Cool
- Homatropaire
- Isopto Atropine
- Isopto Homatropine
- Isopto Hyoscine
- Mydfrin
- Mydral
- Mydriacyl
- Neofrin
- Neo-Synephrine
- Omidria
- Paremyd
In Canada
- Ak-Dilate
- Ak-Pentolate
- Atropine
- Atropine-Ak
- Atropine Eye Ointment
- Atropine Ointment
- Atropisol
- Minims Phenylephrine Hydrochloride
Available Dosage Forms:
- Ointment
- Solution
Warnings and Precautions
Tachycardia
When the recurrent use of Atropine is essential in patients with coronary artery disease, the total dose should be restricted to 2 to 3 mg (maximum 0.03 to 0.04 mg/kg) to avoid the detrimental effects of Atropine-induced tachycardia on myocardial oxygen demand.
Acute Glaucoma
Atropine may precipitate acute glaucoma.
Pyloric Obstruction
Atropine may convert partial organic pyloric stenosis into complete obstruction.
Complete Urinary Retention
Atropine may lead to complete urinary retention in patients with prostatic hypertrophy.
Viscid Plugs
Atropine may cause inspissation of bronchial secretions and formation of viscid plugs in patients with chronic lung disease.
Nonclinical Toxicology
Carcinogenesis, Mutagenesis, Impairment of Fertility
Studies have not been performed to evaluate the carcinogenic or mutagenic potential of Atropine or its potential to affect fertility adversely.
Related drugs
- Alphagan-P
- Azopt
- Xalatan
© Atropine Patient Information is supplied by Cerner Multum, Inc. and Atropine Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.