Atropine sulfate

Atropine sulfate

Parenteral and oral preparations:

Minims (CAN), Sal-Tropine

Ophthalmic solution:

Atropine Sulfate S.O.P., Atropisol, Isopto-Atropine Ophthalmic

Pregnancy Category C

 

Drug classes: Anticholinergic, Antimuscarinic, Parasympatholytic, Antiparkinsonism drug, Antidote, Diagnostic agent (ophthalmic preparations), Belladonna alkaloid

 

Therapeutic actions

Competitively blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic postganglionic impulses, depressing salivary and bronchial secretions, dilating the bronchi, inhibiting vagal influences on the heart, relaxing the GI and GU tracts, inhibiting gastric acid secretion (high doses), relaxing the pupil of the eye (mydriatic effect), and preventing accommodation for near vision (cycloplegic effect); also blocks the effects of acetylcholine in the CNS.

 

 

Indications

Systemic administration

· Antisialagogue for preanesthetic medication to prevent or reduce respiratory tract secretions

· Treatment of parkinsonism; relieves tremor and rigidity

· Restoration of cardiac rate and arterial pressure during anesthesia when vagal stimulation produced by intra-abdominal traction causes a decrease in pulse rate, lessening the degree of AV block when increased vagal tone is a factor (eg, some cases due to digitalis)

· Relief of bradycardia and syncope due to hyperactive carotid sinus reflex

· Relief of pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon

· Relaxation of the spasm of biliary and ureteral colic and bronchospasm

· Relaxation of the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders

· Control of crying and laughing episodes in patients with brain lesions

· Treatment of closed head injuries that cause acetylcholine release into CSF, EEG abnormalities, stupor, neurologic signs

· Relaxation of uterine hypertonicity

· Management of peptic ulcer

· Control of rhinorrhea of acute rhinitis or hay fever

· Antidote (with external cardiac massage) for CV collapse from overdose of parasympathomimetic (cholinergic) drugs (choline esters, pilocarpine), or cholinesterase inhibitors (eg, physostigmine, isoflurophate, organophosphorus insecticides)

· Antidote for poisoning by certain species of mushroom (eg, Amanita muscaria)

Contraindications

· Contraindicated with hypersensitivity to anticholinergic drugs.

· Systemic administration: contraindicated with glaucoma, adhesions between iris and lens, stenosing peptic ulcer, pyloroduodenal obstruction, paralytic ileus, intestinal atony, severe ulcerative colitis, toxic megacolon, symptomatic prostatic hypertrophy, bladder neck obstruction, bronchial asthma, COPD, cardiac arrhythmias, tachycardia, myocardial ischemia, impaired metabolic, liver, or kidney function, myasthenia gravis.

 

Adverse effects

Blurred vision, mydriasis, cycloplegia, photophobia, increased intraocular pressure, headache, flushing, nervousness, weakness, dizziness, insomnia, mental confusion or excitement (after even small doses in the elderly), nasal congestion, Palpitations, bradycardia (low doses), tachycardia (higher doses), Dry mouth, altered taste perception, nausea, vomiting, dysphagia, heartburn, constipation, bloated feeling, paralytic ileus, gastroesophageal reflux, Urinary hesitancy and retention; impotence, Decreased sweating and predisposition to heat prostration, suppression of lactation, Ophthalmic preparations, Transient stinging

Drug Interactions

· Increased anticholinergic effects with other drugs that have anticholinergic activity: certain antihistamines, certain antiparkinsonian drugs, TCAs, MAO inhibitors

· Decreased antipsychotic effectiveness of haloperidol with atropine

· Decreased effectiveness of phenothiazines, but increased incidence of paralytic ileus

 

Nursing considerations

· Ensure adequate hydration; provide environmental control (temperature) to prevent hyperpyrexia.

· Have patient void before taking medication if urinary retention is a problem.