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Atropine sulphate

METABOLISM

EMERGENCY DRUGS - [ METABOLISM ]

Atropine is an antimuscarinic drug. It inhibits the muscarinic actions of acetylcholine. The acetylcholine antagonism is competitive and can be surmounted by increasing the acetylcholine levels.

.When excessive (or sometimes normal) muscarinic effects are judged to be life threatening or are producing symptoms severe enough to call for temporary, reversible muscarinic blockade. As an antisialoagogue when reduction of secretions of the respiratory tract are thought to be needed; its routine use as a preanesthetic agent is discouraged To blunt the increased vagal tone (decreased pulse and blood pressure) produced by intra-abdominal traction or ocular muscle traction, its routine use to prevent such events is discouraged To temporarily increase heart rate or decrease AV-block until definitive intervention can take place, when bradycardias or AV-block are judged to be hemodynamically significant and thought to be due to excess vagal tone As an antidote for inadvertent overdose of cholinergic drugs or for cholinesterase poisoning such as from organophosphorus insecticides As an antidote for the “rapid” type of mushroom poisoning due to the presence of the alkaloid, muscarine, in certain species of fungus such as Amanita muscaria To alleviate the muscarinic side effects of anticholinesterase drugs used for reversal of neuromuscular blockade.

Glaucoma Pyloric stenosis Prostatic hypertrophy

Dryness of the mouth, blurred vision, photophobia and tachycardia Anhidrosis, Constipation and difficulty in micturition. Hypersensitivity reactions have been observed, especially skin rashes. Palpitation, dilated pupils, difficulty in swallowing, hot dry skin, thirst, dizziness, restlessness, tremor, fatigue and ataxia. Restlessness and excitement, hallucinations, delirium and coma. Depression and circulatory collapse

Safety and efficacy is not established in pediatric patients. Dosing in elderly patient should be cautious, since there is a greater frequency of decreased hepatic, renal or cardiac function and of concomitant disease or other drug therapy.

Intramuscular and intravenous injection Adult 1.8 - 3.0 mg intravenous bolus followed by doubling dose every 3 to 5 minutes depending upon response. End-point for atropinization include clear chest with no wheeze, systolic BP >80mm Hg, pulse >80 beats/min., pupils no longer pinpoint and dry axillae. Following that infusion of atropine at 10-20 % of total initial dose required/hour; may require boluses during infusion. Child 20-30 µg/kg initially with same schedule as above.

1. Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. 2. Atropine sulphate injection [Internet]. [cited 2013 Oct 4]. Available from: http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ad8916e7-206e-409e-2582-30d072845dd4#nlm34084-4 3. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011