Medical Syringe

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Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically given intravenously or by injection into a muscle. Eye drops are also available which are used to treat uveitis and early amblyopia. The intravenous solution usually begins working within a minute and lasts half an hour to an hour. Large doses may be required to treat some poisonings.

Quick Facts

Primary function: Disease Treatment & Pain Management
Scarcity level: High

Lore & Background

Atropine occurs naturally in a number of plants of the nightshade family, including deadly nightshade (Atropa belladonna), jimsonweed (Datura stramonium), mandrake (Mandragora officinarum) and angel's trumpet (Brugmansia). Atropine was first isolated in 1833. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. Atropine was added to cafeteria salt shakers in an attempt to poison the staff of Radio Free Europe during the Cold War.

Reader's Guide

Atropine is used in the treatment of symptomatic or unstable bradycardia. For symptomatic bradycardia, the usual dosage is 0.5 to 1 mg IV push; this may be repeated every 3 to 5 minutes, up to a total dose of 3 mg (maximum 0.04 mg/kg). Atropine is also useful in treating second-degree heart block Mobitz type 1 (Wenckebach block), and also third-degree heart block with a high Purkinje or AV-nodal escape rhythm. It is usually not effective in second-degree heart block Mobitz type 2, and in third-degree heart block with a low Purkinje or ventricular escape rhythm.

Atropine acts as an antagonist for organophosphate poisoning by blocking the action of acetylcholine at muscarinic receptors caused by organophosphate insecticides and nerve agents, such as tabun (GA), sarin (GB), soman (GD), and VX. Troops who are likely to be attacked with chemical weapons often carry autoinjectors with atropine and oxime, for rapid injection into the muscles of the thigh. Atropine is often used in conjunction with the oxime pralidoxime chloride.

Atropine or diphenhydramine can be used to treat muscarine intoxication. Atropine has been observed to prevent or treat irinotecan induced acute diarrhea. Atropine's actions on the parasympathetic nervous system inhibit salivary and mucous glands. The drug may also inhibit sweating via the sympathetic nervous system.

This can be useful in treating hyperhidrosis, and can prevent the death rattle of dying patients. Even though atropine has not been officially indicated for either of these purposes by the FDA, it has been used by physicians for these purposes. Topical atropine is used as a cycloplegic, to temporarily paralyze the accommodation reflex, and as a mydriatic, to dilate the pupils. Atropine degrades slowly, typically wearing off in 7 to 14 days, so it is generally used as a therapeutic mydriatic, whereas tropicamide (a shorter-acting anticholinergic) or phenylephrine (an α-adrenergic agonist) is preferred as an aid to ophthalmic examination.

In refractive and accommodative amblyopia, when occlusion is not appropriate sometimes atropine is given to induce blur in the good eye. Evidence suggests that atropine penalization is just as effective as occlusion in improving visual acuity. Antimuscarinic topical medication is effective in slowing myopia progression in children; accommodation difficulties and papillae and follicles are possible side effects. All doses of atropine appear similarly effective, while higher doses have greater side effects.

The lower dose of 0.01% is thus generally recommended due to fewer side effects and potential less rebound worsening when the atropine is stopped.

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