II. Pharmacology
- Tertiary ammonium alkaloid ester of tropic acid
- Naturally occurs in plant sources
- Atropa belladonna (Deadly nightshade)
- Datura stramonium (Jimsonweed, Thorn apple)
- Described as Belladonna (beautiful woman) alkaloid
- Women of past used Atropine to dilate pupils
- Mydriasis was perceived as more attractive
- Related isomer to Scopolamine (hyoscine)
III. Mechanism
- Antimuscarinic Cholinoceptor blocking drug
- Causes parasympathetic blockade (parasympatholytic)
- Inhibits vagal nerve activity (vagolytic)
- Enhances Sinus node automaticity
- Enhances Atrioventricular node (AV) conduction
IV. Indications
-
Symptomatic Bradycardia associated with
- Poor perfusion
- Hypotension
- Relative Bradycardia
- Prevent vagally mediated Bradycardia with intubation
- Symptomatic Bradycardia with AV Block
-
Asystole or Pulseless Electrical Activity
- No evidence that survival is improved with Atropine
- Asystole is nearly always fatal despite intervention
V. Pediatric Dosing
- IV Dose
- Dose: 0.02 mg/kg IV or IO
- Minimum Dose: 0.1 mg
- Maximum Dose
- Child: 0.5 mg
- Adolescent: 1.0 mg
- Endotracheal Dose
- Dose: 2-3x IV dose (0.06 mg/kg) diluted in 3-5cc NS
- Follow dose with several positive pressure breaths
VI. Adult Dosing
-
Bradycardia
- Dose: 0.5-1.0 mg IV
- May repeat q3-5 min to max total dose of 0.04 mg/kg
-
Asystole or Bradycardic Pulseless Electrical Activity
- Dose: 1 mg IV
- Consider giving entire 0.04 mg/kg at start)
- May repeat q3-5 min to max total dose of 0.04 mg/kg
- Endotracheal Dosing
- Dose: 1-2 mg per dose
- Dilute to 10 ml with sterile water or saline
VII. Precautions
- Avoid repeat dosing if possible
- Increases myocardial oxygen demand
- Atropine may provoke Ischemic Heart Disease
- Consider external pacing if repeat dosing needed
- Avoid dosing Atropine below recommended dose
- Causes paradoxical Bradycardia
- May precipitate Ventricular Fibrillation
VIII. Adverse effects
- Rebound Tachycardia
- Paradoxical Bradycardia (if low dose Atropine used)
- Pupil dilatation (Mydriasis)
- Paradoxical rate slowing
- Arrhythmia (especially in Coronary Artery Disease)
- Anticholinergic Toxicity with overdosage
- Decreased Sweating and secretions
- Mild sedation to Delirium
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Related Studies
atropine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
ATROPINE 1% EYE DROPS | Generic | $11.84 per ml |
ATROPINE 1% EYE OINTMENT | Generic | $4.33 per gram |
hyoscyamine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
HYOSCYAMINE 0.125 MG ODT | Generic | $0.24 each |
HYOSCYAMINE 0.125 MG TAB SL | Generic | $0.23 each |
HYOSCYAMINE 0.125 MG/5 ML ELIX | Generic | $0.05 per ml |
HYOSCYAMINE 0.125 MG/ML DROP | Generic | $0.88 per ml |
HYOSCYAMINE SULF 0.125 MG TAB | Generic | $0.26 each |
Ontology: Atropine (C0004259)
Definition (MSH) | An alkaloid, originally from Atropa belladonna, but found in other plants, mainly SOLANACEAE. Hyoscyamine is the 3(S)-endo isomer of atropine. |
Definition (NCI) | A synthetically-derived form of the endogenous alkaloid isolated from the plant Atropa belladonna. Atropine functions as a sympathetic, competitive antagonist of muscarinic cholinergic receptors, thereby abolishing the effects of parasympathetic stimulation. This agent may induce tachycardia, inhibit secretions, and relax smooth muscles. (NCI04) |
Definition (CSP) | anticholinergic alkaloid originally from Atropa belladonna; used as an antispasmodic to relax smooth muscles, to increase heart rate by blocking the vagus nerve, as an antidote for various toxic and anticholinesterase agents, and as an antisecretory, mydriatic, and cycloplegic. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D001285 |
SnomedCT | 372832002, 73949004 |
LNC | LP14891-3, MTHU002117 |
English | Atropine, dl-Hyoscyamine, Benzeneacetic acid, alpha-(hydroxymethyl)- 8-methyl-8-azabicyclo(3.2.1)oct-3-yl ester endo-(+-)-, dl-Tropyl Tropate, endo-(+/-)-alpha-(Hydroxymethyl)benzeneacetic Acid 8-methyl-8-azabicyclo[3.2.1]oct-3-yl Ester, atropine (medication), Atropine [Chemical/Ingredient], ATROPINE, atropine [chemical substance], atropine, Daturine, Dl-hyoscyamine, Atropine (product), Atropine (substance), Hyoscyamine (dl-) |
Swedish | Atropin |
Czech | atropin |
Finnish | Atropiini |
Russian | ATROPIN, АТРОПИН |
Japanese | ヒオスシアミン, アトロピン |
Polish | Atropina |
Spanish | DI-hiosciamina, atropina (producto), atropina (sustancia), atropina, daturina, Atropina |
French | Atropine |
German | Atropin |
Italian | Atropina |
Portuguese | Atropina |
Ontology: Hyoscyamine (C0596004)
Definition (MSH) | The 3(S)-endo isomer of atropine. |
Definition (NCI) | A belladonna alkaloid derivative and the levorotatory form of racemic atropine isolated from the plants Hyoscyamus niger or Atropa belladonna, which exhibits anticholinergic activity. Hyoscyamine functions as a non-selective, competitive antagonist of muscarinic receptors, thereby inhibiting the parasympathetic activities of acetylcholine on the salivary, bronchial, and sweat glands, as well as the eye, heart, bladder, and gastrointestinal tract. These inhibitory effects cause a decrease in saliva, bronchial mucus, gastric juices, and sweat. Furthermore, its inhibitory action on smooth muscle prevents bladder contraction and decreases gastrointestinal motility. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D064692 |
SnomedCT | 372757002, 40851005, 48899009 |
LNC | LP15172-7, MTHU002561 |
English | hyoscyamine, Duboisine, urological antispasmodics hyoscyamine, hyoscyamine (medication), l-hyoscyamine, (-)-Atropine, Benzeneacetic acid, alpha-(hydroxymethyl)-, 8-methyl-8-azabicyclo(3.2.1)oct-3-yl ester, (3(S)-endo)-, (S)-Atropine, HYOSCYAMINE, Atropine, 3(S)-endo-Isomer, Duboisine (substance), Hyoscyamine [Chemical/Ingredient], L-hyoscyamine, Hyoscyamine (product), Hyoscyamine (substance), Hyoscyamine |
Spanish | duboisina, duboisina (sustancia), L-hiosciamina, hiosciamina (producto), hiosciamina (sustancia), hiosciamina |
Czech | levo-atropin, levotočivý izomer atropinu, hyoscyamin |
French | Hyoscyamine |
German | Hyoscyamin |
Italian | Iosciamina |
Russian | ЦИТОСПАЗ, ГИОСЦИАМИН, АТРОПИНА СУЛЬФАТ, 3(S)-ЭНДО-ИЗОМЕР, ГИОСЦИАМИНА СУЛЬФАТ, ANASPAZ, GIOSTSIAMIN, ATROPINA SUL'FAT, 3(S)-ENDO-IZOMER, GIOSTSIAMINA SUL'FAT, АНАСПАЗ, TSITOSPAZ |