ATROPINE BP Injection

Pre-anaesthetic medication to prevent salivary and bronchial secretion.

To restore muscular activity on completion of surgery when anticholinesterase agents are being used. To prevent cardiac dysrhythmias in surgery.

Spasms of the gastrointestinal and uro-genital tract if no better drugs (butyl scopolamine) are available.

As antidote in poisoning with cholinesterase inhibiting insecticides.

Administration

Pre-anaesthetic medication:

Adults: 0.3-0.6mg subcutaneously or intramuscularly 30-60 minutes before induction, or intravenously immediately before induction.

Children: under 5kg: 0.02mg/kg/dose, subcutaneously, 30-60 minutes pre-operatively.

over 5kg: 0.01-0.02mg/kg/dose, subcutaneously, 30-60 minutes pre-operatively. Minimum dose 0.1mg, maximum dose 0.4mg.

In case of cerebral malaria, the initial dose may be 10mg/kg over 8 hours by slow infusion. The maximum dosage is 25mg/kg/day, whatever the route of administration.

Restoration of muscular activity:

Administer intravenously 2-3 minutes before administration of the anti-cholinesterase agent.

Adult: 0.6-1.2mg

Child: 0.02mg/kg

Prevention of cardiac dysrhythmia:

Adult: 0.4-1.0mg intravenously.

Child: 0.01-0.03mg/kg intravenously.

Spasms of the gastrointestinal or uro-genital tract:

0.5mg intramuscularly in one dose.

Antidote:

2mg intramuscularly or intravenously every 20-30 minutes until the skin becomes flushed and dry, pupils dilate and tachycardia develops.

In patients with known hypersensitivity to the drug, obstruction of the bladder neck e.g. due to prostatic hypertrophy, reflux oesophagitis, closed angle glaucoma, myasthenia gravis (unless used to treat the adverse effects of an anti-cholinesterase agent), paralytic ileus, severe ulcerative colitis and obstructive disease of the gastrointestinal tract.

Dry mouth and skin, blurred vision and skin rashes are common. Also cardiac dysrhythmias or tachycardia and confusion. Raised ocular tension especially dangerous in patients with glaucoma. Body temperature may increase and convulsions occur, especially in children, in a hot humid environment this risk is intensified.Dry mouth and skin, blurred vision and skin rashes are common. Also cardiac dysrhythmias or tachycardia and confusion. Raised ocular tension especially dangerous in patients with glaucoma. Body temperature may increase and convulsions occur, especially in children, in a hot humid environment this risk is intensified.

The effects of atropine may be enhanced by the concomitant administration of other drugs with anti-cholinergic activity e.g. tricyclic antidepressants, antispasmodics, anti-parkinsonian drugs, some antihistamines, phenothiazines, disopyramide and quinidine. By delaying gastric emptying, atropine may alter the absorption of other drugs.

Pregnancy

Atropine should be used during pregnancy only when the need out-weighs any possible risk to the foetus.

Lactation

Repeated medication with atropine may reduce breast milk production, and should therefore only be used in nursing mothers if no other alternative is available.

Atropine is an antimuscarinic agent, which competitively antagonizes acetylcholine at postganglionic nerve endings, thus affecting receptors of the exocrine glands, smooth muscle, cardiac muscle and the central nervous system.

Peripheral effects include tachycardia, decreased production of saliva, sweat, bronchial, nasal, lachrymal and gastric secretions, decreased intestinal motility and inhibition of micturition.

Atropine increases sinus rate and sinoatrial and AV conduction. Usually heart rate is increased but there may be an initial bradycardia.

Atropine inhibits secretions throughout the respiratory tract and relaxes bronchial smooth muscle producing broncho dilatation.