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Back to Drug index

Back to Anticholinergics

Name: Atropine Sulfate

 

The FDA approved Xolair?, the first in a new class of asthma therapies that are bioengineered to target IgE.

 
 

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Pregnancy Category C

Drug classes

  • Anticholinergic
  • Antimuscarinic
  • Parasympatholytic
  • Antiparkinsonism drug
  • Antidote
  • Diagnostic agent (ophthalmic preparations)
  • Belladonna alkaloid

Mechanisms of action

Competitively blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic postganglionic impulses, thus 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

  1. Systemic administration: Antisialogogue for preanesthetic medication to prevent or reduce respiratory tract secretions
  2. Treatment of parkinsonism; relieves tremor and rigidity
  3. 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)
  4. Relief of bradycardia and syncope due to hyperactive carotid sinus reflex
  5. Relief of pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
  6. Relaxation of the spasm of biliary and ureteral colic and bronchospasm
  7. Relaxation of the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract disorders
  8. Control of crying and laughing episodes in patients with brain lesions
  9. Treatment of closed head injuries that cause acetylcholine release into CSF, EEG abnormalities, stupor, neurologic signs
  10. Relaxation of uterine hypertonicity
  11. Management of peptic ulcer
  12. Control of rhinorrhea of acute rhinitis or hay fever
  13. Antidote (with external cardiac massage) for cardiovascular collapse from overdose of parasympathomimetic (cholinergic) drugs (choline esters, pilocarpine), or cholinesterase inhibitors (eg, physostigmine, isoflurophate, organophosphorus insecticides)
  14. Antidote for poisoning by certain species of mushroom (eg, Amanita muscaria)
  15. Ophthalmic preparations: diagnostically to produce mydriasis and cycloplegiapupillary dilation in acute inflammatory conditions of the iris and uveal tract

Contraindications/cautions

  • Contraindicated in the presence of hypersensitivity to anticholinergic drugs.
  • Systemic administration: Contraindicated in the presence of 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.
  • Use caution in the presence of Down syndrome, brain damage, spasticity, hypertension, hyperthyroidism, lactation.
  • Ophthalmic solution: Contraindicated with glaucoma or tendency to glaucoma.
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Adverse effects

Systemic Administration

  • CNS: 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
  • GI: Dry mouth, altered taste perception, nausea, vomiting, dysphagia, heartburn, constipation, bloated feeling, paralytic ileus, gastroesophageal reflux
  • CV: Palpitations, bradycardia (low doses), tachycardia (higher doses)
  • GU: Urinary hesitancy and retention; impotence
  • Other: Decreased sweating and predisposition to heat prostration, suppression of lactation

Ophthalmic Preparations

  • Local: Transient stinging
  • Systemic: Systemic adverse effects, depending on amount absorbed
 

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