Dictionary:

atropine

  (ăt'rə-pēn', -pĭn) also atropin (-pĭn)

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A poisonous, bitter, crystalline alkaloid, C₁₇H₂₃NO₃, obtained from belladonna and other related plants. It is used to dilate the pupils of the eyes and as an antispasmodic.

[From New Latin Atropa, genus name of belladonna, from Greek Atropos, Atropos. See Atropos.]

An alkaloid, C₁₇H₂₃NO₃, with the chemical structure below. The systematic chemical name is endo-(±)-α-(hydroxymethyl)phenylacetic acid 8-methyl-8-azabicyclo[3.2.1] oct-3-yl ester, and in phamacy it is sometimes known as dl-hyoscyamine. It occurs in minute amounts

Atropine is used clinically as a mydriatic (pupil dilator). Dilation is produced by paralyzing the iris and ciliary muscles. Atropine is also administered in small doses before general anesthesia to lessen oral and air-passage secretions. Its ability to reduce these secretions is also utilized in several preparations commonly used for symptomatic relief of colds. See also Alkaloid.

Atropine is an alkaloid derived from the solanaceous plants Atropa belladonna (deadly nightshade), Hyoscyamus niger (black henbane), and Datura stramonium (thornapple). These plants contain a mixture of two closely related alkaloids, hyoscyamine and hyoscine; atropine is a mixture of two isomers of hyoscyamine. In 1867, von Bezold found that atropine blocked the slowing of the heart caused by vagal stimulation. We now know that atropine blocks the action of the neurotransmitter acetylcholine at all the nerve endings where the membrane receptors are of the so-called muscarinic type. This includes those of the parasympathetic nervous system in the heart, glandular tissue, and smooth muscle. Thus atropine causes a rise in heart rate and inhibits secretions (for example of saliva, causing a dry mouth, and of the digestive enzymes). It also relaxes smooth muscle in the gastrointestinal tract, the urinary bladder, and the bronchial trees, by preventing the effects of the normal background discharge of parasympathetic neurons to these organs.

The central nervous system also contains muscarinic receptors. Blockade of these by atropine leads to restlessness and mental excitement, and can improve the rigidity and tremor characteristic of Parkinson's disease. Large doses of atropine can cause hallucination.

Long-lasting pupillary dilation results if atropine drops are placed in the eye. The iris has both circular and radial muscles, and the balance between the tonic activities of these two muscle groups controls the pupil diameter. The circular muscle is under parasympathetic control, so when the transmitter, acetylcholine, is blocked with atropine, the pupil will dilate. It is told that Spanish ladies put atropine drops in their eyes for the allure given by large, black pupils: hence the name belladonna — ‘fine lady’.

— Alan W. Cuthbert

See also autonomic nervous system; neurotransmitter; membrane receptors.

An alkaloid that annuls parasympathetic effects and antagonizes the effects of pilocarpine. It acts directly on the effector cells, preventing the action but not the liberation of acetylcholine. It suppresses sweat and other glandular sections.

Brand names: Atreza™, AtroPen®, Atropine Care®, Atropisol®, Atrosulf 1™, Isopto® Atropine, Ocu-Tropine®, Sal-Tropine®

Chemical formula:

Drug Forms:
• Atropine tablets or soluble tablets (below)
• Atropine injection
• Atropine eye ointment or solution
• Atropine auto-injection

Español:
• Tabletas o tabletas solubles de atropina
• Inyección de atropina
• Pomada o solución ocular de atropina
• Auto inyección de atropina

Atropine tablets or soluble tablets

What are atropine tablets?

ATROPINE can help treat many conditions. Administration of atropine before surgery helps to reduce saliva and fluid in the respiratory tract (windpipe). The drug may also be used to treat a slow heartbeat (bradycardia) or to help relieve irritable bowel syndrome. Generic atropine sulfate tablets or soluble atropine sulfate tablets are available.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
• bleeding problems
• closed-angle glaucoma
• diarrhea
• difficulty passing urine
• heart disease, or previous heart attack
• hiatal hernia
• myasthenia gravis
• prostate trouble
• stomach infection
• stomach obstruction
• ulcerative colitis
• an unusual or allergic reaction to atropine, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I take this medicine?

Take atropine tablets by mouth. Follow the directions on the prescription label. Swallow the tablets with a drink of water, or if they are soluble tablets, dissolve in water before taking. Take the tablets 30 to 60 minutes before food. Do not take your medicine more often than directed.

What drug(s) may interact with atropine?

• amantadine
• benztropine
• cisapride
• digoxin
• donepezil
• galantamine
• glutethimide
• medicines for hay fever and other allergies
• medicines for mental depression
• medicines for mental problems and psychotic disturbances
• meperidine
• metoclopramide
• potassium salts
• quinidine
• rivastigmine
• tacrine
• tegaserod

Tell your prescriber or health care professional about all other medicines you are taking, including nonprescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking atropine?

Side effects may occur even though you are no longer taking atropine. Contact your prescriber or health care professional if you are still getting side effects after several days.

You may get dizzy or have blurred vision. Do not drive, use machinery, or do anything that requires mental alertness until you know how atropine affects you. To reduce the risk of dizzy or fainting spells, do not sit or stand up quickly, especially if you are an older patient. Alcohol can make you more dizzy, avoid alcoholic drinks.

Stay out of bright light and wear sunglasses if atropine makes your eyes more sensitive to light.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water will help.

Atropine may cause dry eyes and blurred vision. If you wear contact lenses you may feel some discomfort. Lubricating drops may help. See your ophthalmologist if the problem does not go away or is severe.

Avoid extreme heat (e.g., hot tubs, saunas). Atropine can cause you to sweat less than normal. Your body temperature could increase to dangerous levels, which may lead to heat stroke.

What side effects may I notice from taking atropine?

Side effects that you should report to your prescriber or health care professional as soon as possible:
• anxiety, nervousness
• blurred vision or other eye problems
• confusion
• dizziness or fainting spells
• fast or slow heartbeat
• hallucinations (seeing or hearing things that are not really there)
• loss of memory
• redness, blistering, peeling or loosening of the skin, including inside the mouth
• slurred speech
• unusual weakness or tiredness
• vomiting

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• constipation
• dry mouth
• increased sensitivity of the eyes to sun or ultraviolet light
• nausea
• pain or difficulty passing urine

Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Do not freeze. Throw away any unused medicine after the expiration date.

Last updated: 11/3/2003 10:44:00 AM

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

For more information on atropine, visit Britannica.com.

A drug extracted from belladonna (the juice of the deadly nightshade, Atropa belladonna), which blocks the action of acetylcholine (ACh). Since ACh is the main neurotransmitter of the parasympathetic nervous system, atropine puts this system out of action leaving the sympathetic nervous system to function unopposed. Thus, atropine mimics some actions of the sympathetic nervous system and adrenaline. Small doses of atropine cause a marked increase in heart rate. Belladonna is used in some cold-remedies for bronchitis and whooping cough.

An anticholinergic alkaloid occurring in belladonna, hyoscyamus and stramonium. It acts as a competitive antagonist of acetylcholine at muscarinic receptors, blocking stimulation of muscles and glands by parasympathetic and cholinergic sympathetic nerves; used as a smooth muscle relaxant, as a preanesthetic to reduce secretions, and as an antidote to organophosphate poisoning. Has been used as a spasmolytic in many cases of gut hypermotility, e.g. equine spasmodic colic. Has the disadvantage of causing prolonged pupillary dilatation.

• a. challenge test — used in the diagnosis of narcolepsy in dogs; pretreatment with atropine reduces the number of cataleptic attacks with exposure to food.
• a. methobromide — a synthetic muscarinic blocking agent used as a smooth muscle relaxant but less effective against poisoning with organophosphorus insecticides than atropine. Called also methylatropine.
• a. poisoning — severe toxic reaction due to overdosage of atropine. Signs include dilated pupils, absent pupillary light reflex, dry mouth, high heart rate, excitement, muscle tremor. In animals usually results from atropine overdose.
• a. sulfate — the pharmaceutical preparation in common use.

Atropine
Systematic (IUPAC) name
(8-methyl-8-azabicyclo[3.2.1]oct-3-yl) 3-hydroxy-2-phenylpropanoate
Identifiers
CAS number	51-55-8
ATC code	A03BA01 S01FA01
PubChem	174174
DrugBank	APRD00807
Chemical data
Formula	C17H23NO3
Mol. mass	289.369
Pharmacokinetic data
Bioavailability	25%
Metabolism	50% hydrolysed to tropine and tropic acid
Half life	2 hours
Excretion	50% excreted unchanged in urine
Therapeutic considerations
Pregnancy cat.	C(US)
Legal status	Rx only
Routes	Oral, IV, rectal

Atropine is a tropane alkaloid extracted from the deadly nightshade (Atropa belladonna) and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a drug with a wide variety of effects. Being potentially deadly, it derives its name from Atropos, one of the three Fates who, according to Greek mythology, chose how a person was to die.

Physiological effects and uses

Generally, atropine lowers the "rest and digest" activity of all muscles and glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive antagonist of the muscarinic acetylcholine receptors. (Acetylcholine is the main neurotransmitter used by the parasympathetic nervous system.) Therefore, it may cause swallowing difficulties and reduced secretions.

Ophthalmic use

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 2 to 3 days, so tropicamide (a shorter-acting cholinergic antagonist) or phenylephrine (an α-adrenergic agonist) are generally preferred as mydriatics. The effects of atropine can last up to two weeks. Atropine induces mydriasis by blocking contraction of the circular pupillary sphincter muscle, which is normally stimulated by acetylcholine release, thereby allowing the radial pupillary dilator muscle to contract and dilate the pupil. Atropine is contraindicated in patients predisposed to narrow angle glaucoma.

Atropine can be given to patients who have direct globe trauma.

Resuscitation

Injections of atropine are used in the treatment of bradycardia (an extremely low heart rate), asystole and pulseless electrical activity (PEA) in cardiac arrest. This works because the main action of the vagus nerve of the parasympathetic system on the heart is to slow it down. Atropine blocks that action and therefore may speed up the heart rate. The usual dose of atropine is 0.5 to 1 mg every three to five minutes, up to a maximum dose of 3 mg.

Atropine is also useful in treating first degree heart block, 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 is contraindicated in ischemia-induced conduction block, because the drug increases oxygen demand of the AV nodal tissue, thereby aggravating ischemia and the resulting heart block.

One of the main actions of the parasympathetic nervous system is to stimulate the M₂ muscarinic receptor in the heart, but atropine inhibits this action.

Secretions and bronchoconstriction

Atropine's actions on the parasympathetic nervous system inhibits salivary, sweat, and mucus glands. This can be useful in treating Hyperhidrosis and can prevent the death rattle of dying patients. Even though it has not been officially indicated for either of these purposes by the FDA, it has been used by physicians for these purposes. ^[1]

Antidote for organophosphate poisoning

By blocking the action of acetylcholine at muscarinic receptors, atropine also serves as an antidote for poisoning by organophosphate insecticides and nerve gases. Troops who are likely to be attacked with chemical weapons often carry autoinjectors with atropine and obidoxime which can be quickly injected into the thigh. It is often used in conjunction with Pralidoxime chloride.

Atropine is given as an antidote to SLUDGE (Salivation, Lacrimation, Urination, Diaphoresis, Gastrointestinal motility, Emesis) symptoms caused by organophosphate poisoning.

Some of the nerve gases attack and destroy acetylcholinesterase, so the action of acetylcholine becomes prolonged. Therefore, atropine can be used to reduce the effect of acetylcholine.

Side effects and overdose

Adverse reactions to atropine include ventricular fibrillation, supraventricular or ventricular tachycardia, dizziness, nausea, blurred vision, loss of balance, dilated pupils, photophobia, and possibly, notably in the elderly, extreme confusion, hallucinations, and excitation. These latter effects are due to the fact that atropine is able to cross the blood-brain barrier. Because of the hallucinogenic properties, some have used the drug recreationally, though this is very dangerous and often unpleasant.

In overdoses, atropine is poisonous. Atropine is sometimes added to other potentially addictive drugs; abuse of those drugs is then prevented by the unpleasant effects of atropine overdose.^{[citation needed]}

Although atropine treats bradycardia (slow heart rate) in emergency settings, it can cause heart rate slowing when given at very low doses, presumably as a result of a weak partial agonist effect at the cardiac muscarinic receptors.^{[citation needed]}

The antidote to atropine is physostigmine or pilocarpine.

A commonly used mnemonic used to described the physiologic manifestions of atropine overdose is: "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a wet hen".^[2] This set of symptoms is known as anticholinergic toxidrome, and may also be caused by other drugs with anticholinergic effects, such as diphenhydramine, phenothiazine antipsychotics and benztropine.^[3]

Chemistry and pharmacology

Atropine is a racemic mixture of D-hyoscyamine and L-hyoscyamine, with most of its physiological effects due to L-hyoscyamine. Its pharmacological effects are due to binding to muscarinic acetylcholine receptors. It is an antimuscarinic agent.

The most common atropine compound used in medicine is atropine sulfate (C₁₇H₂₃NO₃)₂·H₂SO₄·H₂O, the full chemical name is 1α H, 5α H-Tropan-3-α ol (±)-tropate(ester), sulfate monohydrate.

History

Mandragora (mandrake) was described by Theophrastus in the fourth century B.C. for treatment of wounds, gout, and sleeplessness, and as a love potion. By the first century A.D. Dioscorides recognized wine of mandrake as an anaesthetic for treatment of pain or sleeplessness, to be given prior to surgery or cautery.^[2] The use of Solanaceae containing tropane alkaloids for anaesthesia, often in combination with opium, persisted throughout the Roman and Islamic Empires and continued in Europe until superseded by the use of ether, chloroform, and other modern anaesthetics.

Atropine extracts from the Egyptian henbane were used by Cleopatra in the last century B.C. to dilate her pupils, in the hope that she would appear more alluring. In the Renaissance, women used the juice of the berries of Atropa belladonna to enlarge the pupils of their eyes, for cosmetic reasons; "bella donna" is Italian for "beautiful lady".

The mydriatic effects of atropine were studied among others by the German chemist Friedrich Ferdinand Runge (1795–1867). In 1831 the pharmacist Mein succeeded the pure crystalline isolation of atropine. The substance was first synthesized by German chemist Richard Willstätter in 1901.

Natural sources

Atropine is found in many members of the Solanaceae family. The most commonly found sources are Atropa belladonna, Datura inoxia, D. metel, and D. stramonium. Other sources include members of the Brugmansia and Hyoscyamus genera. The Nicotiana genus (including the tobacco plant, N. tabacum) is also found in the Solanaceae family, but these plants do not contain atropine or other tropane alkaloids.

See also

• Mark I NAAK

References

1. ^ http://www.eperc.mcw.edu/fastFact/ff_109.htm
2. ^ ^{a b} Robert S. Holzman, MD (1998-07). The Legacy of Atropos 241-249. Retrieved on 2007-05-21. citing J. Arena, Poisoning: Toxicology-Symptoms-Treatments, 3rd edition. Springfield, Charles C. Thomas, 1974, p 345
3. ^ Szajewski J (1995). Acute anticholinergic syndrome. IPCS Intox Databank. Retrieved on 2007-05-22.

Drugs for functional gastrointestinal disorders (A03)
Drugs for functional bowel disorders	antimuscarinics: Mebeverine - Dicycloverine - Propantheline papaverine and derivatives: Papaverine - Drotaverine - Moxaverine acting on serotonin receptors: 5-HT3 antagonists (Alosetron, Cilansetron) - 5HT4 agonists (Mosapride, Tegaserod) other: Diisopromine - Isometheptene - Phloroglucinol - Tridihexethyl
Belladonna and derivatives (antimuscarinics)	Atropine - Hyoscyamine - Butylscopolamine - Methylscopolamine
Propulsives	primarily dopamine antagonists (Metoclopramide/Bromopride, Domperidone, Alizapride) - serotonin agonists (Cisapride) - Clebopride

Ophthalmologicals: mydriatics and cycloplegics (S01F)
Anticholinergics/antimuscarinics	Atropine - Scopolamine - Methylscopolamine - Cyclopentolate - Homatropine - Tropicamide
Sympathomimetics	Phenylephrine - Ephedrine - Ibopamine

Anesthetic: Ancient anaesthesia
Plants/animals	Aconite • Argyreia speciosa • Beaver • Cannabis • Coca • Deadly nightshade • Henbane • Lactucarium • Mandrake • Metel nut • Opium • Poison hemlock • Saussurea • Toloatzin • Willow
People	al-Qasim • al-Razi • Avicenna • Celsus • Dioscorides • Galen • Hippocrates • Susrutha • Theophrastus • Zhang Ji
Molecules	Aconitine • Δ9-THC • Atropine • Cocaine • Coniine • Hyoscyamine • Morphine • Salicylate • Scopolamine

Deliriants (anticholinergic hallucinogens)
3-quinuclidinyl benzilate, Atropine, Dimenhydrinate, Diphenhydramine, Hyoscyamine, Scopolamine, Cyclizine

Health Science > Medicine > Emergency medicine, medical emergency
Procedures	Advanced cardiac life support (ACLS) • Advanced Life Support (ALS) • Advanced Trauma Life Support (ATLS) • Basic life support (BLS) • Cardiopulmonary resuscitation (CPR) • First aid • Pediatric Advanced Life Support (PALS)
Trauma centers	Level I • Level II • Level III • Level IV
Equipment	Ambulance • Bag valve mask • Chest tube • Defibrillation (AED, ICD) • Electrocardiogram (ECG/EKG) • Intraosseous infusion (IO) • Intravenous therapy (IV) • Intubation
People	Certified first responder • Emergency medical technician (EMT) • Paramedic • Emergency physician • BASICS Doctor
Drugs	Atropine • Epinephrine • Amiodarone • Magnesium • Bicarbonate
Other	Golden hour • Emergency department • Emergency medical services • Emergency psychiatry • Triage

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