Atropine sulfate: how does it work?

If you’ve got ever handled a patient code, you are probably conversant in the drug atropine. Have you ever wondered how atropine works? Derived from the Atropa belladonna plant, atropine is an anticholinergic drug – a competitive, reversible antagonist of muscarinic receptors (McLendon and Preuss, 2021). In this blog, we are going to concentrate on atropine sulfate, a systemic drug that has antisalivation and antimuscarinic effects and is a first-line drug for the treatment of symptomatic bradycardia. Not to be confused with Isopto atropine, which is an ophthalmological preparation used to dilate the pupils and temporarily paralyze the attention muscle. Here’s what it’s good to find out about atropine sulfate.

How it’s working?

Atropine sulfate blocks the motion of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the central nervous system, causing a rise in cardiac output and a decrease in secretion (UpToDate, 2022). It also reverses the muscarinic effects of cholinergic toxicity by acting as a competitive acetylcholine antagonist at muscarinic receptors. To understand how atropine affects the guts, first consider how the guts’s electrical conduction system works.
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After releasing the neurotransmitter acetylcholine, the vagus nerve stimulates the sinoatrial (SA) node (pacemaker) and the atrioventricular (AV) node, which control conduction between the atria and ventricles of the guts. This inhibits electrical conduction and causes the guts rate to decelerate.
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Atropine competes with acetylcholine for cholinergic receptor sites within the SA and AV nodes. By blocking acetylcholine, atropine increases the guts rate. In certain doses, it prevents slowing of the guts rate of the vagus nerve or kwasolia. However, a high dose can sometimes cause atrioventricular (AV) block.

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Atropine will be administered subcutaneously, intramuscularly (IM), intravenously (IV), or via an endotracheal tube (ET). The preferred method is intravenous administration. For ET administration, dilute 1 mg to 2 mg in 10 ml of sterile water or normal saline.

Approved indications

• Bradycardia during reversal of neuromuscular blockade
• Sinus bradycardia, symptomatic
• Pre-operative/pre-anesthetic drugs to inhibit salivation and secretion
• Treatment of symptoms of mushroom poisoning containing muscarine
• Antidote for anticholinesterase poisoning (carbamate insecticides, nerve agents, organophosphate insecticides)

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Side effects

Common uncomfortable side effects of atropine include dry mouth, blurred vision, photophobia, tachycardia, skin flushing, constipation, difficulty urinating, inability to sweat adequately, delirium, or coma (McLendon and Preuss, 2021).

Contraindications

Atropine is contraindicated in patients with known hypersensitivity, suspected glaucoma, pyloric stenosis, or prostatic hyperplasia (Pfizer, 2021).
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Facts and comparisons. (2022, April 4). Atropine injection. https://fco.factsandcomparisons.com/lco/action/doc/retrieve/docid/fc_dfc/5549537?cesid=9IuxOVWHUkb&

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McLendon, K., & Preuss, C. V. (2021, September 12). Atropine. . https://www.ncbi.nlm.nih.gov/books/NBK470551/

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Pfizer Inc. (2021, November 23). Product monograph containing drug information for the patient – atropine sulfate injection USP. https://www.pfizer.ca/sites/default/files/202112/Atropine_PM_E_253668_23-Nov-2021.pdf

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Current. (2022). Atropine (systemic): Drug information. . https://www.uptodate.com/contents/atropine-systemic-drug-information

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