Atropine instructions for use in ampoules. Atropine - indications for use

Instructions for use

Attention! The information is provided for informational purposes only. This instruction should not be used as a guide to self-medication. The need for prescription, methods and doses of the drug are determined exclusively by the attending physician.

general characteristics

chemical name: bis(1R,3r,5S)-3-[(RS)-3-hydroxy-2-phenylpropionyl)oxy]-8-methyl-8-azabicyclooctane sulfate monohydrate;

basic physicochemical characteristics: clear colorless liquid;

compound: atropine sulfate - 0.001 g (in 1 ml ampoule);

Excipients: hydrochloric acid 0.1 M, water for injection.

Release form. Solution for injections (Injection- injection, subcutaneous, intramuscular, intravenous, etc. introduction into the tissues (vessels) of the body of small quantities of solutions (mainly medicines)) 0,1 %.

Pharmacological group

Antispasmodics and anticholinergics.

Pharmacological properties

The effects of atropine are associated with blockade (Blockade- slowing down or interrupting the conduction of electrical impulses in any part of the conduction system of the heart or myocardium) M-cholinoreactive systems that lose sensitivity to acetylcholine - mediator (Mediator- a substance that transfers excitation from a nerve ending to a working organ and from one nerve cell to another), which is released in the area of ​​​​the sensory endings of the postganglionic parasympathetic nerves. The pharmacological effects of atropine are almost opposite to those that occur with the action of M- cholinomimetics (cholinomimetics- drugs with different mechanisms of action that cause direct or indirect stimulation of cholinergic receptors). The drug has a central anticholinergic effect, which is manifested by a decrease in tremors and muscle tension during parkinsonism (Parkinsonism– a neurological syndrome caused by a malfunction of the metabolism of adrenaline, norepinephrine, dopamine and their ratio in the subcortical nerve nodes (ganglia). Characterized by rhythmic muscle tremor (fingers, sometimes lips and other parts of the body tremble), rigidity, decreased volume and speed of movements, hypokinesia), however, the use of atropine in this disease has difficulties due to its inherent peripheral M-cholinolytic properties. Atropine increases breathing. In high doses, it stimulates the cerebral cortex and causes psychomotor agitation, hallucinations (Hallucinations- these are perception disorders in which objects or phenomena are found where in reality there is nothing), convulsions. The peripheral M-anticholinergic effect of atropine is manifested in pupil dilation, paralysis (Paralysis- loss of strength during voluntary muscle movements after damage or pathological changes to the nerve innervating these muscles) accommodation (Accommodation- a concept close to the term “adaptation”. For example, accommodation of the eye is an adaptation to clearly seeing objects located at different distances from the eye), increased intraocular pressure. This effect lasts for 6-7 hours. Atropine causes tachycardia (Tachycardia- increase in heart rate to 100 or more beats per minute. Occurs with physical and nervous stress, diseases of the cardiovascular and nervous systems, diseases of the endocrine glands, etc.) due to blockade of the vagus nerve, relaxes smooth muscles internal organs(bronchi, digestive tract, biliary and urinary tracts, etc.), especially in spastic conditions; inhibits secretory function glands (Glands- organs that produce and secrete specific substances that participate in various physiological functions and biochemical processes of the body. The endocrine glands secrete their waste products - hormones - directly into the blood or lymph. Exocrine glands - on the surface of the body, mucous membranes or in external environment(sweat, salivary, mammary glands))(bronchial, salivary, gastric, sweat, etc.); When applied topically, it causes anesthesia.

Pharmacokinetics. Atropine sulfate is quickly resorbed into the bloodstream from the injection site and quickly distributed in the body, passing through the blood-brain and placental barriers. It is excreted in the urine both unchanged and in the form of metabolites. Trace amounts of the drug are detected in breast milk.

Indications for use

Directions for use and doses

The drug is administered subcutaneously, intramuscularly, intravenously at 0.25 - 0.5 - 1 mg (0.25 - 0.5 - 1 ml) 1-2 times a day. Sometimes subconjunctivally 0.2 - 0.5 mg (0.2 - 0.5 ml) or parabulbar 0.3 - 0.5 mg (0.3 - 0.5 ml).
During the introductory anesthesia (Anesthesia- artificially induced deep sleep with loss of consciousness and pain sensitivity. Used for pain relief during operations) to reduce the risk of oppression vagus (Vagus- (nervus vagus), X pair of cranial nerves) heart rate and decreased secretion of the salivary and bronchial glands - 0.3 - 0.6 mg subcutaneously or intramuscularly 30 - 60 minutes before anesthesia; in combination with morphine (10 mg of morphine sulfate) - one hour before anesthesia.
For adults, the highest single dose is 2 mg, daily dose is 3 mg; for children, the highest dose, depending on age, is: up to 6 months - 0.02 mg, from 6 months to 1 year - 0.05 mg, 2 years - 0.2 mg, 3 - 4 years - 0.25 mg, 5 -6 years - 0.3 mg, 7-9 years - 0.4 mg, 10-14 years - 0.5 mg twice a day. In case of poisoning with anticholinesterase drugs - 2 mg intramuscularly every 20-30 minutes until redness and dryness of the skin, pupil dilation and tachycardia appear, and breathing normalizes. For moderate to severe poisoning, atropine can be administered for 2 days.

Side effect

Dry mouth, dry skin, scarlet-like rashes, dysphagia (Dysphagia– a disorder of any phase of the act of swallowing or discomfort experienced by the patient when food passes through the esophagus), thirst, tachycardia, visual impairment, paralysis of accommodation, psychomotor agitation, convulsions, urinary retention (Urinary retention– due to various diseases organs genitourinary system, in which the lumen of the urethra is completely or partially closed as a result of damage to the central nervous system, inflammatory diseases, urinary tract damage), temperature increase.

Contraindications

angle-closure glaucoma; narrow angle between the iris and cornea (Cornea- (cornea), the anterior transparent part of the outer shell of the eye, one of its light-refracting media); organic lesions of the heart and blood vessels; prostatic hypertrophy; kidney diseases; cachexia (Cachexia– extreme degree of exhaustion of the body, which is characterized by severe emaciation, general weakness, decreased activity of physiological processes, mental disorders); miastema gravis (except when atropine is intended to reduce the antimuscarinic side effects of anticholinesterase drugs); hypersensitivity to the drug.

Interaction with other drugs

The effect of Atropine-Darnitsa can be enhanced with the simultaneous use of other drugs with an antimuscarinic effect (amantadine, certain antihistamines (Antihistamines- medicinal substances that prevent or reduce the effects caused by histamine, i.e. effects of dilating capillaries and increasing their permeability, contraction of smooth muscles, etc.), drugs from the group of butyrophenones, phenothiazines, tricyclics antidepressants (Antidepressants- products that improve mood, relieve anxiety and tension, and increase mental activity. Used to treat depression)). Inhibition of peristalsis under the influence of Atropine-Darnitsa can lead to changes in the absorption of other drugs.

Overdose

Symptoms: with a slight overdose - dry mouth, dilated pupils, disturbances of accommodation (Violation of accommodation– disruption of the process of changing the refractive power of the eye to adapt to the perception of objects located at different distances from it), tachycardia, difficulty urinating, intestinal atony, dizziness.
In case of poisoning - dilated pupils, increased intraocular pressure, dry mucous membranes and skin, increased temperature, urinary retention, tachycardia, headache, dizziness, hallucinations, complete loss of orientation, severe psychomotor agitation; convulsions with loss of consciousness may develop, decreased blood pressure, coma.

Treatment: introduction antidote (Antidotes- medicines used to treat poisoning in order to neutralize the poison and eliminate the pathological disorders caused by it)- proserine (1 ml of 0.05% solution under the skin) or physostigmine (0.5 - 1 ml of 0.1% solution under the skin). For psychomotor agitation - aminazine intramuscularly (2 ml of 2.5% solution). For convulsions - barbiturates (5 - 10 ml of 2.5% sodium hexenal solution intravenously or up to 10 - 15 ml of 2.5% hexenal solution intravenously - 3 - 4 ml at intervals of 30 s). With pronounced hyperthermia (Hyperthermia- overheating of the body. A person with a body temperature above 41-42C may experience heatstroke)- ice on the head, groin area, wet wraps. For tachycardia - inderal.
In case of urinary retention - catheterization. With pronounced intoxication (Intoxication- poisoning of the body with toxic substances)- forced diuresis (Diuresis- the amount of urine excreted over a certain time. In humans, daily diuresis averages 1200-1600 ml), alkalization of blood. Intravenous injections indicated glucose (Glucose- grape sugar, a carbohydrate from the group of monosaccharides. One of the key metabolic products that provides living cells with energy) with ascorbic acid.

Features of application

Use with caution in patients with severe lesions of cardio-vascular system. With subconjunctival and parabulbar administration to prevent tachycardia, the patient is given a validol tablet under the tongue along with Atropine-Darnitsa. Precautions. Prescribe with caution to children and the elderly, use in patients with diarrhea (Diarrhea- frequent discharge of liquid feces, associated with accelerated passage of intestinal contents due to increased peristalsis, impaired absorption of water in the large intestine and the release of a significant amount of inflammatory secretion by the intestinal wall), with ulcerative colitis (bloating of the colon with hypertrophy of its wall may develop).

Use with caution, especially for children, when the temperature rises. environment(risk of hyperexia), with hyperthermia, with conditions that are accompanied by tachycardia ( thyrotoxicosis (Thyrotoxicosis- a syndrome caused by the effect of excess thyroxine and triiodothyronine on target tissue. There are many causes of thyrotoxicosis\; the most common reason- diffuse toxic goiter (Graves disease). The clinical picture includes the effect of hormones on different organs. Symptoms of activation of the sympathoadrenal system are characteristic: tachycardia, tremor, sweating, anxiety. These symptoms are eliminated by beta blockers), heart failure, heart surgery), with myocardial infarction (Myocardial infarction- ischemic necrosis of the myocardium, caused by a sharp decrease in the blood supply to one of its segments. The basis of MI is an acutely developed thrombus, the formation of which is associated with the rupture of an atherosclerotic plaque)(risk of increased ischemia (Ischemia- local anemia due to mechanical blockage of the arteries or lack of blood supply) myocardium (Myocardium - muscle heart, making up the bulk of its mass. Rhythmic coordinated contractions of the myocardium of the ventricles and atria are carried out by the conduction system of the heart)), with hypertension.

The effect of atropine on the esophageal sphincter (Sphincter(Greek sphinkter, from sphingo - I squeeze) - a circular muscle that narrows or closes the external (for example, oral) or transitional (for example, Bladder into the urethra) opening) may lead to increased reflux (Reflux(from the Middle Ages. Latin refluxus - reverse flow) - movement of the liquid contents of hollow organs (digestive, urinary, etc.) in the opposite (antiphysiological) direction, for example, throwing gastric contents into the esophagus with a diaphragmatic hernia). While taking Atropine-Darnitsa, you must refrain from work that requires visual control (driving cars, operating machinery, etc.).

General Product Information

Storage conditions and periods. Store in a place protected from light, out of the reach of children! The expiration date is indicated on the packaging.

Vacation conditions. On prescription.

Package. 10 ampoules of 1 ml.

Manufacturer.CJSC "Pharmaceutical Firm "Darnitsa".

Location. 02093, Ukraine, Kiev, st. Boryspilskaya, 13.

Website. www.darnitsa.ua

This material is presented in free form on the basis of the official instructions for medical use of the drug.

Atropine is an antispasmodic and antichilinergic drug. Its active component is a poisonous alkaloid present in the leaves and seeds of plants of the nightshade family. The main principle of action of the drug is the ability to block the body's cholinergic systems located in the heart muscle and organs with smooth muscles.

Dosage form

The drug Atropine is produced by pharmaceutical companies in the form of a solution for injection and in the form of eye drops.

Description and composition

As an active component, regardless of dosage form atropine sulfate appears. Achieving the required dosage formula is ensured by an excipient – ​​saline solution.

The solutions are transparent in color; sedimentation is not allowed during storage. Turbidity in the composition may indicate improper storage of the medication.

Pharmacological group

The drug Atropine belongs to the group of antispasmodic and anticholinergic drugs. The active component of the medicinal composition is rapidly distributed in the patient’s body and removed from it by the liver and due to enzymatic hydrolysis. The binding rate to plasma proteins is about 18%. We should not forget about the ability of the substance to actively overcome the placental barrier and penetrate into breast milk. The half-life of the drug is 2 hours. Half the dose of the drug is excreted from the patient’s body through the kidneys.

Indications for use

Atropine reduces the secretory function of the glands and promotes relaxation of smooth muscles. When using the composition in eye drop format, the pupil dilates and intraocular pressure increases. Paralysis of accommodation is ensured. After taking the drug, acceleration and stimulation of cardiac activity is ensured, this effect is achieved due to the ability of the composition to have a direct effect on the vagus nerve. The drug has a direct effect on the central nervous system and ensures activation of the respiratory center. When using toxic doses, increased motor and mental agitation is possible.

The list of indications for taking the drug can be presented as follows:

• ulcerative lesions of the stomach and duodenum;
• spasms of the bile ducts;
• organ spasms respiratory system;
• parkinsonism;
• poisoning with salts of heavy metals;
• bradycardia;
• renal colic;
• intestinal colic;
• irritable small bowel syndrome;
• bronchospasm;
• laryngospasm.

Atropine can be used during a number of X-ray studies of the gastrointestinal tract, before various surgical interventions in ophthalmology.

for adults

The drug Atropine can be used by patients in this category in the absence of contraindications to use. Elderly people often require dose adjustments to minimize the risk of complications during use. For liver and kidney damage, the composition is used with increased caution.

for children

The medicine can be used in pediatric practice as prescribed by a specialist. In compliance with the rules of increased caution, the composition is prescribed to young children and persons with weakened immune systems. The drug may cause a decrease in the intensity of the processes of producing bronchial secretions, against this background the formation of plugs in the bronchi is possible. The composition is not used for serious brain damage or cerebral palsy.

Atropine can penetrate the placental barrier. Controlled studies of the use of the composition during pregnancy have not been conducted. The composition is not used during pregnancy for intravenous administration due to the possibility of developing tachycardia in the fetus. The active component of the drug can pass into breast milk in small quantities.

Contraindications

The composition is not prescribed to patients with hypersensitivity to the active substance.

Applications and dosages

The dosage regimen, frequency and duration of use are determined by the attending physician on an individual basis. Failure to comply with such recommendations may result in severe complications.

for adults

The recommended dose for adult patients is 300 mcg every 4-6 hours. In order to eliminate bradycardia, the composition is prescribed to adult patients at a dose of 0.5 - 1 mg. If necessary, the administration is repeated after 5 minutes. For premedication – 400-600 mcg once.

for children

To eliminate bradycardia in children, a dose of 10 mcg/kg of the patient’s body is used.

for pregnant women and during lactation

During pregnancy, the composition is used in doses recommended for adult patients as prescribed by a specialist.

Side effects

When taken systemically, the following reactions may occur:

• dry mouth;
• tachycardia;
• difficulty urinating;
• photophobia;
• dizziness;
• tactile perception disorders;
• paralysis of accommodation;
• mydriasis

When using eye drops, side effects may include the following:

• swelling of the skin of the eyelids;
• hypermia;
• swelling of the conjunctiva;
• photophobia;
• tachycardia.

Interaction with other drugs

There are no data on the interaction of the drug with other medications. The possibility of sharing the composition with other drugs is determined on an individual basis.

special instructions

During the period of use of the drug Atropine, the patient must be careful when driving vehicles and while working with complex mechanisms.

Overdose

When used in doses regulated by the instructions, the likelihood of overdose is minimized. If the recommended doses are exceeded, a significant deterioration in the patient's well-being may occur. Sedatives can be used to eliminate adverse reactions that occur. If acute reactions occur, the patient should seek emergency medical help.

Storage conditions

The medicine is sold to the public through a network of pharmacies with a prescription. The composition should be stored at a temperature of no more than 25 degrees in a place protected from children. Eye drops should be stored in the refrigerator after opening the package.

Analogues

The drug Atropine has no structural analogues of the active substance. If it is impossible to use Atropine, your doctor will be able to select an adequate replacement.

Price

The cost of Atropine is on average 50 rubles. Prices range from 13 to 55 rubles.

Pharmacological.

The mechanism of action is due to the selective blockade of M-cholinergic receptors by atropine (it has a lesser effect on N-cholinergic receptors), as a result of which M-cholinergic receptors become insensitive to acetylcholine, which is formed in the area of ​​​​the endings of postganglionic parasympathetic neurons. The ability of atropine to bind to cholinergic receptors is explained by the presence in its molecule of a fragment that gives it affinity with the molecule of the endogenous ligand - acetylcholine. Atropine sulfate reduces the secretion of the salivary, bronchial, gastric and sweat glands, increases the viscosity of bronchial secretions, suppresses the activity of the cilia of the ciliated epithelium of the bronchi, thereby reducing mucociliary transport, accelerates heart contraction, increases AV conductivity, reduces the tone of smooth muscle organs, reduces the number and total acidity gastric juice (especially with the predominance of cholinergic regulation of secretion), reduces basal and nocturnal secretion of gastric juice, to a lesser extent reduces stimulated secretion, vira enno dilates the pupil (this may increase intraocular pressure). Penetrating the blood-brain barrier, atropine in therapeutic doses stimulates the respiratory center.

Pharmacokinetics.

After intravenous administration, the maximum effect appears within 2-4 minutes. Atropine sulfate is quickly absorbed into the bloodstream from the injection site. It is quickly distributed in the body, penetrates the blood-brain, placental barrier and into breast milk. In the blood, atropine is 50% protein bound, its volume of distribution is about 3 l/kg. After administration, the concentration of atropine in the blood plasma decreases in two stages. The first stage is fast - the half-life is 2:00. During this time, approximately 80% of the administered dose of atropine is excreted in the urine. The second stage - the rest of the drug is excreted in the urine - the half-life is 13-36 hours. Atropine is metabolized in the liver by enzymatic hydrolysis, approximately 50% of the dose is excreted unchanged by the kidneys.

Indications

As a symptomatic remedy for gastric and duodenal ulcers, pylorospasm, acute pancreatitis, cholelithiasis, cholecystitis, intestinal spasms, urinary tract spasms, bronchial asthma, bradycardia, as a result of increased tone of the vagus nerve, to reduce the secretion of salivary, gastric, bronchial, and sometimes sweat glands, for X-ray examination digestive system(decreased tone and motor activity of organs).

The drug is also used before anesthesia, surgery and during surgery as a means of preventing broncho and laryngospasms, reduces gland secretion, reflex reactions and side effects caused by excitation of the vagus nerve. As a specific antidote for poisoning with cholinomimetic compounds and anticholinesterase (including organophosphorus) substances.

Contraindications

Hypersensitivity to the components of the drug. Diseases of the cardiovascular system in which an increase in heart rate may be undesirable: atrial fibrillation, tachycardia, chronic heart failure, coronary heart disease, mitral stenosis, severe arterial hypertension. Acute bleeding. Thyrotoxicosis. Hyperthermic syndrome. Diseases of the digestive system accompanied by obstruction (achalasia of the esophagus, pyloric stenosis, intestinal atony). Glaucoma. Hepatic and renal failure. Myasthenia gravis gravis. Urinary retention or predisposition to it. Brain damage.

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Interaction with other drugs and other types of interactions

When using atropine sulfate with MAO inhibitors, cardiac arrhythmias occur; with quinidine, novocainamide, a summation of the anticholinergic effect is observed. When taken orally with lily of the valley preparations, a physicochemical interaction is observed with tannin, which leads to a mutual weakening of the effects.

Atropine sulfate reduces the duration and depth of action of narcotic drugs and weakens the analgesic effect of opiates.

When used simultaneously with diphenhydramine or diprazine, the effect of atropine increases; with nitrates, haloperidol, corticosteroids for systemic use - the likelihood of increasing intraocular pressure increases; with sertraline - the depressive effect of both drugs increases; with spironolactone, minoxidil - the effect of spironolactone and minoxidil decreases; with penicillins - the effect of both drugs is enhanced, with nizatidine - the effect of nizatidine is enhanced, ketoconazole - the absorption of ketoconazole is reduced, with ascorbic acid and attapulgite - the effect of atropine is reduced, with pilocarpine - the effect of pilocarpine in the treatment of glaucoma is reduced, with oxprenolone - the antihypertensive effect of the drug is reduced. Under the influence of octadin, it is possible to reduce the hyposecretory effect of atropine, which weakens the effect of M-cholinomimetics and anticholinesterase drugs. When used simultaneously with sulfonamide drugs, the risk of kidney damage increases; with drugs containing potassium, the formation of intestinal ulcers is possible; with nonsteroidal anti-inflammatory drugs, the risk of gastric ulcers and bleeding increases.

The effect of atropine sulfate can be enhanced by the simultaneous use of other drugs with an antimuscarinic effect (M-anticholinergics, antispasmodics, amantadine, some antihistamines, drugs from the butyrophenone group, phenothiazines, dispyramidives, quinidine, tricyclic antidepressants, non-selective monoamine reuptake inhibitors). Inhibition of peristalsis under the influence of atropine can lead to changes in the absorption of other drugs.

Features of application

Use with caution in patients with prostatic hypertrophy without urinary tract obstruction, with Down's disease, with cerebral palsy, reflux esophagitis, hiatal hernia combined with reflux esophagitis, nonspecific ulcerative colitis, megacolon, patients with xerostomia, elderly patients or weakened patients, with chronic lung diseases without reversible obstruction, with chronic lung diseases occurring with low production of thick sputum, which is difficult to separate, especially in children younger age and weakened patients with autonomic (autonomic) neuropathy.

Use during pregnancy or breastfeeding

The drug is contraindicated during pregnancy.

The use of atropine sulfate during breastfeeding is contraindicated due to the risk of developing toxic effects on the child.

The ability to influence the reaction rate when driving vehicles or other mechanisms

Considering the possibility of adverse reactions such as dizziness, hallucinations, and accommodation disturbances, when using the drug you should refrain from driving vehicles or other mechanisms.

Directions for use and doses

Atropine sulfate is administered subcutaneously, intramuscularly, intravenously. During induction of anesthesia in order to reduce the risk of vagal suppression of the heart rate and reduce the secretion of the salivary and bronchial glands - 0.3-0.6 mg subcutaneously or 30-60 minutes before anesthesia in combination with morphine (10 mg morphine sulfate) - 1:00 before anesthesia. In case of poisoning with anticholinesterase drugs, atropine sulfate is administered 2 mg intramuscularly every 20-30 minutes until redness and dryness of the skin occurs, pupil dilation and tachycardia appear, and breathing normalizes. In case of moderate and severe poisoning, atropine can be administered for two days (until signs of “pereatropinization” appear).

For children, the highest single dose is:

• up to 6 months - 0.02 mg
• aged 6 months to 1 year - 0.05 mg
• aged 1 to 2 years - 0.2 mg
• at the age of 3 to 4 years - 0.25 mg
• aged 5 to 6 years - 0.3 mg
• aged 7 to 9 years - 0.4 mg
• aged 10 to 14 years - 0.5 mg.

Higher doses for adults subcutaneously: single - 1 mg, daily - 3 mg.

Adverse reactions

The side effects of the drug are mainly associated with the M-anticholinergic effect of atropine.

From the digestive system: dry mouth, thirst, impaired taste, dysphagia, decreased intestinal motility to atony, decreased tone of the biliary tract and gallbladder.

From the urinary system: difficulty and retention of urination.

From the cardiovascular system: tachycardia, arrhythmia, including extrasystole, myocardial ischemia, facial flushing, feeling of hot flashes.

From the nervous system: headache, dizziness, nervousness, insomnia.

From the side of the organ of vision: dilated pupils, photophobia, paralysis of accommodation, increased intraocular pressure, visual impairment.

From the respiratory system: a decrease in secretory activity and bronchial tone, which leads to the formation of viscous sputum, making it difficult to cough up.

From the skin: rash, urticaria, exfoliative dermatitis.

Manufacturer

LLC "Kharkov Pharmaceutical Enterprise" Health of the People ".

Atropine is a toxic substance, an alkaloid, a non-selective blocker of M-cholinergic receptors.

Active substance

Plants of the nightshade family:

• belladonna;
• dope;
• henbane;
• scopoly

Release form and composition

Available in the following forms:

• powder;
• tablets 0.5 mg;
• oral solution 10 ml;
• solution in ampoules of 1 ml;
• solution in syringe tubes of 1 ml;
• eye drops – solution in 5 ml bottles;
• eye ointment;
• eye films.

Indications for use

Symptomatic treatment of such pathologies:

• peptic ulcer of the stomach and duodenum;
• spasms of the stomach in the area of ​​its transition to the duodenum (pylorospasm);
• intestinal spasms;
• urinary tract spasms;
• pain in the pelvis and abdomen;
• pain when urinating;
• acute, chronic and unspecified cholecystitis;
• acute and chronic, alcoholic pancreatitis;
• cholelithiasis;
• bile duct stones;
• eye diseases: keratitis, iridocyclitis, keratoconjunctivitis;
• disturbances of refraction and accommodation of the eye;
• diseases of the vocal cords and larynx;
• bronchial, allergic and other types of asthma;
• bradycardia;
• atrioventricular block;
• secondary parkinsonism;
• other diseases and conditions.

In combination with analgesics, it effectively relieves pain caused by smooth muscle spasms.

The use of drugs in anesthesiological practice (before and during surgery) can reduce the likelihood of many reflex reactions, such as involuntary contraction of the muscles of the larynx and bronchi, excessive production of secretions by the body’s glands (salivary, bronchial, etc.).

Use of the abdominal organs before x-ray examination can reduce their tone and motor activity.

It can also be used as an antidote for poisoning with organophosphorus compounds (sarin, soman, chlorophos and others).

Contraindications

• increased individual sensitivity to the components of the drug;
• age up to 7 years;
• organic damage to the heart and blood vessels;
• prostatic hypertrophy;
• kidney diseases.

Ointment and drops:

• glaucoma;
• keratoconus;
• iris adhesions.

Solutions and drops are used with caution by the elderly, as well as people whose work requires increased concentration and clarity of vision.

Instructions for use Atropine (method and dosage)

Subcutaneously, intramuscularly and intravenously, 0.25 to 1 mg of the drug is administered twice a day. After each injection, wait a few minutes; if the desired effect is not observed, the injection is repeated.

Children's dosage depends on age and can vary between 0.05-0.5 mg 1-2 times a day. The maximum daily dose cannot exceed 3 mg.

In case of poisoning, it is administered intravenously. The dose is determined by the doctor and depends on the degree of poisoning.

In ophthalmology, 1-2 drops are instilled into the affected eye 3 times a day every 5-6 hours. Eye ointment should be applied to the eyelids 1-2 times a day.

Side effects

Atropine causes the following side effects:

• dry mouth;
• pupil dilation;
• photophobia;
• headache;
• dizziness;
• hyperemia of the skin of the eyelids and conjunctiva;
• swelling of the skin of the eyelids and conjunctiva;
• cardiopalmus;
• bladder atony;
• intestinal atony.

Overdose

Large doses of Atropine lead to the following symptoms:

• respiratory paralysis;
• excessive mental and motor agitation;
• severe dizziness;
• convulsions;
• hallucinations.

The use of large doses of drops leads to a significant increase in eye pressure, disruption of the accommodation of the lens, up to its paralysis.

Analogues

Analogs by ATX code: Atropin-Nova.

Do not decide to change the drug on your own; consult your doctor.

pharmachologic effect

• The mechanism of action of the drug is the selective blockade of M-cholinergic receptors, as a result of which they become insensitive to acetylcholine. The atropine molecule contains a fragment similar to acetylcholine, which explains the ability of atropine to bind to cholinergic receptors.
• As a result of the action of Atropine, the secretion of the salivary, bronchial, sweat and gastric glands decreases, the viscosity of their secretion increases, the activity of the bronchial epithelium is suppressed, heart contractions become more frequent, the tone of muscles and smooth muscle organs decreases, atrioventricular patency increases, the amount and acidity of gastric juice decreases, its production, the pupil dilates, breathing is excited.
• The drug is metabolized (broken down) in the liver. Approximately 80% of the dose taken is excreted by the kidneys two hours after administration, the rest is excreted by the kidneys within 12-36 hours after administration.

special instructions

• With parabulbar or subconjunctival administration, the patient must be given a validol tablet under the tongue in order to reduce tachycardia.
• The interval between taking antacids and drugs should be at least 1 hour.
• During the treatment period, the patient must be careful when driving vehicles and engaging in other potentially dangerous species activities that require increased concentration, speed of psychomotor reactions and good vision.

During pregnancy and breastfeeding

Contraindicated.

In childhood

Use with caution in chronic lung diseases, especially in young children and debilitated patients; with brain damage in children, cerebral palsy, Down's disease (reaction to anticholinergic drugs increases).

In old age

Use with caution in patients with diseases of the cardiovascular system, intestinal atony, prostatic hypertrophy without urinary tract obstruction, urinary retention or predisposition to it, or diseases accompanied by urinary tract obstruction.

For impaired renal function

Use with caution in case of renal failure (risk of developing side effects due to decreased excretion).

For liver dysfunction

Use with caution in case of liver failure (decreased metabolism).

Drug interactions

• When taken orally with antacids containing calcium carbonate or aluminum, the absorption of atropine from the gastrointestinal tract is reduced.
• When used together, it is possible to slow down the absorption of mexiletine, zopiclone, reduce the absorption of nitrofurantoin and its excretion by the kidneys. The therapeutic and side effects of nitrofurantoin are likely to increase.
• When administered simultaneously with anticholinergic drugs and drugs with anticholinergic activity, the anticholinergic effect is enhanced.
• When used in combination with phenylephrine, blood pressure may increase.
• Nitrates increase the risk of increased intraocular pressure.
• Reduces the level of levodopa in blood plasma.
• Under the influence of guanethidine, the hyposecretory effect of atropine may be reduced.
• Procainamide enhances the anticholinergic effect of drugs.

Gross formula

C 17 H 23 N 03

Pharmacological group of the substance Atropine

Nosological classification (ICD-10)

CAS Code

51-55-8

Characteristics of the substance Atropine

Atropine sulfate is a white crystalline or granular powder, odorless. Easily soluble in water and ethanol, practically insoluble in chloroform and ether.

Pharmacology

pharmachologic effect- anticholinergic.

Blocks m-cholinergic receptors. Causes mydriasis, paralysis of accommodation, increased intraocular pressure, tachycardia, xerostomia. Inhibits the secretion of bronchial and gastric, sweat glands. Relaxes the smooth muscles of the bronchi, gastrointestinal tract, biliary and urinary systems - antispasmodic effect. Stimulates (large doses) the central nervous system. After intravenous administration, the maximum effect appears after 2-4 minutes, after oral administration (in the form of drops) after 30 minutes. In the blood, it is 18% bound to plasma proteins. Passes through the BBB. Excreted by the kidneys (50% unchanged).

Use of the substance Atropine

Peptic ulcer of the stomach and duodenum, pylorospasm, cholelithiasis, cholecystitis, acute pancreatitis, hypersalivation (parkinsonism, poisoning with heavy metal salts, during dental procedures), irritable bowel syndrome, intestinal colic, biliary colic, renal colic, symptomatic bradycardia (sinus, sinoatrial blockade, proximal AV blockade, electrical activity of the ventricles without pulse, asystole), for preoperative sedation; poisoning with m-cholinergic stimulants and anticholinesterase drugs (reversible and irreversible action), incl. organophosphorus compounds; for X-ray studies of the gastrointestinal tract (if necessary to reduce the tone of the stomach and intestines), bronchial asthma, bronchitis with hyperproduction of mucus, bronchospasm, laryngospasm (prevention).

In ophthalmology. To dilate the pupil and achieve paralysis of accommodation (determining the true refraction of the eye, examining the fundus), creating functional rest in inflammatory diseases and injuries of the eye (iritis, iridocyclitis, choroiditis, keratitis, thromboembolism and spasm of the central retinal artery).

Contraindications

Hypersensitivity, for ophthalmic forms - closed-angle glaucoma (including if it is suspected), open-angle glaucoma, keratoconus, childhood(1% solution - up to 7 years).

Restrictions on use

Diseases of the cardiovascular system in which an increase in heart rate may be undesirable: atrial fibrillation, tachycardia, chronic heart failure, coronary heart disease, mitral stenosis, arterial hypertension, acute bleeding; thyrotoxicosis (possibly increased tachycardia); increased body temperature (further increase is possible due to suppression of the activity of the sweat glands); reflux esophagitis, hiatal hernia, combined with reflux esophagitis (decreased motility of the esophagus and stomach and relaxation of the lower esophageal sphincter can slow down gastric emptying and increase gastroesophageal reflux through the sphincter with impaired function); gastrointestinal diseases accompanied by obstruction: achalasia of the esophagus, pyloric stenosis (possibly decreased motility and tone, leading to obstruction and delayed evacuation of gastric contents); intestinal atony in elderly or debilitated patients (possible development of obstruction), paralytic intestinal obstruction (possible development of obstruction); diseases with increased intraocular pressure: closed-angle (mydriatic effect, leading to an increase in intraocular pressure, can cause an acute attack) and open-angle glaucoma (mydriatic effect can cause a slight increase in intraocular pressure; adjustment of therapy may be required); nonspecific ulcerative colitis(high doses can inhibit intestinal motility, increasing the likelihood of paralytic ileus; in addition, the manifestation or exacerbation of such a severe complication as toxic megacolon is possible); dry mouth (long-term use may further increase the severity of xerostomia); liver failure (decreased metabolism) and renal failure (risk of side effects due to decreased excretion); chronic lung diseases, especially in young children and weakened patients (a decrease in bronchial secretion can lead to thickening of secretions and the formation of plugs in the bronchi); myasthenia gravis (the condition may worsen due to inhibition of the action of acetylcholine); prostatic hypertrophy without urinary tract obstruction, urinary retention or predisposition to it, or diseases accompanied by urinary tract obstruction (including bladder neck due to prostatic hypertrophy); gestosis (possibly increased arterial hypertension); brain damage in children, cerebral palsy, Down's disease (response to anticholinergic drugs increases). For ophthalmological forms (additionally) - age over 40 years (risk of undiagnosed glaucoma), synechia of the iris.

Use during pregnancy and breastfeeding

Side effects of the substance Atropine

Systemic effects

From the nervous system and sensory organs: headache, dizziness, insomnia, confusion, euphoria, hallucinations, mydriasis, paralysis of accommodation, impaired tactile perception.

From the cardiovascular system and blood (hematopoiesis, hemostasis): sinus tachycardia, worsening myocardial ischemia due to excessive tachycardia, ventricular tachycardia and ventricular fibrillation.

From the gastrointestinal tract: xerostomia, constipation.

Others: fever, intestinal and bladder atony, urinary retention, photophobia.

Local effects: transient tingling and increased intraocular pressure; with prolonged use - irritation, hyperemia of the skin of the eyelids; hyperemia and swelling of the conjunctiva, the development of conjunctivitis, mydriasis and paralysis of accommodation.

When administered in single doses<0,5 мг возможна парадоксальная реакция, связанная с активацией парасимпатического отдела вегетативной нервной системы (брадикардия, замедление AV проводимости).

Interaction

Weakens the effect of m-cholinomimetics and anticholinesterase drugs. Drugs with anticholinergic activity enhance the effect of atropine. When taken simultaneously with antacids containing Al 3+ or Ca 2+, the absorption of atropine from the gastrointestinal tract is reduced. Diphenhydramine and promethazine enhance the effect of atropine. The likelihood of developing systemic side effects is increased by tricyclic antidepressants, phenothiazines, amantadine, quinidine, antihistamines and other drugs with m-anticholinergic properties. Nitrates increase the likelihood of increased intraocular pressure. Atropine changes the absorption parameters of mexiletine and levodopa.

Routes of administration

Inside, intravenously, intramuscularly, PC, conjunctivally, subconjunctival or parabulbar, by electrophoresis. The ointment is placed behind the eyelids.

Precautions for the substance Atropine

For distal AV block (with wide QRS complexes), atropine is ineffective and is not recommended.

When instilling into the conjunctival sac, it is necessary to press the lower lacrimal opening to prevent the solution from entering the nasopharynx. With subconjunctival or parabulbar administration, it is advisable to prescribe validol to reduce tachycardia.

An intensely pigmented iris is more resistant to dilatation and to achieve an effect it may be necessary to increase the concentration or frequency of administration, so one should be wary of an overdose of mydriatics.

Atropine sulfate