transplant. Atropine is likely to be ineffective after cardiac transplantation, as the transplanted heart lacks vagal innervation. One small uncontrolled study has documented paradoxical slowing of the heart rate and high-degree AV block when atropine is administered after cardiac transplantation.
Asthma, chronic lung disease (CLD), chronic obstructive pulmonary disease (COPD), respiratory infection
Atropine should be used cautiously in patients with chronic lung disease (CLD). The use of atropine can dry and thicken bronchial secretions in the respiratory tract, thereby aggravating respiratory infection, or asthma or chronic obstructive pulmonary disease (COPD) in some patients. However, depending on the dosage and route of administration, antimuscarinics may have beneficial effect in some patients with pulmonary disease. Atropine is considered a potent bronchodilator.
Hepatic disease
Atropine is extensively metabolized in the liver. Those with hepatic disease may be at increased risk for developing increased drug concentrations, with resultant side effects. Use systemic formulations with caution.
Bladder obstruction, prostatic hypertrophy, renal failure, renal impairment, urinary retention, urinary tract obstruction
Antimuscarinics, including atropine, should be used with caution in patients with renal impairment or renal failure. Metabolites and unchanged drug are excreted in the kidneys. Additionally, the antimuscarinic actions of atropine may cause urinary retention and should be avoided in patients with prostatic hypertrophy, bladder obstruction, or urinary tract obstruction.
Autonomic neuropathy, myasthenia gravis
Atropine should be avoided in patients with myasthenia gravis, because the anticholinergic competes with the small amount of acetylcholine that has potential to act in the bodies of these patients. However, atropine may be administered if it is used to reduce the adverse muscarinic effects of a cholinesterase inhibitor. Atropine should similarly be used with extreme caution in patients with autonomic neuropathy.
Achalasia, colostomy, diarrhea, esophagitis, gastroesophageal reflux disease (GERD), GI disease, GI obstruction, hiatal hernia, ileostomy, ileus, peptic ulcer disease, pseudomembranous colitis, pyloric stenosis, toxic megacolon, ulcerative colitis
Atropine should be administered with caution to patients with GI disease, including those with partial organic pyloric stenosis or GI obstruction (e.g., achalasia, etc.) as the drugs antimuscarinic effects may further decrease GI motility and cause paralytic ileus. Likewise, antimuscarinic use should be avoided in patients with ulcerative colitis, ileus, and intestinal atony because they decrease GI motility and can exacerbate these conditions. Toxic megacolon may also be precipitated or aggravated. Use extreme caution in persons with suspected or known GI infection such as infectious diarrhea (e.g., pseudomembranous colitis) because atropine can decrease GI motility and may decrease elimination of the bacteria or toxin from the body and thus prolong the infection. Also, atropine should be used with caution in patients with diarrhea that may be an early sign of incomplete GI obstruction, especially in patients with ileostomy or colostomy. This drug should be used cautiously in patients with gastroesophageal reflux disease (GERD) or hiatal hernia associated with reflux esophagitis. Atropine may decrease gastric |
