motility and relax the lower esophageal sphincter, promoting gastric retention and reflux. Although antimuscarinics have been used as adjunct treatment of peptic ulcer disease, there are no conclusive data that the drug aids in healing, decreases rate of recurrence, or prevents the complications of peptic ulcer. In patients with gastric ulcer, antimuscarinics may delay gastric emptying and promote antral stasis.
Closed-angle glaucoma, contact lenses, glaucoma, increased intraocular pressure, synechia
Avoid use of atropine in patients with closed-angle glaucoma as the drug, administered either systemically or ophthalmically, can increase intraocular pressure by inducing cycloplegia and mydriasis. Atropine should be avoided in patients with synechia (iris adhesion to the cornea or the capsule of the crystalline lens) or increased intraocular pressure. The anticholinergic effect of atropine may also make the eyes dry; this can cause an increased lens awareness, or blurred vision for wearers of contact lenses. The use of lubricating drops may be necessary, or in severe cases discontinued use of contact lenses while taking this drug.
Ambient temperature increase, dehydration, fever, strenuous exercise
Atropine can suppress sweat gland activity causing increases in body temperature. Antimuscarinics should be prescribed cautiously for patients who experience conditions that would elevate core body temperature (e.g., strenuous exercise, ambient temperature increase, fever, or dehydration). It is recommended that patients avoid excessive exposure to heat.
Children, infants, neonates
Special care and close monitoring may be necessary when administering atropine and related antimuscarinic drugs to children and adolescents. Neonates, infants, and young children are especially sensitive to the anticholinergic effects. Intoxication has been observed even upon conjunctival instillation in some circumstances. The AtroPen auto-injector for use in the treatment of nerve agent or organophosphate insecticide toxicity is approved for use in children weighing >= 6.8 kg (dose is weight-specific). In children < 6.8 kg, a dose is not available with the auto-injector; individualize atropine doses at 0.05 mg/kg IM or IV. In a survey of children accidentally exposed to higher doses of atropine (up to 0.175 mg/kg), it was reported that serious adverse events were few, primarily consisting of tachycardia.
Pregnancy
Atropine is classified as FDA pregnancy risk category C. There are no adequate and well-controlled studies in pregnant women. Although observational data of mothers exposed to atropine during pregnancy suggest the possibility of defects, a definitive association of the drug with fetal harm has not been established. Therefore, in making the decision to administer this drug during pregnancy, the potential risks to the fetus must be weighed against the potential benefits to the mother. The drug is commonly used during labor prior to cesarean section, to reduce secretions.
Breast-feeding
Trace amounts of atropine are excreted in human breast milk. The American Academy of Pediatrics has considered use of atropine compatible with breast-feeding, due to the lack of reported effects on the nursing infant. Of note, long-term use of antimuscarinic medications has been reported to inhibit lactation; thus, some experts discourage the use of these agents during breast-feeding. The manufacturer advises caution when administe |
