How to use atropine for complex treatment. Medicinal guide geotar Atropine for joints

INSTRUCTIONS
(information for specialists) on the medical use of the drug

Registration number:Р №002652/01-130514

Trade name of the drug: Atropine sulfate

International non-proprietary name: Atropine

Dosage form: Injection.

Composition:
1 ml of solution contains 1 mg or 0.5 mg of atropine sulfate.
Excipients: hydrochloric acid, water for injection.

Description: clear colorless liquid.

Pharmacotherapeutic group: M-holinoblokator

ATS code: A03BA01

Pharmacological properties
An alkaloid contained in plants of the nightshade family, a blocker of M-cholinergic receptors, binds equally to the m1-, m2- and m3-subtypes of muscarinic receptors. It affects both central and peripheral M-cholinergic receptors. It also acts (although much weaker) on n-cholinergic receptors. Interferes with the stimulating action of acetylcholine; reduces the secretion of salivary, gastric, bronchial, lacrimal, sweat glands, pancreas. Reduces the tone of the muscles of internal organs (bronchi, gastrointestinal tract, bile ducts and gallbladder, urethra, bladder); causes tachycardia, improves AV conduction. Reduces the motility of the gastrointestinal tract, practically does not affect the secretion of bile. It dilates the pupils, impedes the outflow of intraocular fluid, increases intraocular pressure, causes accommodation paralysis. In average therapeutic doses, it has a stimulating effect on the central nervous system and a delayed, but prolonged sedative effect; excites respiration (large doses - respiratory paralysis). It excites the cerebral cortex (in high doses), in toxic doses causes agitation, agitation, hallucinations, coma. Reduces the tone of the vagus nerve, which leads to an increase in heart rate (with a slight change in blood pressure) and a slight increase in conductivity in the bundle of His. The action is more pronounced with an initially increased tone of the vagus nerve.
After intravenous administration, the maximum effect appears after 2-4 minutes, after oral administration (in the form of drops) - after 30 minutes.

Pharmacokinetics. Widely distributed in the body. Metabolized in the liver by enzymatic hydrolysis. Communication with plasma proteins -18%. Penetrates through the blood-brain barrier, placenta and breast milk. In significant concentrations, it is found in the central nervous system after 0.5-1 hours. The half-life is -2 hours.
Excretion by the kidneys - 50% unchanged, the rest - in the form of hydrolysis and conjugation products.

Indications for use

Exacerbation of peptic ulcer of the stomach and duodenum; acute pancreatitis; pylorospasm; spasms of the intestines, gallbladder and bile ducts, urinary tract, bronchi; laryngospasm (prevention); hypersalivation (parkinsonism, poisoning with salts of heavy metals); bradycardia; AV block; poisoning with cholinomimetic and anticholinesterase agents; premedication before surgery.

Contraindications

Hypersensitivity, angle-closure glaucoma or predisposition to it, tachyarrhythmias, severe congestive heart failure, coronary heart disease, mitral stenosis, reflux esophagitis, liver and / or kidney failure, intestinal atony, myasthenia gravis, prostatic hyperplasia, obstructive bowel disease, paralytic ileus, toxic megacolon, ulcerative colitis, hiatal hernia.

Carefully
Hyperthermia, arterial hypertension. Hyperthyroidism, age over 40 (risk of undiagnosed glaucoma).

Use during pregnancy and during breastfeeding
Atropine crosses the placental barrier. Adequate and well-controlled clinical studies of the safety of the use of atropine during pregnancy have not been conducted. With intravenous administration of the drug during pregnancy or shortly before childbirth, tachycardia in the fetus may develop.

It is not prescribed during pregnancy complicated by preeclampsia, because. may lead to an increase in blood pressure. The use of the drug during breastfeeding is contraindicated.

The effect of the drug on the ability to drive vehicles, mechanisms
During the period of treatment, it is necessary to refrain from driving vehicles and engaging in other potentially hazardous activities that require an increased concentration of attention and speed of psychomotor reactions.

Dosage and administration

For the relief of acute pain in gastric and duodenal ulcers and pancreatitis, renal, hepatic colic, etc. The drug is administered s / c or / m at 0.25-1 mg (0.25-1 ml of solution).
To eliminate bradycardia - in / in 0.5 - 1 mg, if necessary, after 5 minutes, the introduction can be repeated.
For the purpose of premedication - in / m 0.4 - 0.6 mg 45 - 60 minutes before anesthesia.
For children, the drug is administered at a dose of 0.01 mg / kg.
In case of poisoning with m-cholinergic stimulants and anticholinesterase agents, 1.4 ml of a 0.1% intravenous solution (syringe-tube) is administered, preferably in combination with cholinesterase reactivators.

Side effect

Dry mouth, tachycardia, headache, dizziness, intestinal and bladder atony, constipation, difficulty urinating, photophobia, mydriasis, accommodation paralysis, increased intraocular pressure, xerostomia, impaired tactile perception.

Overdose
Symptoms. Dryness of the mucous membrane of the oral cavity and nasopharynx, impaired swallowing and speech, dry skin, hyperthermia, mydriasis, etc. (see section "Side effects") motor and speech agitation, memory impairment, hallucinations, psychosis.
Treatment. Anticholinesterase and sedatives.

drug interaction

Weakens the action of m-cholinomimetics and anticholinesterase agents. Diphenhydramine or promethazine - enhancing the action of atropine. Nitrates increase the likelihood of increased intraocular pressure. Procainamide - increased anticholinergic action.
Under the influence of guanethidine, a decrease in the hyposecretory effect of atropine is possible.

Release form
Solution for injection 0.05% or 0.1%. 1 ml in neutral glass ampoules. 10 ampoules, together with instructions for use and a knife for opening ampoules or an ampoule scarifier, are placed in a cardboard box.
When using ampoules with notches, rings and break points, the knife for opening ampoules or the ampoule scarifier may not be inserted.
5 ampoules in a blister pack made of PVC film and lacquered aluminum foil or without foil. 1 or 2 blister packs together with instructions for use are placed in a cardboard pack.

Storage conditions
To store in the place protected from light at a temperature from 2 to 30 °C. Keep out of the reach of children.

Name, address of the manufacturer and address of the place of manufacture of the medicinal product / organization accepting claims

JSC DALHIMFARM, 680001, Russian Federation, Khabarovsk Territory, Khabarovsk, st. Tashkentskaya, 22

Instructions for use:

Atropine is an anticholinergic drug, a blocker of m-cholinergic receptors.

Release form and composition

Atropine is produced in the following forms:

• Solution for injection containing 1 mg of atropine sulfate in 1 ml (in ampoules of 1 ml);
• Eye drops 1% containing 10 mg of atropine sulfate in 1 ml (in 5 ml polyethylene dropper bottles).

Indications for use

Atropine is an anticholinergic and antispasmodic agent. Its active substance is a poisonous alkaloid, which is found in the leaves and seeds of plants of the nightshade family, such as henbane, belladonna, dope. The main chemical feature of the drug lies in its ability to block the m-cholinergic systems of the body, which are located in the heart muscle, organs with smooth muscles, the central nervous system and secretory glands.

The use of Atropine helps to reduce the secretory function of the glands, relax the tone of smooth muscle organs, dilate the pupil, increase intraocular pressure and paralysis of accommodation (the ability of the eye to change focal length). The acceleration and excitation of cardiac activity after the use of the drug is due to its ability to remove the inhibitory effects of the vagus nerve. The effect of the drug on the central nervous system occurs in the form of stimulation of the respiratory center, and when using toxic doses, motor and mental excitement (convulsions, visual hallucinations) is possible.

Atropine is prescribed:

• Peptic ulcer of the stomach and duodenum;
• Spasms of the bile ducts, smooth muscle organs of the gastrointestinal tract, bronchi;
• Hypersalivation (parkinsonism, poisoning with salts of heavy metals, dental interventions);
• bradycardia;
• Acute pancreatitis;
• Intestinal and renal colic;
• irritable bowel syndrome;
• Bronchospasm;
• Bronchitis with hypersecretion;
• AV block;
• laryngospasm;
• Poisoning with anticholinesterase substances and m-cholinomimetics.

Atropine is also used in X-ray studies of the gastrointestinal tract, for premedication before surgical operations and in ophthalmology (to dilate the pupil and achieve accommodation paralysis in order to determine the true refraction of the eye, study the fundus, treat spasm of the central retinal artery, keratitis, iritis, choroiditis , iridocyclitis, embolism and some eye injuries).

Contraindications

The use of Atropine is contraindicated in case of hypersensitivity to the components that make up the drug.

Method of application and dosage

Injection

Depending on the indications, Atropine is administered subcutaneously, intramuscularly or intravenously at 0.25-1 mg, the frequency of use is up to 2 times a day.

For adults, to eliminate bradycardia, 0.5-1 mg is administered intravenously, if necessary, after 5 minutes, the administration of the drug is repeated. Children's dosage is determined by body weight - 0.01 mg / kg.

For premedication, Atropine is administered intramuscularly 45-60 minutes before anesthesia:

• Adults - 0.4-0.6 mg;
• Children - 0.01 mg / kg.

Eye drops

When using Atropine in ophthalmology, 1-2 drops of a 1% solution are instilled into the diseased eye, the frequency of use (determined by the indications) is up to 3 times a day with an interval of 5-6 hours. In some cases, it is possible to introduce a 0.1% solution:

• Subconjunctival - 0.2-0.5 ml;
• Parabulbarno - 0.3-0.5 ml.

For electrophoresis, a 0.5% solution of Atropine is injected from the anode through the eyelids.

Side effects

With the systemic use of Atropine, the following can develop:

• Tachycardia;
• dry mouth;
• Difficulty urinating;
• Dizziness;
• Constipation;
• Photophobia;
• Midriaz;
• Paralysis of accommodation;
• Violation of tactile perception.

When using Atropine in the treatment of eye diseases, in some cases, there may be:

• Swelling of the conjunctiva and hyperemia of the eyeball and eyelids;
• Hyperemia of the skin of the eyelids;
• dry mouth;
• Photophobia;
• Tachycardia.

special instructions

Atropine should be used with caution in diseases of the cardiovascular system, in which an increase in heart rate is undesirable:

• Tachycardia;
• Atrial fibrillation;
• Coronary artery disease;
• Chronic heart failure;
• Arterial hypertension;
• mitral stenosis.

Atropine should also be used with caution in thyrotoxicosis, acute bleeding, reflux esophagitis, elevated body temperature, increased intraocular pressure, diseases of the gastrointestinal tract, accompanied by obstruction, preeclampsia, dry mouth, ulcerative colitis, chronic diseases of the lungs, liver and kidney. insufficiency, prostatic hypertrophy without urinary tract obstruction, myasthenia gravis, cerebral palsy, brain damage in children, Down's disease.

An interval of at least 1 hour between the use of antacids and Atropine should be observed.

With parabulbar or subconjunctival administration of the drug, in order to reduce tachycardia, the patient should be given a validol tablet under the tongue.

During the period of treatment with Atropine, care should be taken when engaging in potentially hazardous activities and when driving vehicles.

Analogues

According to the mechanism of action, analogues of Atropine are: Bellacehol, Appamid Plus, Cyclomed, Tropicamide, Hyoscyamine, Midriacil, Cycloptik, Midrimax, Becarbon.

Terms and conditions of storage

The drug is dispensed by prescription. The shelf life of Atropine at temperatures up to 25 ° C is:

• Solution for injection - 5 years;
• Eye drops - 3 years.

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, odorless, crystalline or granular powder. Easily soluble in water and ethanol, practically insoluble in chloroform and ether.

Pharmacology

pharmachologic effect- anticholinergic.

Blocks m-cholinergic receptors. Causes mydriasis, accommodation paralysis, increased intraocular pressure, tachycardia, xerostomia. Inhibits the secretion of bronchial and gastric, sweat glands. Relaxes the smooth muscles of the bronchi, gastrointestinal tract, bile 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, 18% binds to plasma proteins. Passes through the BBB. Excreted by the kidneys (50% - unchanged).

The use of the substance Atropine

Peptic ulcer of the stomach and duodenum, pylorospasm, cholelithiasis, cholecystitis, acute pancreatitis, hypersalivation (parkinsonism, heavy metal salt poisoning, during dental interventions), irritable bowel syndrome, intestinal colic, biliary colic, renal colic, symptomatic bradycardia (sinus, sinoatrial block, proximal AV block, pulseless ventricular electrical activity, asystole), for preoperative premedication; poisoning with m-holinostimulants and anticholinesterase drugs (reversible and irreversible action), incl. organophosphorus compounds; with X-ray studies of the gastrointestinal tract (if necessary, reduce the tone of the stomach and intestines), bronchial asthma, bronchitis with hyperproduction of mucus, bronchospasm, laryngospasm (prevention).

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

Contraindications

Hypersensitivity, for ophthalmic forms - angle-closure glaucoma (including if it is suspected), open-angle glaucoma, keratoconus, children's age (1% solution - up to 7 years).

Application restrictions

Diseases of the cardiovascular system, in which an increase in heart rate may be undesirable: atrial fibrillation, tachycardia, chronic heart failure, coronary artery disease, mitral stenosis, arterial hypertension, acute bleeding; thyrotoxicosis (may increase tachycardia); increased body temperature (possible further increase due to suppression of the activity of the sweat glands); reflux esophagitis, hiatal hernia associated with reflux esophagitis (decreased motility of the esophagus and stomach and relaxation of the lower esophageal sphincter may slow gastric emptying and increase gastroesophageal reflux through the sphincter with impaired function); diseases of the gastrointestinal tract, accompanied by obstruction: esophageal achalasia, pyloric stenosis (possibly decreased motility and tone, leading to obstruction and delayed evacuation of the contents of the stomach); intestinal atony in elderly patients or debilitated patients (possible development of obstruction), paralytic ileus (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 some increase in intraocular pressure; therapy may need to be adjusted); non-specific 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 debilitated patients (a decrease in bronchial secretion can lead to thickening of the secretion 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 a predisposition to it, or diseases accompanied by urinary tract obstruction (including bladder neck due to prostatic hypertrophy); preeclampsia (possibly increased arterial hypertension); brain damage in children, cerebral palsy, Down's disease (the response to anticholinergic drugs increases). For ophthalmic forms (optional) - age over 40 years (risk of undiagnosed glaucoma), synechia of the iris.

Use during pregnancy and lactation

Side effects of the substance Atropine

System effects

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

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

From the digestive tract: xerostomia, constipation.

Others: fever, atony of the intestines and bladder, urinary retention, photophobia.

Local Effects: transient tingling and increased intraocular pressure; with prolonged use - irritation, hyperemia of the skin of the eyelids; hyperemia and edema of the conjunctiva, 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 action of m-cholinomimetics and anticholinesterase agents. 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 decreases. 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 alters the absorption parameters of mexiletine and levodopa.

Routes of administration

Inside, in / in, in / m, PC, conjunctival, subconjunctival or parabulbarno by electrophoresis. The ointment is applied over the eyelids.

Atropine Precautions

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

When instilled 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 dilation and it may be necessary to increase the concentration or frequency of injections to achieve the effect, so an overdose of mydriatics should be wary.

Pupil dilation can trigger an acute attack of glaucoma in people over 60 and hyperopic people who are prone to glaucoma due to their shallow anterior chamber.

The drug Atropine lowers the tone of the internal muscles of the bronchi, stomach and bladder. It is prescribed to reduce the secretion of the salivary, sweat and bronchial glands. You need to know in what dosage the medicine is taken, and what side effects it has on the body.

The main task of Atropine is the blocking of M-cholinergic receptors. The drug will reduce the secretion of saliva in bronchial diseases. Atropine will also increase heart rate for a therapeutic effect. The medicine can reduce the tone in the bronchi and in the abdominal cavity. If the patient has an elevated vagal tone, then Atropine will act even more strongly. The medicine affects the dilation of the pupil in the eye. This happens at the moment of relaxation of the muscles in the shell of the eye.

Doctors prescribe Atropine as a symptomatic therapy for such diseases:

• stomach ulcer;
• Problems with the duodenum;
• Acute pancreatitis;
• At the time of pylorospasms;
• For the treatment of gallstone disease;
• Treatment of cholecystitis;
• Severe spasms in the intestines;
• problems with the urinary tract;
• Severe attacks of bronchial asthma;
• To increase nerve tone in bradycardia;
• To reduce the tone of the activity of organs during x-rays.

Also, the doctor may prescribe injections of the drug for such purposes:

1. Before the introduction of anesthesia at the time of surgery;
2. To relieve bronchial spasms during surgery;
3. To reduce the secretion of the gland;
4. Removal of a reflex reaction;
5. It is prescribed as an antidote for overdose of cholinomimetic drugs.

In some cases, the use of Atropine is dangerous to the health of the patient. Doctors prohibit the medicine in such situations:

• Severe allergy to any component in the composition;
• problems with the heart system;
• The occurrence of atrial fibrillation;
• Attacks of tachycardia;
• Insufficiency in the work of the heart;
• Ischemic attacks;
• Dangerous with mitral stenosis;
• It is not prescribed for the severe stage of arterial hypertension;
• If the patient has any bleeding;
• Dangerous drug for thyrotoxicosis;
• Not prescribed for hyperthermic syndrome;
• If the patient has stomach problems;
• Dangerous for glaucoma;
• It is not prescribed for problems with the kidneys and liver;
• If the patient has frequent urinary retention;
• Dangerous for severe brain damage.

If the drug is used in specific cases, it can cause complications and harm the body. Be sure to get tested to properly use Atropine.

You need to know with which drugs Atropine is incompatible or can cause side effects. Here is a complete list of drug combinations:

• Use together with MAO inhibitors leads to a change in the rhythm in the heart;
• The use of Atropine with Quinidine causes an increase in anticholinergic action;
• If you take the drug together with tannin, this will weaken the effect of both substances;
• Atropine will reduce the analgesic effect of all opiates;
• The drug reduces the time of action of narcotic drugs;
• Parallel intake of Diphenhydramine enhances the effect of Atropine;
• The use of haloperidol leads to an increase in pressure inside the eye;
• The use together with sertraline will cause a feeling of depression and oppression;
• Taking penicillin leads to an increase in the effect of both drugs;
• If you use Atropine together with ketoconazole, its absorption into the blood will decrease.

Also, experts have identified a number of other interactions that you need to pay attention to before taking:

1. The drug attapulgite will reduce the therapeutic effect of Atropine;
2. The drug will, when taken in parallel, reduce the therapeutic effect of Pilocarpine;
3. When using octadine, the effect of Atropine is reduced;
4. If you use the medicine together with sulfa drugs, a big problem with the kidneys and liver may begin;
5. Concurrent use with potassium preparations leads to ulcers in the stomach. It can also cause bleeding;
6. The effect of the drug Atropine is enhanced when taking antidepressants, Amantadine and Phenothiazine;
7. Any other drugs will be absorbed and act more slowly after taking Atropine.

If the patient is taking other drugs for therapy, he needs to adjust the dosage or temporarily suspend treatment. This should be decided only by the attending physician.

Doctors have identified a number of diseases in which Atropine is prescribed with great care. In this case, the doctor must monitor the patient's condition and adjust the dosage. Here is a list of the main diseases in which the drug can harm:

• Cerebral palsy in children;
• problems with urination;
• Down's disease;
• With hernias in the digestive zone;
• Any stage of ulcerative colitis;
• At the moment of megacolony;
• Caution for dosage in elderly patients;
• With an advanced stage of lung disease;
• For children with autonomic neuropathy.

Patients with such diseases should definitely monitor the state of health after the use of Atropine and inform the attending physician.

Doctors do not allow the use of Atropine by pregnant women at any time. Also, do not use the drug at the time of breastfeeding. Scientists have proven that toxic substances can get to the baby through milk. This will lead to severe allergies and health complications.

Driving during treatment

Be aware that atropine causes side effects of dizziness and mild hallucinations. That is why you should refrain from driving until the end of therapy. Doctors advise patients also not to work with mechanisms that require a lot of concentration.

Atropine can be administered intramuscularly, intravenously and subcutaneously. To reduce heart contraction and reduce bronchial glands, doctors prescribe 0.5 mg of the drug as a subcutaneous injection. It must be used one hour before anesthesia along with morphine.

In case of severe poisoning with cholinomimetic substances, use the drug at a dose of 2 mg by intramuscular injection. It is necessary to enter Atropine every half an hour. It is necessary to stop the administration of the drug after reddening of the skin or with an attack of tachycardia. In severe stage of poisoning, use the drug for 1-2 weeks.

The maximum dose for an adult is 3 mg per day. At one time, you can enter 1 mg of Atropine. For children, an individual dosage is selected by the attending physician. It depends on the age and weight of the baby, as well as on the stage of the disease. Dosage should be used with caution in elderly patients.

If a person begins to experience side effects, the doctor should reduce the dose of Atropine or reduce the frequency of injections.

If you give too much of the drug to the patient, he may begin complications and health problems. The first signs of an overdose are displayed in the following symptoms:

1. Strong feeling of nausea, vomiting;
2. The patient's blood pressure drops;
3. There is a tremor;
4. The person feels overexcited;
5. severe convulsions;
6. Difficulty falling asleep at night
7. Hallucinations may begin;
8. The patient becomes nervous and irritable;
9. Hyperthermia occurs;
10. The process of oppression in the nervous system;
11. Decreased activity in the respiratory zone.

As soon as the patient feels such symptoms, he should immediately stop using Atropine and go to the hospital. Doctors are required to quickly rinse the stomach and introduce cholinomimetic agents into the body. With a symptom of hyperthermia, you need to wipe the patient with wet towels and prescribe antipyretic drugs.

If a person feels overexcited and afraid, the doctor prescribes thiopental injections. You can also take Physostigmine. If glaucoma is detected, the patient should instill Pilocarpine into the eye sac. At this point, you can inject Prozerin 3 times a day. The patient can leave the hospital only after all unpleasant symptoms have passed.

Adverse drug reactions

In the instructions for use, you can see all the side effects of the drug. Usually, complications occur with individual intolerance to the drug or with an overestimated dosage for use.

Where do they occur?	Side effects
In the stomach, such side effects can begin	Feeling of dry mouth; Strong thirst; Changes in taste sensations when eating; Problems with motility in the intestines; Decreased tone in bile; The occurrence of dysphagia; Problems with urination.
In the heart zone, such complications can begin	Attacks of tachycardia; Severe arrhythmia; An attack of ischemic disorder; The patient's face turns red; There is a feeling of a rush of blood to the body.
In the nervous system, such side effects are observed	Attacks of severe headache; The patient is dizzy; There is a feeling of nervousness and fear; It is difficult for a person to fall asleep at night.
In vision, such complications can begin	The patient's pupils will dilate; Photophobia occurs; An attack of paralysis of accommodation; The pressure inside the eye rises; Visual clarity drops rapidly.
In the respiratory system, such side effects are manifested	The tone of the bronchi decreases; The sputum becomes more viscous; The patient has difficulty coughing.
The following side effects are observed on the skin:	Red rash on the body; The occurrence of urticaria; Manifestation of exfoliative dermatitis; Severe allergy to the composition of the drug.
Other side effects on the drug	The patient begins to sweat less; The skin at the injection site becomes dry; There is dysarthria; The skin may turn red due to sensitivity to the composition.

If any side effect is detected, it is necessary to stop the injection with the drug. The doctor must determine the cause of such a reaction. It may be necessary to reduce the dosage or replace Atropine with a similar agent.

Keep the drug only in the original packaging. It is important to keep the ampoules at a temperature of no more than +25 degrees and no less than +15 degrees. In no case do not put Atropine in the refrigerator. It is important that children cannot get medicines and take them inside. The shelf life of ampoules is no more than 3 years from the date of production. It is forbidden to inject if Atropine is expired.

The price of the drug

Now you can buy Atropine in the form of ampoules at any pharmacy. Some pharmacists will require a doctor's prescription with the exact dosage. The average price of the drug is from 70 to 90 rubles. For this cost, you can purchase 1 ampoule of a 0.1 percent solution.

Composition and form of release of the drug

1 ml - ampoules (10) - cardboard boxes.
1 ml - ampoules (5) - contour plastic packaging (1) - cardboard packs.
1 ml - ampoules (5) - blister packs (1) - cardboard packs.

pharmachologic effect

Blocker of m-cholinergic receptors, is a natural tertiary amine. It is believed that atropine equally binds to the m 1 -, m 2 - and m 3 subtypes of muscarinic receptors. It affects both central and peripheral m-cholinergic receptors.

Reduces the secretion of salivary, gastric, bronchial, sweat glands. Reduces the tone of smooth muscles of internal organs (including bronchi, organs of the digestive system, urethra, bladder), reduces gastrointestinal motility. Virtually no effect on the secretion of bile and pancreas. Causes mydriasis, accommodation paralysis, reduces the secretion of lacrimal fluid.

In average therapeutic doses, atropine has a moderate stimulating effect on the central nervous system and a delayed but prolonged sedative effect. The central anticholinergic effect explains the ability of atropine to eliminate tremor in Parkinson's disease. In toxic doses, atropine causes agitation, agitation, hallucinations, coma.

Atropine reduces the tone of the vagus nerve, which leads to an increase in heart rate (with a slight change in blood pressure), an increase in conductivity in the bundle of His.

At therapeutic doses, atropine does not have a significant effect on peripheral vessels, but vasodilation is observed with an overdose.

When applied topically in ophthalmology, the maximum expansion of the pupil occurs after 30-40 minutes and disappears after 7-10 days. Mydriasis caused by atropine is not eliminated by the instillation of cholinomimetic drugs.

Pharmacokinetics

It is well absorbed from the gastrointestinal tract or through the conjunctival membrane. After systemic administration, it is widely distributed in the body. Penetrates through the BBB. A significant concentration in the central nervous system is achieved within 0.5-1 h. Moderate protein binding.

T 1/2 is 2 hours. Excreted in the urine; about 60% - unchanged, the rest - in the form of hydrolysis and conjugation products.

Indications

Systemic use: spasm of smooth muscle organs of the gastrointestinal tract, bile ducts, bronchi; peptic ulcer of the stomach and duodenum, acute pancreatitis, hypersalivation (parkinsonism, poisoning with salts of heavy metals, during dental interventions), irritable bowel syndrome, intestinal colic, renal colic, bronchitis with hypersecretion, bronchospasm, laryngospasm (prevention); premedication before surgical operations; AV blockade, bradycardia; poisoning with m-cholinomimetics and anticholinesterase substances (reversible and irreversible action); x-ray examination of the gastrointestinal tract (if necessary, reduce the tone of the stomach and intestines).

Topical application in ophthalmology: to study the fundus, to dilate the pupil and achieve accommodation paralysis in order to determine the true refraction of the eye; for the treatment of iritis, iridocyclitis, choroiditis, keratitis, embolism and spasm of the central retinal artery and some eye injuries.

Contraindications

Hypersensitivity to atropine.

Dosage

Inside - 300 mcg every 4-6 hours.

To eliminate bradycardia in / in adults - 0.5-1 mg, if necessary, after 5 minutes, the introduction can be repeated; children - 10 mcg / kg.

For the purpose of premedication in / m adults - 400-600 mcg 45-60 minutes before anesthesia; children - 10 mcg / kg 45-60 minutes before anesthesia.

When applied topically in ophthalmology, 1-2 drops of a 1% solution are instilled (in children, a solution of a lower concentration is used) into the diseased eye, the frequency of use is up to 3 times with an interval of 5-6 hours, depending on the indications. In some cases, a 0.1% solution is administered subconjunctivally 0.2-0.5 ml or parabulbarno - 0.3-0.5 ml. By electrophoresis, a 0.5% solution from the anode is injected through the eyelids or eye bath.

Side effects

With systemic use: dry mouth, tachycardia, constipation, difficulty urinating, mydriasis, photophobia, accommodation paralysis, dizziness, impaired tactile perception.

When applied topically in ophthalmology: hyperemia of the skin of the eyelids, hyperemia and swelling of the conjunctiva of the eyelids and the eyeball, photophobia, dry mouth, tachycardia.

drug interaction

With simultaneous ingestion with those containing aluminum or calcium carbonate, the absorption of atropine from the gastrointestinal tract decreases.

With simultaneous use with anticholinergic agents and agents with anticholinergic activity, the anticholinergic effect is enhanced.

With simultaneous use with atropine, it is possible to slow down the absorption of mexiletine, reduce the absorption of nitrofurantoin and its excretion by the kidneys. Probably increased therapeutic and side effects of nitrofurantoin.

With simultaneous use with phenylephrine, an increase in blood pressure is possible.

Under the influence of guanethidine, a decrease in the hyposecretory effect of atropine is possible.

Nitrates increase the likelihood of increased intraocular pressure.

Procainamide enhances the anticholinergic effect of atropine.

Atropine reduces the concentration of levodopa in plasma.

special instructions

Use with caution in patients with diseases of the cardiovascular system, in which an increase in heart rate may be undesirable: atrial fibrillation, tachycardia, chronic insufficiency, ischemic heart disease, mitral stenosis, arterial hypertension, acute bleeding; with thyrotoxicosis (possibly increased tachycardia); at elevated temperature (may still increase due to suppression of the activity of the sweat glands); with reflux esophagitis, hiatal hernia, combined with reflux esophagitis (decrease in motility of the esophagus and stomach and relaxation of the lower esophageal sphincter can slow gastric emptying and increase gastroesophageal reflux through the sphincter with impaired function); in diseases of the gastrointestinal tract accompanied by obstruction - esophageal achalasia, pyloric stenosis (possible decrease in motility and tone, leading to obstruction and retention of stomach contents), intestinal atony in elderly patients or debilitated patients (possible development of obstruction), paralytic ileus; with an increase in 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 some increase in intraocular pressure; therapy may need to be adjusted); with 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); with dry mouth (long-term use may cause a further increase in the severity of xerostomia); with liver failure (decreased metabolism) and renal failure (risk of side effects due to reduced excretion); in chronic lung diseases, especially in young children and debilitated patients (a decrease in bronchial secretion can lead to thickening of secretions and the formation of plugs in the bronchi); with myasthenia gravis (the condition may worsen due to inhibition of the action of acetylcholine); prostatic hypertrophy without urinary tract obstruction, urinary retention or a predisposition to it, or diseases accompanied by urinary tract obstruction (including the bladder neck due to prostatic hypertrophy); with gestosis (possibly increased arterial hypertension); brain damage in children, cerebral palsy, Down's disease (the reaction to anticholinergics increases).

Between taking atropine and antacids containing aluminum or calcium carbonate, the interval should be at least 1 hour.

With subconjunctival or parabulbar administration of atropine, the patient should be given a tablet under the tongue to reduce tachycardia.

Influence on the ability to drive vehicles and mechanisms

During the period of treatment, the patient must be careful when driving vehicles and engaging in other potentially hazardous activities that require increased concentration, psychomotor speed and good vision.

Pregnancy and lactation

Atropine crosses the placental barrier. Adequate and strictly controlled clinical studies of the safety of the use of atropine during pregnancy have not been conducted.

With intravenous administration during pregnancy or shortly before childbirth, tachycardia in the fetus may develop.

Atropine is found in breast milk in trace concentrations.

Use with caution in liver failure (decreased metabolism).

Use in the elderly

Use with caution in patients with diseases of the cardiovascular system, in which an increase in heart rate may be undesirable; with intestinal atony in elderly or debilitated patients (obstruction is possible), with prostatic hypertrophy without urinary tract obstruction, urinary retention or a predisposition to it, or diseases accompanied by obstruction of the urinary tract (including the bladder neck due to prostatic hypertrophy glands).