Editing Atropine (section)

== Medical uses ==
[[File:Atropine injection ampoule.JPG|thumb|An [[ampoule]] containing atropine injection 0.5mg/1mL]]

=== Eyes ===
[[Ophthalmic drug administration|Topical]] atropine is used as a [[cycloplegic]], to temporarily paralyze the [[accommodation reflex]], and as a [[mydriatic]], to dilate the [[pupil]]s.<ref name="pmid29132914"/> Atropine degrades slowly, typically wearing off in 7 to 14 days, so it is generally used as a therapeutic [[mydriatic]], whereas [[tropicamide]] (a shorter-acting [[cholinergic]] antagonist) or [[phenylephrine]] (an α-adrenergic agonist) is preferred as an aid to [[Ophthalmology|ophthalmic]] examination.<ref name="pmid29132914">{{cite journal | vauthors = Yazdani N, Sadeghi R, Momeni-Moghaddam H, Zarifmahmoudi L, Ehsaei A | title = Comparison of cyclopentolate versus tropicamide cycloplegia: A systematic review and meta-analysis | journal = Journal of Optometry | volume = 11 | issue = 3 | pages = 135–143 | date = 2018 | pmid = 29132914 | pmc = 6039578 | doi = 10.1016/j.optom.2017.09.001 }}</ref>

In refractive and accommodative [[amblyopia]], when occlusion is not appropriate sometimes atropine is given to induce blur in the good eye.<ref>{{cite journal | vauthors = Georgievski Z, Koklanis K, Leone J | year = 2008 | title = Fixation behavior in the treatment of amblyopia using atropine | journal = Clinical and Experimental Ophthalmology | volume = 36 | issue = Suppl 2| pages = A764–A765 }}</ref> Evidence suggests that atropine penalization is just as effective as occlusion in improving visual acuity.<ref>{{Cite journal |date=2019-12-05 |title=A patch or eye drops are similarly effective for the treatment of "lazy eye" in children |url=https://evidence.nihr.ac.uk/alert/a-patch-or-eye-drops-are-similarly-effective-for-the-treatment-of-lazy-eye-in-children |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/signal-000849 |s2cid=243130859 |access-date=2022-09-16 |archive-date=2024-05-26 |archive-url=https://web.archive.org/web/20240526050121/https://evidence.nihr.ac.uk/alert/a-patch-or-eye-drops-are-similarly-effective-for-the-treatment-of-lazy-eye-in-children/ |url-status=live |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Li T, Qureshi R, Taylor K | title = Conventional occlusion versus pharmacologic penalization for amblyopia | journal = The Cochrane Database of Systematic Reviews | volume = 8 | pages = CD006460 | date = August 2019 | issue = 8 | pmid = 31461545 | pmc = 6713317 | doi = 10.1002/14651858.CD006460.pub3 }}</ref>

Antimuscarinic topical medication is effective in slowing myopia progression in children; accommodation difficulties and papillae and follicles are possible side effects.<ref>{{Cite journal|vauthors=Walline JJ, Lindsley KB, Vedula SS, Cotter SA, Mutti DO, Ng SM, Twelker JD|date=13 Jan 2020|title=Interventions to slow progression of myopia in children|journal=Cochrane Database Syst Rev|volume=1|issue=9|pages=CD004916|doi=10.1002/14651858.CD004916.pub4|pmid=31930781|pmc=6984636}}</ref> All doses of atropine appear similarly effective, while higher doses have greater side effects.<ref name="Gong2017">{{cite journal | vauthors = Gong Q, Janowski M, Luo M, Wei H, Chen B, Yang G, Liu L | title = Efficacy and Adverse Effects of Atropine in Childhood Myopia: A Meta-analysis | journal = JAMA Ophthalmology | volume = 135 | issue = 6 | pages = 624–630 | date = June 2017 | pmid = 28494063 | pmc = 5710262 | doi = 10.1001/jamaophthalmol.2017.1091 }}</ref> The lower dose of 0.01% is thus generally recommended due to fewer side effects and potential less rebound worsening when the atropine is stopped.<ref name="Gong2017" /><ref>{{cite journal | vauthors = Fricke T, Hurairah H, Huang Y, Ho SM | title = Pharmacological interventions in myopia management | journal = Community Eye Health | volume = 32 | issue = 105 | pages = 21–22 | date = 2019 | pmid = 31409953 | pmc = 6688412 }}</ref>

=== Heart ===
[[Injection (medicine)|Injection]]s of atropine are used in the treatment of symptomatic or unstable [[bradycardia]].

Atropine was previously included in international resuscitation guidelines for use in cardiac arrest associated with [[asystole]] and [[pulseless electrical activity|PEA]] but was removed from these guidelines in 2010 due to a lack of evidence for its effectiveness.<ref>{{cite journal | vauthors = Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL | title = Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | volume = 122 | issue = 18 Suppl 3 | pages = S640-56 | date = November 2010 | pmid = 20956217 | doi = 10.1161/CIRCULATIONAHA.110.970889 | s2cid = 1031566 | doi-access =  }}</ref>  For symptomatic bradycardia, the usual dosage is 0.5 to 1&nbsp;mg IV push; this may be repeated every 3 to 5 minutes, up to a total dose of 3&nbsp;mg (maximum 0.04&nbsp;mg/kg).<ref>* {{cite book | vauthors = Bledsoe BE, Porter RS, Cherry RA | year = 2004| title =  Intermediate Emergency Care | chapter = Ch. 3| page = 260 | publisher = Pearson Prentice Hill| location =Upper Saddle River, NJ | isbn = 0-13-113607-0}}</ref>

Atropine is also useful in treating [[Second-degree AV block#Types|second-degree heart block Mobitz type 1 (Wenckebach block)]], and also [[Third-degree AV block|third-degree heart block]] with a high [[Purkinje fibers|Purkinje]] or [[Atrioventricular node|AV-nodal]] [[escape rhythm]].  It is usually not effective in [[Second degree AV block#Type 2 Second-degree AV block|second-degree heart block Mobitz type 2]], and in [[Third-degree AV block|third-degree heart block]] with a low Purkinje or ventricular escape rhythm.{{citation needed|date=January 2022}}

Atropine has also been used to prevent a low heart rate during [[intubation]] of children; however, the evidence does not support this use.<ref>{{cite journal | vauthors = de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt ÉW, Schexnayder SM, Samson RA | title = Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | volume = 132 | issue = 18 Suppl 2 | pages = S526-42 | date = November 2015 | pmid = 26473000 | pmc = 6191296 | doi = 10.1161/cir.0000000000000266 }}</ref>

=== Secretions ===
Atropine's actions on the parasympathetic nervous system inhibit salivary and mucous glands. The drug may also inhibit sweating via the sympathetic nervous system.  This can be useful in treating [[hyperhidrosis]], and can prevent the [[death rattle]] of dying patients. Even though atropine has not been officially indicated for either of these purposes by the FDA, it has been used by physicians for these purposes.<ref>{{cite web | title=Death Rattle and Oral Secretions, 2nd ed | website=eperc.mcw.edu | url=http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_109.htm | archive-url=https://web.archive.org/web/20140414033606/http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_109.htm | archive-date=2014-04-14 | url-status=dead | access-date=2019-10-20}}</ref>

=== Poisonings ===
Atropine acts as an [[Drug antagonism|antagonist]] for [[organophosphate poisoning]] by blocking the action of [[acetylcholine]] at [[muscarinic]] receptors caused by [[organophosphate]] [[insecticide]]s and [[nerve agent]]s, such as [[Tabun (nerve agent)|tabun]] (GA), [[sarin]] (GB), [[soman]] (GD), and [[VX (nerve agent)|VX]]. Troops who are likely to be attacked with [[chemical weapon]]s often carry [[autoinjector]]s with atropine and [[oxime]], for rapid injection into the muscles of the thigh.  In a developed case of nerve gas poisoning, maximum atropinization is desirable. Atropine is often used in conjunction with the oxime [[pralidoxime chloride]].

Some of the nerve agents attack and destroy [[acetylcholinesterase]] by [[phosphorylation]], so the action of acetylcholine becomes excessive and prolonged. Pralidoxime (2-PAM) can be effective against organophosphate poisoning because it can re-cleave this phosphorylation.  Atropine can be used to reduce the effect of the poisoning by blocking muscarinic acetylcholine receptors, which would otherwise be overstimulated, by excessive acetylcholine accumulation.

Atropine or [[diphenhydramine]] can be used to treat [[muscarine]] intoxication.{{medcn|date=March 2022}}

Atropine was added to cafeteria salt shakers in an attempt to poison the staff of [[Radio Free Europe]] during the [[Cold War]].<ref>The Battle Over Hearts and Minds
A Cold War of Spies: Episode 4 |https://www.imdb.com/title/tt27484449/?ref_=ttep_ep4 {{Webarchive|url=https://web.archive.org/web/20240526050120/https://www.imdb.com/title/tt27484449/?ref_=ttep_ep4 |date=2024-05-26 }}</ref><ref>{{cite web | url=https://www.pbsamerica.co.uk/series/a-cold-war-of-spies/#7749 | title=A Cold War of Spies {{pipe}} PBS America {{pipe}} UK | access-date=2024-02-11 | archive-date=2024-02-16 | archive-url=https://web.archive.org/web/20240216182829/https://www.pbsamerica.co.uk/series/a-cold-war-of-spies/#7749 | url-status=live }}</ref>

=== Irinotecan-induced diarrhea ===
Atropine has been observed to prevent or treat [[irinotecan]] induced acute diarrhea.<ref>{{cite journal | vauthors = Yumuk PF, Aydin SZ, Dane F, Gumus M, Ekenel M, Aliustaoglu M, Karamanoglu A, Sengoz M, Turhal SN | title = The absence of early diarrhea with atropine premedication during irinotecan therapy in metastatic colorectal patients | journal = International Journal of Colorectal Disease | volume = 19 | issue = 6 | pages = 609–610 | date = November 2004 | pmid = 15293062 | doi = 10.1007/s00384-004-0613-5 | s2cid = 11784173 }}</ref>