From the FDA Drug Label
1 INDICATIONS & USAGE Atropine Sulfate Injection, USP, is indicated for temporary blockade of severe or life threatening muscarinic effects, e.g., as an antisialagogue, an antivagal agent, an antidote for organophosphorus or muscarinic mushroom poisoning, and to treat bradyasystolic cardiac arrest.
The role of atropine in the treatment of opiate (opioid) poisoning is not explicitly stated in the provided drug labels.
- The labels do mention that atropine is used as an antidote for organophosphorus or muscarinic mushroom poisoning, but it does not mention opioid poisoning.
- Atropine is used to treat bradyasystolic cardiac arrest, which can be a complication of opioid poisoning, but this is not the same as treating the poisoning itself. 1
From the Research
Atropine has no direct role in the treatment of opioid poisoning, and naloxone is the primary medication used to reverse opioid overdose. The primary medication used for opioid overdose is naloxone (Narcan), which is an opioid antagonist that rapidly reverses the effects of opioids by competing for the same receptor sites. Naloxone is typically administered at 0.4-2 mg intravenously, intramuscularly, subcutaneously, or intranasally, with repeat doses given every 2-3 minutes as needed until respiratory function improves 2. Atropine, an anticholinergic medication, is instead used to treat poisoning from cholinergic agents like organophosphates or certain mushrooms, as well as for symptomatic bradycardia. The confusion may arise because both medications are used in emergency situations, but for entirely different toxidromes. In opioid poisoning, the focus is on reversing respiratory depression with naloxone, supporting breathing, maintaining oxygenation, and providing supportive care until the opioid effects subside.
Some key points to consider in the treatment of opioid poisoning include:
- The use of naloxone to reverse opioid-induced respiratory depression, with higher doses potentially needed for synthetic opioids like fentanyl 2
- The importance of prompt treatment, as delayed administration of naloxone can increase the risk of mortality 3
- The potential for naloxone to precipitate acute opioid withdrawal syndrome, particularly in opioid-dependent patients, and the need for careful titration of the dose 4
- The safety of naloxone administration, with no deaths associated with patient refusal of transport after naloxone-reversed opioid overdose 5
Overall, the treatment of opioid poisoning should focus on the administration of naloxone, with careful consideration of the dose and potential risks, as well as supportive care to manage respiratory depression and other symptoms. Naloxone is the primary medication used to reverse opioid overdose, and atropine has no direct role in the treatment of opioid poisoning.