From the Guidelines
Atropine is an effective option for managing excessive secretions, particularly in palliative care settings, due to its antimuscarinic properties, as noted in the 2016 palliative care guidelines 1. When considering the management of secretions, it's crucial to weigh the benefits and risks of various antimuscarinic agents. Atropine, scopolamine, hyoscyamine, and glycopyrrolate are all options, but they differ in their side effect profiles and routes of administration.
- Atropine can be administered subcutaneously or intravenously, with typical doses ranging from 0.4-0.6 mg every 4-6 hours as needed, and it's also available as sublingual drops for easier administration.
- The mechanism of action involves blocking muscarinic acetylcholine receptors, which reduces secretion production from salivary, bronchial, and gastrointestinal glands, thus alleviating symptoms in patients with dyspnea or those requiring end-of-life care.
- However, atropine can cause side effects such as dry mouth, blurred vision, urinary retention, confusion, and tachycardia, making monitoring essential, especially in elderly patients or those with pre-existing cardiac conditions.
- Alternative anticholinergics like glycopyrrolate may be considered for their potentially fewer central nervous system effects, or scopolamine patches for their convenience, as discussed in the guidelines 1.
- It's also important to note that non-pharmacologic interventions, such as proper patient positioning, gentle suctioning, and good oral care, should be used in conjunction with medication to provide comprehensive care.
From the FDA Drug Label
Atropine is an antimuscarinic agent since it antagonizes the muscarine-like actions of acetylcholine and other choline esters. The receptors antagonized by atropine are the peripheral structures that are stimulated or inhibited by muscarine (i.e., exocrine glands and smooth and cardiac muscle).
The role of Atropine in managing secretions is to inhibit secretions, as it antagonizes the muscarinic actions of acetylcholine on exocrine glands.
- Antisialagogue effect: Atropine can be used as an antisialagogue, which means it can reduce salivation.
- Key words: Antimuscarinic agent, exocrine glands, secretions. 2
From the Research
Role of Atropine in Managing Secretions
- Atropine, an antimuscarinic agent, has been studied for its effects on secretions in various clinical settings 3, 4, 5.
- In a study comparing glycopyrrolate and atropine during reversal of nondepolarizing neuromuscular block with neostigmine, glycopyrrolate was found to be a superior oropharyngeal drying agent 3.
- Another study found that atropine increased heart rate and caused a higher incidence of dysrhythmias compared to glycopyrrolate when used as an intravenous anticholinergic agent 6.
- The effect of atropine on airway secretions was also studied during isoflurane anesthesia, and it was found that atropine did not significantly reduce airway secretions 4.
- A comparison of the combination of atropine and glycopyrrolate with atropine alone for the reversal of muscle relaxant found that the combination did not significantly reduce heart rate increase, but it can be an alternative to antagonize muscarinic effects of neostigmine 7.
- A study on the pharmacokinetics and effects of sublingual and oral atropine on saliva flow found that both forms of atropine were effective in reducing saliva secretion, with a dose-dependent effect 5.
Key Findings
- Atropine can increase heart rate and cause dysrhythmias 6, 4.
- Atropine may not be the most effective agent for reducing airway secretions 3, 4.
- The combination of atropine and glycopyrrolate can be an alternative to atropine alone for reversing muscle relaxant 7.
- Sublingual and oral atropine can reduce saliva secretion, with a dose-dependent effect 5.