From the Guidelines
Atropine used for saliva management can indeed affect blood pressure, particularly in patients with pre-existing hypertension or cardiovascular conditions, as it can increase heart rate and potentially elevate blood pressure. Atropine is an anticholinergic medication that blocks the action of acetylcholine, leading to increased heart rate and potentially elevated blood pressure, especially at higher doses 1. When used for saliva management, atropine is typically administered at doses of 0.4-0.6 mg sublingually or orally, or as a 1% solution (1-2 drops) under the tongue. These effects on blood pressure are generally mild at the lower doses used for controlling excessive salivation, but can be more pronounced in elderly patients or those with pre-existing cardiovascular conditions. The blood pressure effects occur because atropine blocks parasympathetic nervous system activity, leading to unopposed sympathetic activity that increases heart rate and can raise blood pressure, as noted in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Some key points to consider when using atropine for saliva management include:
- Monitoring blood pressure closely in patients with hypertension, heart disease, or glaucoma
- Considering alternative treatments if blood pressure control is a significant concern
- Being aware of potential drug–drug or drug–food interactions that may impair BP control, as highlighted in the guideline 1.
From the FDA Drug Label
Atropine in clinical doses counteracts the peripheral dilatation and abrupt decrease in blood pressure produced by choline esters However, when given by itself, atropine does not exert a striking or uniform effect on blood vessels or blood pressure. Systemic doses slightly raise systolic and lower diastolic pressures and can produce significant postural hypotension. Atropine Sulfate Injection, USP in clinical doses counteracts the peripheral dilatation and abrupt decrease in blood pressure produced by choline esters However, when given by itself, atropine does not exert a striking or uniform effect on blood vessels or blood pressure. Systemic doses slightly raise systolic and lower diastolic pressures and can produce significant postural hypotension.
Atropine's effect on blood pressure:
- Atropine can counteract the decrease in blood pressure produced by choline esters.
- When given by itself, atropine does not have a significant effect on blood vessels or blood pressure.
- Systemic doses of atropine can slightly raise systolic and lower diastolic pressures.
- Atropine can produce significant postural hypotension. 2, 2, and 3 all support the idea that atropine can affect blood pressure, particularly in the context of saliva management and its effects on the body. Key points:
- Atropine's effects on blood pressure are not uniform and can vary depending on the context.
- Atropine can produce postural hypotension, which is a significant drop in blood pressure when standing up.
- The effects of atropine on blood pressure should be carefully considered when using it for saliva management.
From the Research
Atropine and Blood Pressure
- Atropine can affect blood pressure, as seen in a study where sublingual and oral atropine administration reduced blood pressure and pulse rate over 3 hours 4.
- Another study found that atropine sulphate increased heart rate 30 minutes after administration, but had no significant change in arterial pressure 5.
- A comparative study of atropine and hyoscine found that atropine had a ratio of oral to i.m. doses of 2:1 for heart rate and salivary secretion, and that oral administration had minimal effects on the eye but adequate decrease in salivation 6.
- A systematic review and meta-analysis found that atropine is efficacious in managing sialorrhea, but did not specifically address the effect on blood pressure 7.
- A study comparing glycopyrrolate to atropine in carotid angioplasty and stenting found that glycopyrrolate reduced hemodynamic instability, including bradycardia and hypotension, compared to atropine 8.