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Sal-Tropine Side Effects

Generic Name: atropine

Note: This page contains side effects data for the generic drug atropine. It is possible that some of the dosage forms included below may not apply to the brand name Sal-Tropine.

For the Consumer

Applies to atropine: oral tablets, parenteral injection

Side effects include:

Most adverse effects are manifestations of pharmacologic effects at muscarinic-cholinergic receptors and usually are reversible when therapy is discontinued.

Severity and frequency of adverse effects are dose related and individual intolerance varies greatly; adverse effects occasionally may be obviated by a reduction in dosage but this also may eliminate potential therapeutic effects.

Frequent effects include xerostomia (dry mouth), dry skin, blurred vision, cycloplegia, mydriasis, photophobia, anhidrosis, urinary hesitancy and retention, tachycardia, palpitation, xerophthalmia, and constipation, which may appear at therapeutic or subtherapeutic doses. Xerostomia is the dose-limiting effect.

Other common effects include increased ocular tension (especially in patients with angle-closure glaucoma), loss of taste, headache, nervousness, restlessness, drowsiness, weakness, dizziness, flushing, insomnia, nausea, vomiting, bloated feeling, anhidrosis (especially in hot environments), fever, mild to moderate pain at the injection site, loss of libido, and erectile dysfunction (via block of cholinergically mediated vasodilation).

For Healthcare Professionals

Applies to atropine: compounding powder, injectable solution, oral tablet


General side effects have included hyperpyrexia, chest pain, excessive thirst, weakness, syncope, tongue chewing, dehydration, and feeling hot, Other general side effects include "atropine (the active ingredient contained in Sal-Tropine) toxicity" (anticholinergic side effects) which often present as fever, agitation, and dry skin/mucous membranes.[Ref]


Tachycardia has sometimes been preceded by an initial, transient bradycardia after smaller doses (less than 0.4 mg) were given. Atropine has produced sustained AV junctional rhythm in some patients with sinus node dysfunction. Premature ventricular depolarizations or ventricular tachycardia has been rare. Ventricular fibrillation have rarely been associated with the use of atropine (the active ingredient contained in Sal-Tropine) especially in the setting of acute myocardial infarction. Rare cases of low and high grade AV block have been associated with the use of atropine in patients with acute inferior myocardial infarction. Atropine has caused peripheral vasodilation, known as the "atropine flush".

The use of atropine to treat asymptomatic bradyarrhythmias in patients with acute myocardial infarction (MI) is somewhat controversial because (1) it appears that asymptomatic bradycardia is relatively benign, (2) vagolytic drugs may decrease the threshold for ventricular arrhythmias, and (3) animal (dog) data have demonstrated that the use of atropine increases the area of ischemia during MI. Limited human data has agreed with the latter, and have shown that adverse effects in acute MI are related to higher initial and total doses. Patients with two or three vessel coronary artery disease (CAD) appear to be less able to increase nutrient myocardial blood flow in response to atropine-induced cardioacceleration relative to patients without CAD or with less extensive CAD.

While atropine appears to consistently accelerate conduction through the AV node at any dose, atropine may cause SA nodal slowing at lower doses (less than 0.4 mg) and acceleration at higher doses (greater than 4.0 mg), depending on the degree of endogenous parasympathetic activity at the time of drug administration.[Ref]

Cardiovascular side effects have included sinus tachycardia, supraventricular tachycardia, junctional tachycardia, ventricular tachycardia, bradycardia, palpitations, ventricular arrhythmia, ventricular flutter, ventricular fibrillation, atrial arrhythmia, atrial fibrillation, atrial ectopic beats, ventricular premature contractions, bigeminal beats, trigeminal beats, nodal extrasystole, ventricular extrasystole, supraventricular extrasystole, asystole, cardiac syncope, prolongation; of sinus node recovery time, cardiac dilation, left ventricular failure, myocardial infarction, intermittent nodal rhythm, prolonged P wave, shortened PR segment, R on T phenomenon, shortened RT duration, widening and flattening of QRS complex, prolonged QT interval, flattening of T wave, repolarization abnormalities, altered ST-T waves, retrograde conduction, transient, AV dissociation, increased blood pressure, decreased blood pressure, labile blood pressure, and weak or impalpable peripheral pules.[Ref]

Nervous system

If delirium due to atropine (the active ingredient contained in Sal-Tropine) develops and there are no contraindications, many experts recommend the use of 2 mg of physostigmine IM or IV once or twice (as needed) as an effective antidote. Repeated doses may be necessary. Diazepam has been useful for the treatment of convulsions secondary to atropine poisoning.[Ref]

Nervous system side effects have included lethargy, somnolence, and insomnia. Higher doses (10 mg or more) may be associated with ataxia, hallucinations (visual or aural), coma, or seizures (generally tonic clonic), abnormal movements, confusion, stupor dizziness, amnesia, headache, diminished tendon reflexes, hyperreflexia, muscle twitching, opisthotonus, Babinski's reflex/Chaddock's reflex, hypertonia, dysmetria, muscle clonus, sensation of intoxication, difficulty concentration, vertigo and dysarthria. Atropine may be the cause of "intensive care unit delirium" in some cases. The elderly appear to be more prone to the anticholinergic effects of atropine on the CNS.[Ref]


When atropine (the active ingredient contained in Sal-Tropine) is given orally or parenterally, its effects on the eyes are essentially the same as when applied directly to the eye, except that the concentration of drug that reaches the eye after systemic administration is relatively small and the effects accordingly less.[Ref]

Ocular side effects have included mydriasis, blurred vision, pupils poorly reactive to light, photophobia, decrease contrast sensitivity, decreased visual acuity, decreased accommodation, strabismus, heterophoria, cyclophoria, acute angle glaucoma, conjunctivitis, keratoconjunctivitis sicca, blindness, tearing, dry eyes, dry conjunctiva, irritated eyes, crusting of eyelids and blepharitis.[Ref]


Atropine (the active ingredient contained in Sal-Tropine) significantly decreases lower esophageal sphincter pressure for 5 to 60 minutes after injection. Because this can place patients at risk of aspiration, it is used with caution as a preanesthetic medication.[Ref]

Gastrointestinal side effects have included dry mouth and mucous membranes (78% of patients), delayed gastric emptying time, reduced gastric acid secretion, constipation, nausea, abdominal pain, paralytic ileus, decreased bowel sounds, distended abdomen, decreased food absorption, dysphagia, and gastroesophageal reflux.[Ref]


Genitourinary side effects have commonly included dose-related urinary retention (due to anticholinergic effects on the urinary sphincter), and impotence in male patients.[Ref]


Dermatologic side effects have included dry mucous membranes, dry warm skin, flushed skin, oral lesions, dermatitis, petechiae rash, macular rash, papular rash, maculopapular rash, scarlatiniform rash, erythematous rash, sweating/ moist skin, cold skin, cyanosed skin and salivation. Inhibition of exocrine sweat glands has not usually been clinically significant except when perspiration is a major factor in body temperature control.[Ref]


Hypersensitivity side effects have been rare and have included urticaria, eczema, papillary hyperplasia, mucopurulent discharge, eosinophilia, pruritus, edema, hypotension, abdominal pain, tachypnea, nausea and vomiting.[Ref]


Local side effects have included mild to moderate pain at the site of injection.[Ref]


Psychiatric side effects have included agitation, restlessness, delirium, paranoia, anxiety, mental disorders, mania, withdrawn behavior and behavior changes.[Ref]


Immunologic side effects have included anaphylactic reactions.[Ref]


Respiratory side effects have included tachypnea, slow respirations, shallow respirations, breathing difficulty, labored respirations, inspiratory stridor, laryngitis, laryngospasm, pulmonary edema, respiratory failure and subcostal recession.[Ref]


1. "Product Information. AtroPen (atropine)." Meridian Medical Technologies Inc, Columbia, MD.

2. "Product Information. Atropine Sulfate Injection, USP (atropine)." ESI Lederle Generics, Philadelphia, PA.

3. Mevorach D "Adverse effects of atropine sulfate autoinjection." Ann Pharmacother 26 (1992): 564

4. Knoebel SB, McHenry PL, Phillips JF, Widlansky S "Atropine-induced cardioacceleration and myocardial blood flow in subjects with and without coronary artery disease." Am J Cardiol 33 (1974): 327-32

5. Kyei-Mensah K "Heart rate changes in halothane anaesthesia: effect of varying doses of atropine and neostigmine." Br J Anaesth 45 (1973): 507-10

6. Purcell MJ "Atropine poisoning in infancy." Br Med J 5489 (1966): 738

7. Shutt LE, Bowes JB "Atropine and hyoscine." Anaesthesia 34 (1979): 476-90

8. Bradshaw EG "Dysrhythmias associated with oral surgery." Anaesthesia 31 (1976): 13-7

9. Lazzari JO, Benchuga EG, Elizari MV, Rosenbaum MB "Ventricular fibrillation after intravenous atropine in a patient with atrioventricular block." Pacing Clin Electrophysiol 5 (1982): 196-200

10. Lunde P "Ventricular fibrillation after intravenous atropine for treatment of sinus bradycardia." Acta Med Scand 199 (1976): 369-71

11. Joseph VJ, Rekha S, Subba Rao SD, Chandrasekhara MK "An unusual case of atropine toxicity." Indian Pediatr 28 (1991): 943-4

12. Kongsrud F, Sponheim S "A comparison of atropine and glycopyrrolate in anaesthetic practice." Acta Anaesthesiol Scand 26 (1982): 620-5

13. Horio Y, Okajima T, Ono T, Matsumoto Y, Hokamura Y, Tokuomi H "Adverse effects of atropine on the sinus node in familial amyloid polyneuropathy." Chest 82 (1982): 190-2

14. Ng L, Nikolic G "Atropine bradycardia." Heart Lung 20 (1991): 414-5

15. Castellanos A, Garcia HG, Rozanski JJ, Zaman L, Pefkaros K, Myerburg RJ "Atropine-induced multilevel block in acute inferior myocardial infarction. A possible indication for prophylactic pacing." Pacing Clin Electrophysiol 4 (1981): 528-37

16. Jenssen H "Fetal systolic time intervals in late pregnancy. Effect of atropine." Acta Obstet Gynecol Scand 58 (1979): 519-26

17. Cooper MJ, Abinader EG "Atropine-induced ventricular fibrillation: case report and review of the literature." Am Heart J 97 (1979): 225-8

18. Gillick JS "Atropine toxicity in a neonate." Br J Anaesth 46 (1974): 793-4

19. Spiers SP "Atropine or glycopyrronium?--a dangerous dilemma." Anaesthesia 46 (1991): 151

20. German E, Siddiqui N "Atropine toxicity from eyedrops." N Engl J Med 282 (1970): 689

21. Das G, Talmers FN, Weissler AM "New observations on the effects of atropine on the sinoatrial and atrioventricular nodes in man." Am J Cardiol 36 (1975): 281-5

22. Scherf D "Atropine in acute myocardial infarction." Am Heart J 86 (1973): 284

23. Reiffel JA, Bigger JT, Giardina EG ""Paradoxical" prolongation of sinus nodal recovery time after atropine in the sick sinus syndrome." Am J Cardiol 36 (1975): 98-104

24. Klein MD, Barret J, Ryan TJ, Flessas AP "Atropine dose in acute myocardial infarction in man." Cardiology 60 (1975): 193-205

25. Lowenthal DT, Reidenberg MM "The heart rate response to atropine in uremic patients, obese subjects before and during fasting, and patients with other chronic illnesses." Proc Soc Exp Biol Med 139 (1972): 390-3

26. Johns G "Hypotensive reaction after propanidid and atropine." Br Med J 4 (1969): 52

27. Miller RD, Eger EI 2d, Stevens WC, Gibbons R "Pancuronium-induced tachycardia in relation to alveolar halothane, dose of pancuronium, and prior atropine." Anesthesiology 42 (1975): 352-5

28. Valentin N, Staffeldt H, Kyst A "Effect of i.v. atropine on cardiac rhythm, heart rate, blood pressure and airway secretion during isoflurane anaesthesia." Acta Anaesthesiol Scand 28 (1984): 621-4

29. Greenan J "Cardiac dysrhythmias and heart rate changes at induction of anaesthesia: a comparison of two intravenous anticholinergics." Acta Anaesthesiol Scand 28 (1984): 182-4

30. Mirakhur RK, Jones CJ "Atropine and glycopyrrolate: changes in cardiac rate and rhythm in conscious and anaesthetised children." Anaesth Intensive Care 10 (1982): 328-32

31. Horgan J "Atropine and ventricular tachyarrhythmia." JAMA 223 (1973): 693

32. Taylor WJ, Llewellyn-Thomas E, Sellers EA "A comparative evaluation of intramuscular atropine, dicyclomine and glycopyrrolate using healthy medical students as volunteer subjects." Int Z Klin Pharmakol Ther Toxikol 3 (1970): 358-64

33. Zsigmond EK, Matsuki A, Sharafabadi C "Atropine and cardiac arrhythmia." N Engl J Med 288 (1973): 635

34. Massumi RA, Mason DT, Amsterdam EA, DeMaria A, Miller RR, Scheinman MM, Zelis R "Ventricular fibrillation and tachycardia after intravenous atropine for treatment of bradycardias." N Engl J Med 287 (1972): 336-8

35. Mirakhur RK, Clarke RS, Elliott J, Dundee JW "Atropine and glycopyrronium premedication. A comparison of the effects on cardiac rate and rhythm during induction of anaesthesia." Anaesthesia 33 (1978): 906-12

36. Sanitato JJ, Burke MJ "Atropine toxicity in identical twins." Ann Ophthalmol 15 (1983): 380-2

37. Harris WS, Goodman RM "Hyper-reactivity to atropine in Down's syndrome." N Engl J Med 279 (1968): 407-10

38. Han J "Atropine and acute myocardial infarction." Circulation 47 (1973): 429-31

39. Stokes HR "Drug reactions reported in a survey of South Carolina." Ophthalmology 86 (1979): 161-5

40. Richman S "Adverse effect of atropine during myocardial infarction. Enchancement of ischemia following intravenously administered atropine." JAMA 228 (1974): 1414-6

41. Arthurs GJ, Davies R "Atropine--a safe drug." Anaesthesia 35 (1980): 1077-9

42. ApIvor D, Ravi PK, Little L "Cardiac effects of intravenous atropine. Electrocardiographic studies during ketamine anaesthesia." Anaesthesia 33 (1978): 542-5

43. Warren JV, Lewis RP "Beneficial effects of atropine in the pre-hospital phase of coronary care." Am J Cardiol 37 (1976): 68-72

44. Flaherty JA "Psychiatric complications of medical drugs." J Fam Pract 9 (1979): 243-51

45. Baker JH, Silver JR "Atropine toxicity in acute cervical spinal injury." Paraplegia 22 (1984): 379-82

46. Erikssen J "Atropine psychosis." Lancet 1 (1969): 53-4

47. O'Connor PS, Mumma JV "Atropine toxicity." Am J Ophthalmol 99 (1985): 613-4

48. Meerstadt PW "Atropine poisoning in early infancy due to Eumydrin drops." Br Med J (Clin Res Ed) 285 (1982): 196-7

49. Heiser JF, Gillin JC "The reversal of anticholinergic drug-induced delirium and coma with physostigmine." Am J Psychiatry 127 (1971): 1050-4

50. Kounis NG "Atropine eye-drops delirium." Can Med Assoc J 110 (1974): 759

51. Carney MW "Atropine poisoning." Br Med J 2 (1974): 334

52. Linnoila M "Drug effects on psychomotor skills related to driving: interaction of atropine, glycopyrrhonium and alcohol." Eur J Clin Pharmacol 6 (1973): 107-12

53. Joel SW "Atropine pupils." JAMA 229 (1974): 1863

54. Greene LT "Physostigmine treatment of anticholinergic-drug depression in postoperative patients." Anesth Analg 50 (1971): 222-6

55. Hirshman CA, Downes H "A possible undesirable interaction of propranolol and atropine." Anesthesiology 53 (1980): 521

56. Burmeister-Rother R, Streatfeild KA, Yoo MC "Convulsions following ketamine and atropine." Anaesthesia 48 (1993): 82

57. Kanto J "New aspects in the use of atropine." Int J Clin Pharmacol Ther Toxicol 21 (1983): 92-4

58. Gooding JM, Holcomb MC "Transient blindness following intravenous administration of atropine." Anesth Analg 56 (1977): 872-3

59. Winslow RL "Atropine pupils." JAMA 229 (1974): 1863-4

60. Weinstock FJ "Dilated fixed pupils from atropine." JAMA 229 (1974): 267-8

61. Higgins ST, Lamb RJ, Henningfield JE "Dose-dependent effects of atropine on behavioral and physiologic responses in humans." Pharmacol Biochem Behav 34 (1989): 303-11

62. Karliner W "Accidental convulsion induced by atropine." Am J Psychiatry 122 (1965): 578-9

63. Pecora JL "Atropine pupils." JAMA 229 (1974): 1864

64. Clearkin LG "Angle closure glaucoma precipitated by atropine." Arch Intern Med 152 (1992): 880

65. Goldstein JH "Effects of drugs on cornea, conjunctiva, and lids." Int Ophthalmol Clin 11 (1971): 13-34

66. Pecora JL "Malignant glaucoma worsened by miotics in a postoperative angle- closure glaucoma patient." Ann Ophthalmol 11 (1979): 1412-4

67. Pickford EJ, Hanson RM, O'Halloran MT, Fenwick D, Noble P, McDonald JD "Infants and atropine: a dangerous mixture." J Paediatr Child Health 27 (1991): 55-6

68. Palmer EA "How safe are ocular drugs in pediatrics?" Ophthalmology 93 (1986): 1038-40

69. Berdy GJ, Berdy SS, Odin LS, Hirst LW "Angle closure glaucoma precipitated by aerosolized atropine." Arch Intern Med 151 (1991): 1658-60

70. Holland MG "Autonomic drugs in ophthalmology: some problems and promises. Section II: Anticholinergic drugs." Ann Ophthalmol 6 (1974): 661-4

71. Marshall WF Jr, Rosenthal P, Merritt RJ "Atropine therapy and paralytic ileus in an infant." J Pediatr Gastroenterol Nutr 9 (1989): 532-4

72. Cotton BR, Smith G "Single and combined effects of atropine and metoclopramide on the lower oesophageal sphincter pressure." Br J Anaesth 53 (1981): 869-74

73. Chernish SM, Brunelle RR, Rosenak BD, Ahmadzai S "Comparison of the effects of glucagon and atropine sulfate on gastric emptying." Am J Gastroenterol 70 (1978): 581-6

74. Howells TH "The administration of metoclopramide with atropine." Anaesthesia 32 (1977): 677

75. Dow TG, Brock-Utne JG, Rubin J, Welman S, Dimopoulos GE, Moshal MG "The effect of atropine on the lower esophageal sphincter in late pregnancy." Obstet Gynecol 51 (1978): 426-30

76. "Lomotil for diarrhea in children." Med Lett Drugs Ther 17 (1975): 104

77. Famewo CE "A re-evaluation of anticholergic premedication." Can Anaesth Soc J 24 (1977): 39-41

78. Brock-Utne JG, Rubin J, Downing JW, Dimopoulos GE, Moshal MG, Naicker M "The administration of metoclopramide with atropine. A drug interaction effect on the gastro-oesophageal sphincter in man." Anaesthesia 31 (1976): 1186-90

79. Klock LE, Miller TD, Morris AH, Watanabe S, Dickman M "A comparative study of atropine sulfate and isoproterenol hydrochloride in chronic bronchitis." Am Rev Respir Dis 112 (1975): 371-6

80. O'Kelly SW, Spargo PM "Postoperative urinary retention in men." BMJ 302 (1991): 1403-4

81. van der Willigen AH, de Graaf YP, van Joost T "Periocular dermatitis from atropine." Contact Dermatitis 17 (1987): 56-7

82. Lacouture PG, Lovejoy FH Jr, Mitchell AA "Acute hypothermia associated with atropine." Am J Dis Child 137 (1983): 291-2

83. Yoshikawa K, Kawahara S "Contact allergy to atropine and other mydriatic agents." Contact Dermatitis 12 (1985): 56-7

84. Turner KJ, Keep VR, Bartholomaeus N "Anaphylaxis induced by propanidid and atropine." Br J Anaesth 44 (1972): 211-4

85. Dundee JW, Mirakhur RK "Hypersensitivity to atropine." Br J Anaesth 50 (1978): 866

86. Aguilera L, Martinez-Bourio R, Cid C, Arino JJ, Saez de Eguilaz JL, Arizaga A "Anaphylactic reaction after atropine." Anaesthesia 43 (1988): 955-7

It is possible that some side effects of Sal-Tropine may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

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