Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery.[5] It is typically given intravenously or by injection into a muscle.[5] Eye drops are also available which are used to treat uveitis and early amblyopia.[6][7] The intravenous solution usually begins working within a minute and lasts half an hour to an hour.[8] Large doses may be required to treat some poisonings.[5]
Atropine
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Atropine is a naturally occurring tropane alkaloid and non-selective muscarinic acetylcholine receptor antagonist, originally extracted from toxic Solanaceae plants including belladonna (Atropa belladonna), jimsonweed, and henbane. It is a widely used generic medication with multiple clinical applications, ranging from pupil dilation for ophthalmic procedures to life-saving rescue for organophosphate poisoning.
Key moments
- 1831Atropine was first isolated in pure crystalline form from belladonna plant material by German chemist Heinrich F. G. Mein
- 1960First formal U.S. FDA approval granted to atropine sulfate injectable and ophthalmic solution formulations for clinical use
- 2010s onwardLow-dose atropine eye drops gained widespread clinical adoption as an evidence-based intervention to slow progressive childhood myopia
Pre-modern cultural and folk uses before formal pharmaceutical development
Long before its formal chemical isolation, atropine-containing Solanaceae plants occupied a unique niche in Eurasian cultural and folk practice: Renaissance European women used diluted belladonna berry extracts to intentionally dilate their pupils, a trait widely perceived as a sign of greater beauty, which gave the belladonna plant its common name (literally "beautiful lady"). The same plants were also historically deployed as poisons and hallucinogens, due to their high atropine content that crosses the blood-brain barrier to alter central nervous system function.
Unique duality as a lethal toxin and life-saving antidote
Atropine has a very narrow therapeutic window: even small overdoses cause the characteristic anticholinergic delirium syndrome, with symptoms including hyperthermia, hallucinations, and tachycardia that can progress to fatal cardiac arrest. At the same time, its specific blocking effect on muscarinic receptors makes it the frontline universal antidote for organophosphate pesticide and military nerve agent poisoning, where excess acetylcholine accumulation causes life-threatening respiratory failure. For decades, pre-loaded atropine autoinjectors have been standard issue in military and emergency medical response kits globally.
Unmet public health demand for low-concentration atropine for myopia
The global surge in childhood myopia prevalence in the 21st century created unexpected new demand for low-dose 0.01% atropine formulations, which avoid the full mydriasis, photosensitivity, and blurred near vision of standard 1% atropine eye drops while slowing axial eye growth to reduce progression to high myopia that carries risk of permanent retinal damage. Many regions still lack widely accessible approved low-dose atropine products, forcing patients to rely on compounding pharmacy preparations to access the intervention.