Last update July 31, 2022

Atropine

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

It is an antimuscarinic alkaloid with antispasmodic action on smooth muscle, reduces salivary and bronchial secretions and perspiration, depresses the vagus nerve and increases heart rate. It is used parenterally in bradycardia and asystole in acute cardiopulmonary resuscitation, as anesthetic premedication, as an antispasmodic in gastrointestinal disorders, to treat or prevent bronchospasm and in poisoning by muscarinic fungi or by organophosphate pesticides. It is used topically in ophthalmology as a mydriatic and cycloplegic. (Martindale)

Since the last update we have not found published data on its excretion in breastmilk.

Its low percentage of protein binding and low molecular weight facilitate the passage into breast milk, while its very large volume of distribution makes excretion in breast milk difficult.

Theoretically, the maximum concentration that atropine would reach in breast milk would be 11 micrograms/L of milk, which would mean a theoretical dose for the infant of 0.0017 milligrams/kg/day, an amount 12 times lower than that used in a single preanesthetic dose. (Hale 1999)

Although antimuscarinics are thought to decrease prolactin production (Müller 1983), atropine and prolactin-oxytocin relationships are little and poorly studied, with conflicting results in humans (Kamimori 2009, Satar 2004, Casanueva 1984, De Martino 1980). Once lactation is established, milk production depends more on the repeated stimulation of suckling than on prolactin levels. There is no proven relationship between atropine and breast milk production.

Expert authors consider that, in isolated doses or used as eye drops, atropine is probably safe during lactation(Hale, LactMed, Briggs 2015, Hagemann 1998)American Academy of Pediatrics: Maternal Medication Usually Compatible With Breastfeeding. (AAP 2001)Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs: compatible with breastfeeding. (WHO-UNICEF 2002)

OPHTHALMIC USE:

Systemic absorption should be minimized by pressing the tear duct (inner corner of the eye) with the finger for 1 to 2 minutes and administering the dose immediately after breastfeeding. (Belkin 2020, Blumen 2020, Méndez 2012)

The small dose and poor plasma absorption of most topical ophthalmological preparations make it unlikely that significant amounts will transfer into breastmilk. Topical use of Atropine in the form of eye drops is compatible with breastfeeding.

Alternatives

We do not have alternatives for Atropine since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Atropine is also known as


Atropine in other languages or writings:

Tradenames

Main tradenames from several countries containing Atropine in its composition:

  • Atropinol
  • Atropisol
  • Atropt
  • Barbidonna
  • Buton™. Contains other elements than Atropine in its composition
  • Causat™. Contains other elements than Atropine in its composition
  • Colestase™. Contains other elements than Atropine in its composition
  • Colicor™. Contains other elements than Atropine in its composition
  • Dipatropin™. Contains other elements than Atropine in its composition
  • Dolospam™. Contains other elements than Atropine in its composition
  • Dymotil™. Contains other elements than Atropine in its composition
  • Eumidral™. Contains other elements than Atropine in its composition
  • Lofenoxal™. Contains other elements than Atropine in its composition
  • Logen™. Contains other elements than Atropine in its composition
  • Migrane™. Contains other elements than Atropine in its composition
  • Neo-Diophen™. Contains other elements than Atropine in its composition
  • Retardin™. Contains other elements than Atropine in its composition
  • Yanal™. Contains other elements than Atropine in its composition

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 90 %
Molecular weight 289 daltons
Protein Binding 14 - 22 %
VD 2.3 - 3.6 l/Kg
pKa 15.15 -
Tmax 1 hours
3.0 ± 0.9 hours

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Royal Pharmaceutical Society. Martindale: The Complete Drug Reference Medicines Complete. available online from: https://www.medicinescomplete.com 2022 Abstract
  4. Blumen-Ohana E, Sellem E. [Pregnancy & glaucoma: SFO-SFG recommendations]. J Fr Ophtalmol. 2020 Jan;43(1):63-66. Abstract
  5. Belkin A, Chen T, DeOliveria AR, Johnson SM, Ramulu PY, Buys YM; American Glaucoma Society and the Canadian Glaucoma Society.. A Practical Guide to the Pregnant and Breastfeeding Patient with Glaucoma. Ophthalmol Glaucoma. 2020 Mar - Apr;3(2):79-89. Abstract
  6. Reece-Stremtan Sarah, Campos Matilde, Kokajko Lauren, and The Academy of Breastfeeding Medicine. Breastfeeding Medicine. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med. 2017 Nov;12(9):500-506. Full text (link to original source) Full text (in our servers)
  7. Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Wolters Kluwer Health. Tenth edition (acces on line) 2015
  8. Méndez-Hernández C. Uso de fármacos antiglaucomatosos durante el embarazo y lactancia. [Use of glaucoma medications during pregnancy and breastfeeding]. Arch Soc Esp Oftalmol. 2012 Dec;87(12):389-91. Abstract
  9. Chen LH, Zeind C, Mackell S, LaPointe T, Mutsch M, Wilson ME. Breastfeeding travelers: precautions and recommendations. J Travel Med. 2010 Jan-Feb;17(1):32-47. Abstract Full text (link to original source) Full text (in our servers)
  10. Kamimori GH, Bellar D, Fein HG, Smallridge RC. Hormonal and cardiovascular response to low-intensity exercise with atropine administration. Mil Med. 2009 Mar;174(3):253-8. Abstract Full text (link to original source)
  11. Satar S, Sebe A, Topal M, Karcioglu O. Endocrine effects of organophosphate antidotal therapy. Adv Ther. 2004 Sep-Oct;21(5):301-11. Abstract
  12. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  13. AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Abstract Full text (link to original source) Full text (in our servers)
  14. Hale TW. Anesthetic medications in breastfeeding mothers. J Hum Lact. 1999 Sep;15(3):185-94. Review. No abstract available. Abstract
  15. Hagemann TM. Gastrointestinal medications and breastfeeding. J Hum Lact. 1998 Sep;14(3):259-62. Review. Abstract
  16. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993 Jul;48(7):616-25. Review. Abstract Full text (link to original source) Full text (in our servers)
  17. Casanueva FF, Villanueva L, Cabranes JA, Cabezas-Cerrato J, Fernandez-Cruz A. Cholinergic mediation of growth hormone secretion elicited by arginine, clonidine, and physical exercise in man. J Clin Endocrinol Metab. 1984 Sep;59(3):526-30. Abstract
  18. Müller EE, Locatelli V, Cella S, Peñalva A, Novelli A, Cocchi D. Prolactin-lowering and -releasing drugs. Mechanisms of action and therapeutic applications. Drugs. 1983 Apr;25(4):399-432. Review. Abstract
  19. De Martino F, De Matteo A, L'Abbate V, Soricelli A, Fontana A, Petrenga E, Cesarone M. [Inhibitory effects of atropine on serum prolactin levels after TRH stimulation]. Boll Soc Ital Biol Sper. 1980 Abstract

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