Atropine clinical efficacy

Doxorubicin is a nonspecific inhibitor of topoiso-merase I and II. Topotecan and irinotecan selectively inhibit topoisomerase I, an enzyme required for DNA replication. These agents have clinical efficacy in relapsed ovarian and colorectal cancer, respectively. Dose limiting toxicity is bone marrow depression and, in the case of irinotecan, delayed diarrhoea. Administration of irinotecan may be complicated by an acute cholinergic reaction, reversible by administering atropine s.c. 

Although the clinical efficacy of atropine in OP poisoning is well established (Bardin etal., 1987 DuToit etaL, 1981 Namba etal., 1971 Senanayake and Karalliedde, 1987 Ztlker and Hibler, 1996), no controlled studies have been published. 

At the same time, with the accumulation of both experimental and clinical data, it becomes evident that atropine and other cholinolytic compounds only exert a pronounced therapeutic effect in poisonings of mild and moderate severity, and are less efficacious in severe intoxications. 

Clinical experience with the use of PAM-2 iodide, given with atropine and diazepam, in the treatment of the victims of the Tokyo sarin attack in 1995 was extremely favourable (Stojdjkovic and Jokanovic, 2005). Still, 2-PAM should not be recommended as the drug of choice due to its lack of efficacy against tabun and soman (Kassa, 2005). 

There are many anticholinergic drugs, some structurally related to atropine, others quaternary ammonium compounds or tertiary amines. Although many of these products are claimed to have superior efficacy, specificity, or tolerance, few have ever been critically compared with others. The so-called freedom from adverse effects claimed for many of these compounds can often be traced to uncritical clinical work, the use of ineffective doses, or mere lack of activity of the compound. 

Certain drugs with anticholinergic effects are used for the symptomatic treatment of Parkinson s disease (paralysis agitans) and related syndromes of the extrapyramidal tracts. (Of the presently available drugs, none is useful in all cases of Parkinsonism.) Despite claims of superiority for newly introduced synthetic agents, none possesses outstanding efficacy and freedom from adverse side effects when compared clinically with atropine and scopolamine (241). 

---