Disorientation, atropine

Therapeutic doses of scopolamine produce CNS depression, characterized by drowsiness, amnesia, and dreamless sleep (Brown and Taylor 1996). It reduces arousal and increases the effort required to awaken (Parrott 1987). Higher therapeutic doses of atropine cause central excitation, characterized by restlessness, irritability, confusion, disorientation, hallucinations, and delirium. Larger doses produce central depression, paralysis, coma, and death by respiratory failure and cardiovascular collapse. 

Central Motor restlessness, progressing to maniacal agitation, psychic disturbances, disorientation, and hallucinations. Elderly subjects are more sensitive to such central effects, in this context, the diversity of drugs producing atropine-like side effects should be borne in mind e.g., tricyclic antidepressants, neuroleptics, antihistamines, antiarrhythmics, antiparkinsonian agents. 

In doses used clinically (0,5-1.0 mg), this effect is usually confined to mild vagal excitation. The rate and occasionally the depth of breathing are increased, but this effect is probably the result of bronchlolar dilatation and the consequent Increase in physiologic "dead space." With toxic doses of atropine, central excitation becomes more pronflnent, leading to restlessness, irritability, disorientation, hallucinations, or delirium. With still larger doses, stimulation is followed by depression, coma, and medullary paralysis. The latter may be primarily responsible for a fatal outcome. Even moderate doses of atropine may depress some central motor mechanisms that control muscle tone and movement. 

BZ (7.4 - 14.5 pg/kg) aerosol Inhalation, 2 subjects 3834 (2 0 mg) percutaneous, 1 subject Atropine (125 pg/kg) Intramuscular, 3 subjects Prolixin (15.0 - 23.0 pg/kg) Intramuscular, 6 subjects 302668 (10.0 pg/kg) Intravenous, 1 subject 302196 (75.6 Pg/kg) oral, 1 subject TAB (90 mg total) Intramuscular, 1 subject Pretreatment with methyl scopolamine (1.0 mg) 1 subject Only 2 subjects (AlOJ) and (AlOK) who received doses of BZ and were subsequently treated with physostlgmine, showed any prolonged central effects (hallucinations, disorientation, confusion) lasting 4 to 6 days post >exposure Both subjects were asymptomatic and appeared normal when discharged from test. One subject (AlCM)) was exposed to Prolixin (23.0 pg/kg) and then treated with multiple doses (1.0 mg X 7 doses) over a 2 ay period, intramuscularly At 27 hours post-exposure, the subject complained of blurred vision, and facial expression was mask-llke, tongue "thick" and jaws open. 

Ostfeld and Aruguete (127) performed a similar study In which 54 volunteers were subjected to subcutaneous Injections of 150-800 ug of scopolamine hydrobromide. The lowest dose Induced moderate bradycardia, but decreased salivation. The highest dose completely blocked the secretion of saliva and seemed to induce sleep, hallucination, and mental disorientation more frequently chan the dose of 10 mg of atropine sulfate used by Ostfeld et al. (126). The larger doses were associated with decreased ability to perform casks requiring close accentlon. 

The presence of an epo group seems to increase the mydriatic activity (Table 3.13). However, scopolamine (7), which contains an epoxy group, is a central depressant, as indicated by drowsiness, euphoria, amnesia, and dreamless sleep. Atropine (4), which does not contain an epoxy group, stimulates the medulla and higher cerebral centers. In clinical doses (0.5-1.0 mg), this effect is usually confined to mild vagal excitation. Toxic doses of atropine cause restlessness, disorientation, hallucinations, and delirium. 

Trade name. One of the glycolate esters that have atropine-like effects but more marked actions on the CNS. Disorientation, depersonalization, hallucinations, paranoid feelings. Related to BZ and phencyclidine. 

See Procaine derivatives Mania or hypomania Delirium, hallucinations, paranoia, mania See Benzodiazepines See Thiazides See Atropine and Anticholinergics Psychosis, depression, disorientation, hallucinations, delusions... 

Dilated pupils, xerostomia, gastrointestinal hypomotility, tachycardia atropine and scopolamine may cause disorientation and ataxia... 

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