Table 2

Atropine sublingual

Atropine sublingual
What is it?Anticholinergic
Mechanism of actionNon-selective antimuscarinic
Starting doseFour drops (800 μg—1 mg as size of drop varies) of 1% eye drops 4 hourly prn sublingually
Time to onset of effectUncertain (half-life 2–2.5 hours)17
Formulation1% eye drops
IndicationSialorrhoea
Noisy rattling breathing
Common adverse effectsConstipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; nausea; palpitations; skin reactions; tachycardia; urinary disorders; vision disorders; vomiting16
ContraindicationsAcute myocardial infarction; arrhythmias; autonomic neuropathy; cardiac insufficiency; cardiac surgery; diarrhoea; elderly; gastro-oesophageal reflux disease; hypertension; hyperthyroidism; narrow angle-closure glaucoma; ileus; prostatic hyperplasia; fever; ulcerative colitis; myasthenia gravis16
CautionElderly
LicenceUnlicensed use and route for a licensed product
BenefitsSmall volume
Established body of use in palliative care practice
RisksVarying dose with different droppers
Systemic absorption
Cost£131.89 for 10 mL 1% eye drops