Atropine - wikipedia Atropine Atropine Clinical data Trade names Atropen, others Synonyms Daturin AHFS / Drugs.com Monograph MedlinePlus a682487 Pregnancy category AU : A US : C ( Risk not ruled out ) Routes of administration by mouth, IV, IM, rectal Drug class antimuscarinic ( anticholinergic ) ATC code A03BA01 ( WHO ) S01FA01 ( WHO ) Pharmacokinetic data Bioavailability 25 % Metabolism ≥ 50 % hydrolysed to tropine and tropic acid Onset of action ~ 1 minute Biological half - life 2 hours Duration of action 30 to 60 min Excretion 15 -- 50 % excreted unchanged in urine Identifiers IUPAC name ( RS ) - ( 8 - Methyl - 8 - azabicyclo ( 3.2. 1 ) oct - 3 - yl ) 3 - hydroxy - 2 - phenylpropanoate CAS Number 51 - 55 - 8 PubChem CID 174174 IUPHAR / BPS 320 DrugBank DB00572 ChemSpider 10194105 UNII 7C0697DR9I KEGG D00113 ChEBI CHEBI : 16684 ChEMBL CHEMBL9751 ECHA InfoCard 100.000. 096 Chemical and physical data Formula C H NO Molar mass 289.369 g / mol 3D model ( JSmol ) Interactive image SMILES CN3 ( C@H ) 1CC ( C @ @ H ) 3C ( C @ @ H ) ( C1 ) OC ( = O ) C ( CO ) c2ccccc2 InChI InChI = 1S / C17H23NO3 / c1 - 18 - 13 - 7 - 8 - 14 ( 18 ) 10 - 15 ( 9 - 13 ) 21 - 17 ( 20 ) 16 ( 11 - 19 ) 12 - 5 - 3 - 2 - 4 - 6 - 12 / h2 - 6, 13 - 16, 19H, 7 - 11H2, 1H3 / t13 -, 14 +, 15 +, 16 ? Key : RKUNBYITZUJHSG - SPUOUPEWSA - N ( what is this ? ) ( verify ) Atropine is a medication 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. It is typically given intravenously or by injection into a muscle. Eye drops are also available which are used to treat uveitis and early amblyopia. The intravenous solution usually begins working within a minute and lasts half an hour to an hour. Large doses may be required to treat some poisonings. Common side effects include a dry mouth, large pupils, urinary retention, constipation, and a fast heart rate. It should generally not be used in people with angle closure glaucoma. While there is no evidence that its use during pregnancy causes birth defects, it has not been well studied. It is likely safe during breastfeeding. It is an antimuscarinic ( a type of anticholinergic ) that works by inhibiting the parasympathetic nervous system. Atropine occurs naturally in a number of plants of the nightshade family including deadly nightshade, Jimson weed, and mandrake. It was first isolated in 1833. It is on the World Health Organization 's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication and is not very expensive. A one - milligram vial costs between US $0.06 and US $0.44, wholesale, in the developing world. Contents 1 Medical uses 1.1 Eyes 1.2 Heart 1.3 Secretions 1.4 Poisonings 2 Side - effects 3 Contraindications 4 Mechanism of action 5 Chemistry and pharmacology 6 History 7 Natural sources 8 Synthesis 8.1 Biosynthesis 9 Name 10 See also 11 References 12 External links Medical uses An ampoule containing atropine injection 1mL / 0.5 mg. Eyes Topical atropine is used as a cycloplegic, to temporarily paralyze the accommodation reflex, and as a mydriatic, to dilate the pupils. Atropine degrades slowly, typically wearing off in 7 to 14 days, so it is generally used as a therapeutic mydriatic, whereas tropicamide ( a shorter - acting cholinergic antagonist ) or phenylephrine ( an α - adrenergic agonist ) is preferred as an aid to ophthalmic examination. In refractive and accommodative amblyopia, when occlusion is not appropriate sometimes atropine is given to induce blur in the good eye. Evidence suggests that atropine penalization is just as effective as occlusion in improving visual acuity. Atropine eye drops have been shown to be effective in slowing the progression of myopia in children in several studies, but it is not available for this use, and side effects would limit its use. Heart Injections of atropine are used in the treatment of bradycardia ( a heart rate < 60 beats per minute ). Atropine was previously included in international resuscitation guidelines for use in cardiac arrest associated with asystole and PEA, but was removed from these guidelines in 2010 due to a lack of evidence for its effectiveness. For symptomatic bradycardia, the usual dosage is 0.5 to 1 mg IV push, may repeat every 3 to 5 minutes up to a total dose of 3 mg ( maximum 0.04 mg / kg ). Atropine is also useful in treating second - degree heart block Mobitz type 1 ( Wenckebach block ), and also third - degree heart block with a high purkinje or AV - nodal escape rhythm. It is usually not effective in second - degree heart block Mobitz type 2, and in third - degree heart block with a low Purkinje or ventricular escape rhythm. Atropine has also been used in an effort to prevent a low heart rate during intubation of children ; however, evidence does not support this use. Secretions Atropine 's actions on the parasympathetic nervous system inhibit salivary and mucus glands. The drug may also inhibit sweating via the sympathetic nervous system. This can be useful in treating hyperhidrosis, and can prevent the death rattle of dying patients. Even though atropine has not been officially indicated for either of these purposes by the FDA, it has been used by physicians for these purposes. Poisonings Atropine is not an actual antidote for organophosphate poisoning. However, by blocking the action of acetylcholine at muscarinic receptors, atropine also serves as a treatment for poisoning by organophosphate insecticides and nerve gases, such as tabun ( GA ), sarin ( GB ), soman ( GD ) and VX. Troops who are likely to be attacked with chemical weapons often carry autoinjectors with atropine and obidoxime, for rapid injection into the muscles of the thigh. In a developed case of nerve - gas poisoning, maximum atropinization is desirable. Atropine is often used in conjunction with pralidoxime chloride. Atropine is given as a treatment for SLUDGE syndrome ( salivation, lacrimation, urination, diaphoresis, gastrointestinal motility, emesis ) symptoms caused by organophosphate poisoning. Another mnemonic is DUMBBELSS, which stands for diarrhea, urination, miosis, bradycardia, bronchoconstriction, excitation ( as of muscle in the form of fasciculations and CNS ), lacrimation, salivation, and sweating ( only sympathetic innervation using muscarinic receptors ). Some of the nerve agents attack and destroy acetylcholinesterase by phosphorylation, so the action of acetylcholine becomes excessive and prolonged. Pralidoxime ( 2 - PAM ) can be effective against organophosphate poisoning because it can re-cleave this phosphorylation. Atropine can be used to reduce the effect of the poisoning by blocking muscarinic acetylcholine receptors, which would otherwise be overstimulated, by excessive acetylcholine accumulation. Side - effects Adverse reactions to atropine include ventricular fibrillation, supraventricular or ventricular tachycardia, dizziness, nausea, blurred vision, loss of balance, dilated pupils, photophobia, dry mouth and potentially extreme confusion, deliriant hallucinations and excitation especially amongst the elderly. Most of available ampules are carried on sulphate which can cause histamine release and anaphylaxis to susceptible patients or patients with allergy to sulpha products. These latter effects are because atropine is able to cross the blood -- brain barrier. Because of the hallucinogenic properties, some have used the drug recreationally, though this is potentially dangerous and often unpleasant. In overdoses, atropine is poisonous. Atropine is sometimes added to potentially addictive drugs, particularly anti-diarrhea opioid drugs such as diphenoxylate or difenoxin, wherein the secretion - reducing effects of the atropine can also aid the anti-diarrhea effects. Although atropine treats bradycardia ( slow heart rate ) in emergency settings, it can cause paradoxical heart rate slowing when given at very low doses ( i.e. < 0.5 mg ), presumably as a result of central action in the CNS. One proposed mechanism for atropine 's paradoxical bradycardia effect at low doses involves blockade of inhibitory presynaptic muscarinic autoreceptors, thereby blocking a system that inhibits the parasympathetic response. Atropine is incapacitating at doses of 10 to 20 mg per person. Its LD is estimated to be 453 mg per person ( by mouth ) with a probit slope of 1.8. The antidote to atropine is physostigmine or pilocarpine. A common mnemonic used to describe the physiologic manifestations of atropine overdose is : `` hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter ''. These associations reflect the specific changes of warm, dry skin from decreased sweating, blurry vision, decreased sweating / lacrimation, vasodilation, and central nervous system effects on muscarinic receptors, type 4 and 5. This set of symptoms is known as anticholinergic toxidrome, and may also be caused by other drugs with anticholinergic effects, such as hyoscine hydrobromide ( scopolamine ), diphenhydramine, phenothiazine antipsychotics and benztropine. Contraindications Atropine is contraindicated in patients pre-disposed to narrow angle glaucoma. Mechanism of action In general, atropine counters the `` rest and digest '' activity of glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive, reversible antagonist of the muscarinic acetylcholine receptors ( acetylcholine being the main neurotransmitter used by the parasympathetic nervous system ). Atropine is a competitive antagonist of the muscarinic acetylcholine receptor types M1, M2, M3, M4 and M5. It is classified as an anticholinergic drug ( parasympatholytic ). In cardiac uses, it works as a nonselective muscarinic acetylcholinergic antagonist, increasing firing of the sinoatrial node ( SA ) and conduction through the atrioventricular node ( AV ) of the heart, opposes the actions of the vagus nerve, blocks acetylcholine receptor sites, and decreases bronchial secretions. In the eye, atropine induces mydriasis by blocking contraction of the circular pupillary sphincter muscle, which is normally stimulated by acetylcholine release, thereby allowing the radial pupillary dilator muscle to contract and dilate the pupil. Atropine induces cycloplegia by paralyzing the ciliary muscles, whose action inhibits accommodation to allow accurate refraction in children, helps to relieve pain associated with iridocyclitis, and treats ciliary block ( malignant ) glaucoma. Chemistry and Pharmacology Atropine is a enantiomeric mixture of d - hyoscyamine and l - hyoscyamine, with most of its physiological effects due to l - hyoscyamine. Its pharmacological effects are due to binding to muscarinic acetylcholine receptors. It is an antimuscarinic agent. Significant levels are achieved in the CNS within 30 minutes to 1 hour and disappears rapidly from the blood with a half - life of 2 hours. About 60 % is excreted unchanged in the urine, most of the rest appears in urine as hydrolysis and conjugation products. Effects on the iris and ciliary muscle may persist for longer than 72 hours. The most common atropine compound used in medicine is atropine sulfate ( monohydrate ) ( C H N O ) H SO H O, the full chemical name is 1α H, 5α H - Tropan - 3 - α ol ( ± ) - tropate ( ester ), sulfate monohydrate. The vagus ( parasympathetic ) nerves that innervate the heart release acetylcholine ( ACh ) as their primary neurotransmitter. ACh binds to muscarinic receptors ( M2 ) that are found principally on cells comprising the sinoatrial ( SA ) and atrioventricular ( AV ) nodes. Muscarinic receptors are coupled to the Gi - protein ; therefore, vagal activation decreases cAMP. Gi - protein activation also leads to the activation of KACh channels that increase potassium efflux and hyperpolarizes the cells. Increases in vagal activities to the SA node decreases the firing rate of the pacemaker cells by decreasing the slope of the pacemaker potential ( phase 4 of the action potential ) ; this decreases heart rate ( negative chronotropy ). The change in phase 4 slope results from alterations in potassium and calcium currents, as well as the slow - inward sodium current that is thought to be responsible for the pacemaker current ( If ). By hyperpolarizing the cells, vagal activation increases the cell 's threshold for firing, which contributes to the reduction in the firing rate. Similar electrophysiological effects also occur at the AV node ; however, in this tissue, these changes are manifested as a reduction in impulse conduction velocity through the AV node ( negative dromotropy ). In the resting state, there is a large degree of vagal tone on the heart, which is responsible for low resting heart rates. There is also some vagal innervation of the atrial muscle, and to a much lesser extent, the ventricular muscle. Vagus activation, therefore, results in modest reductions in atrial contractility ( inotropy ) and even smaller decreases in ventricular contractility. Muscarinic receptor antagonists bind to muscarinic receptors thereby preventing ACh from binding to and activating the receptor. By blocking the actions of ACh, muscarinic receptor antagonists very effectively block the effects of vagal nerve activity on the heart. By doing so, they increase heart rate and conduction velocity. History Mandragora ( mandrake ) was described by Theophrastus in the fourth century B.C. for treatment of wounds, gout, and sleeplessness, and as a love potion. By the first century A.D. Dioscorides recognized wine of mandrake as an anaesthetic for treatment of pain or sleeplessness, to be given prior to surgery or cautery. The use of Solanaceae containing tropane alkaloids for anesthesia, often in combination with opium, persisted throughout the Roman and Islamic Empires and continued in Europe until superseded by the use of ether, chloroform, and other modern anesthetics. Atropine extracts from the Egyptian henbane were used by Cleopatra in the last century B.C. to dilate her pupils, in the hope that she would appear more alluring. In the Renaissance, women used the juice of the berries of Atropa belladonna to enlarge the pupils of their eyes, for cosmetic reasons. This practice resumed briefly in the late nineteenth - and early twentieth - century in Paris. The mydriatic effects of atropine were studied among others by the German chemist Friedlieb Ferdinand Runge ( 1795 -- 1867 ). In 1831, the German pharmacist Heinrich F.G. Mein ( 1799 - 1864 ) succeeded in preparing atropine in pure crystalline form. The substance was first synthesized by German chemist Richard Willstätter in 1901. Natural sources Atropa belladonna Atropine is found in many members of the Solanaceae family. The most commonly found sources are Atropa belladonna, Datura innoxia, D. metel, and D. stramonium. Other sources include members of the Brugmansia and Hyoscyamus genera. Synthesis Atropine can be synthesized by the reaction of tropine with tropic acid in the presence of hydrochloric acid. Biosynthesis Biosynthesis of atropine starting from L - Phenylalanine The biosynthesis of atropine starting from l - phenylalanine first undergoes a transamination forming phenylpyruvic acid which is then reduced to phenyl - lactic acid. Coenzyme A then couples phenyl - lactic acid with tropine forming littorine, which then undergoes a radical rearrangement initiated with a P450 enzyme forming hyoscyamine aldehyde. A dehydrogenase then reduces the aldehyde to a primary alcohol making ( − ) - hyoscyamine, which upon racemization forms atropine. Name The species name `` belladonna '' ( `` beautiful woman '' in Italian ) comes from the original use of deadly nightshade to dilate the pupils of the eyes for cosmetic effect. Both atropine and the genus name for deadly nightshade derive from Atropos, one of the three Fates who, according to Greek mythology, chose how a person was to die. See also Apoatropine Mark I Nerve Agent Antidote Kit References Jump up ^ Medical Flora ; Or, Manual of the Medical Botany of the United States of... - Constantine Samuel Rafinesque - Google Books. Books.google.com. 1828. Retrieved 2012 - 11 - 07. ^ Jump up to : Barash, Paul G. ( 2009 ). Clinical anesthesia ( 6th ed. ). 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Jump up ^ de Caen, AR ; Berg, MD ; Chameides, L ; Gooden, CK ; Hickey, RW ; Scott, HF ; Sutton, RM ; Tijssen, JA ; Topjian, A ; van der Jagt, ÉW ; Schexnayder, SM ; Samson, RA ( 3 November 2015 ). `` Part 12 : Pediatric Advanced Life Support : 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. ''. Circulation. 132 ( 18 Suppl 2 ) : S526 -- 42. PMID 26473000. doi : 10.1161 / cir. 0000000000000266. Jump up ^ Death Rattle and Oral Secretions Archived 2014 - 04 - 14 at the Wayback Machine. Jump up ^ `` Archived copy ''. Archived from the original on 2014 - 02 - 20. Retrieved 2014 - 02 - 02. Jump up ^ * Rang HP, Dale MM, Ritter JM, Flower RJ ( 2007 ). `` Ch. 10 ''. Rang and Dale 's Pharmacology. Elsevier Churchill Livingstone. p. 153. ISBN 0 - 443 - 06911 - 5. Jump up ^ Laurence, Brunton ( 2010 ). Goodman & Gilman 's Pharmacological Basis of Therapeutics, 12th Edition. McGraw - Hill. ISBN 978 - 0 - 07 - 162442 - 8. Jump up ^ * Goodman E ( 2010 ). Ketchum J, Kirby R, eds. Historical Contributions to the Human Toxicology of Atropine. Eximdyne. p. 120. ISBN 978 - 0 - 9677264 - 3 - 4. ^ Jump up to : Robert S. Holzman, MD ( July 1998 ). `` The Legacy of Atropos ''. Anesthesiology. 89 ( 1 ) : 241 -- 249. PMID 9667313. doi : 10.1097 / 00000542 - 199807000 - 00030. Retrieved 2007 - 05 - 21. citing J. Arena, Poisoning : Toxicology - Symptoms - Treatments, 3rd edition. Springfield, Charles C. Thomas, 1974, p 345 Jump up ^ Szajewski J ( 1995 ). `` Acute anticholinergic syndrome ''. IPCS Intox Databank. Archived from the original on 2 July 2007. Retrieved 2007 - 05 - 22. Jump up ^ Rang, Dale, Ritter and More : Pharmacology, p. 139. Elsevier 2003. Jump up ^ Biography of Heinrich Friedrich Georg Mein ( 1799 - 1864 ) ( in German ). Jump up ^ Heinrich Friedrich Georg Mein ( 1831 ) `` Ueber die Darstellung des Atropins in weissen Kristallen '' Archived 2016 - 05 - 15 at the Wayback Machine. 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ISBN 978 - 0470741672 External links U.S. National Library of Medicine : Drug Information Portal - Atropine Ancient anaesthesia Plants / animals Aconitum ( aconite ) Atropa belladonna ( belladonna ) Cannabis medical use Castoreum Coca Conium ( hemlock ) Datura innoxia ( thorn - apple ) Datura metel ( devil 's trumpet ) Hyoscyamus niger ( henbane ) Lactucarium Mandragora officinarum ( mandrake ) Opium Saussurea ( saw - wort ) Willow People Abulcasis Avenzoar Avicenna Celsus Dioscorides Galen Hippocrates Rhazes Sabuncuoğlu Sushrutha Theophrastus Zhang Compounds Aconitine Atropine Cocaine Coniine Hyoscine Δ9 - THC Hyoscyamine Morphine Salicylate Drugs for functional gastrointestinal disorders ( A03 ) Drugs for functional bowel disorders Antimuscarinics Tertiary amino group Oxyphencyclimine Camylofin Mebeverine Trimebutine Rociverine Dicycloverine Dihexyverine Difemerine Piperidolate Quaternary ammonium compounds Benzilone Mepenzolate Pipenzolate Glycopyrronium Oxyphenonium Penthienate Methantheline Propantheline Otilonium Tridihexethyl Isopropamide Hexocyclium Poldine Bevonium Diphemanil Tiemonium Prifinium Timepidium Fenpiverinium Phosphodiesterase inhibitors Papaverine Drotaverine Moxaverine Acting on serotonin receptors 5 - HT antagonists Alosetron Cilansetron 5 - HT agonists Mosapride Prucalopride Tegaserod Other Alverine Caroverine Chlorbenzoxamine Diisopromine Dimethylaminopropionylphenothiazine Fenpiprane Fenoverine Idanpramine Isometheptene Phloroglucinol Pinaverium Proxazole Silicones Tiropramide Trepibutone Trimethyldiphenylpropylamine Belladonna and derivatives ( antimuscarinics ) Tertiary amines : Atropine Hyoscyamine Quaternary ammonium compounds : Scopolamine Butylscopolamine Methylscopolamine Methylatropine Fentonium Cimetropium bromide Propulsives Primarily dopamine antagonists Metoclopramide / Bromopride Clebopride Domperidone Alizapride 5 - HT agonists Cinitapride Cisapride Emergency medicine Emergency medicine Emergency department Emergency medical services Emergency nursing Emergency psychiatry Golden hour Medical emergency International emergency medicine Pediatric emergency medicine Pre-hospital emergency medicine Major trauma Trauma center Triage Equipment Bag valve mask ( BVM ) Chest tube Defibrillation ( AED ICD ) Electrocardiogram ( ECG / EKG ) Intraosseous infusion ( IO ) Intravenous therapy ( IV ) Tracheal intubation Laryngeal tube Combitube Nasopharyngeal airway ( NPA ) Oropharyngeal airway ( OPA ) Pocket mask Drugs Atropine Amiodarone Epinephrine / Adrenaline Magnesium sulfate Sodium bicarbonate Naloxone Organisations International Federation for Emergency Medicine American College of Emergency Physicians Australasian College for Emergency Medicine Canadian Association of Emergency Physicians Royal College of Emergency Medicine European Society of Emergency Medicine Asian Society for Emergency Medicine Courses / Life support Acute Care of at - Risk Newborns ( ACoRN ) Advanced cardiac life support ( ACLS ) Advanced trauma life support ( ATLS ) Basic life support ( BLS ) Cardiopulmonary resuscitation ( CPR ) Care of the Critically Ill Surgical Patient ( CCrISP ) First aid Neonatal Resuscitation Program ( NRP ) Pediatric Advanced Life Support ( PALS ) Scoring systems NACA score Injury Severity Score Book : Emergency medicine Category : Emergency medicine Hallucinogens Psychedelics ( 5 - HT agonists ) Lyserg ‐ amides 1P - ETH - LAD 1P - LSD 2 - Butyllysergamide 3 - Pentyllysergamide AL - LAD ALD - 52 BU - LAD Diallyllysergamide Dimethyllysergamide Ergometrine ETH - LAD IP - LAD LAE - 32 LPD - 824 LSA LSD LSD - Pip LSH LSM - 775 LSZ Methylergometrine Methylisopropyllysergamide Methysergide MLD - 41 PARGY - LAD PRO-LAD Phenethyl ‐ amines 2C - x 2C - B 2C - B - AN 2C - Bn 2C - Bu 2C - C 2C - CN 2C - CP 2C - D 2C - E 2C - EF 2C - F 2C - G 2C - G - 1 2C - G - 2 2C - G - 3 2C - G - 4 2C - G - 5 2C - G - 6 2C - G-N 2C - H 2C - I 2C - iP 2C - N 2C - NH2 2C - O 2C - O - 4 2C - P 2C - Ph 2C - SE 2C - T 2C - T - 2 2C - T - 3 2C - T - 4 2C - T - 5 2C - T - 6 2C - T - 7 2C - T - 8 2C - T - 9 2C - T - 10 2C - T - 11 2C - T - 12 2C - T - 13 2C - T - 14 2C - T - 15 2C - T - 16 2C - T - 17 2C - T - 18 2C - T - 19 2C - T - 20 2C - T - 21 2C - T - 22 2C - T - 22.5 2C - T - 23 2C - T - 24 2C - T - 25 2C - T - 27 2C - T - 28 2C - T - 30 2C - T - 31 2C - T - 32 2C - T - 33 2C - TFE 2C - TFM 2C - YN 2C - V 25x - NBx ( except FLY ) 25x - NB3OMe 25B - NB3OMe 25C - NB3OMe 25D - NB3OMe 25E - NB3OMe 25H - NB3OMe 25I - NB3OMe 25N - NB3OMe 25P - NB3OMe 25T2 - NB3OMe 25T4 - NB3OMe 25T7 - NB3OMe 25TFM - NB3OMe 25x - NB4OMe 25B - NB4OMe 25C - NB4OMe 25D - NB4OMe 25E - NB4OMe 25H - NB4OMe 25I - NB4OMe 25N - NB4OMe 25P - NB4OMe 25T2 - NB4OMe 25T4 - NB4OMe 25T7 - NB4OMe 25TFM - NB4OMe 25x - NBF 25B - NBF 25C - NBF 25D - NBF 25E - NBF 25H - NBF 25I - NBF 25P - NBF 25T2 - NBF 25T7 - NBF 25TFM - NBF 25x - NBMD 25B - NBMD 25C - NBMD 25D - NBMD 25E - NBMD 25F - NBMD 25H - NBMD 25I - NBMD 25P - NBMD 25T2 - NBMD 25T7 - NBMD 25TFM - NBMD 25x - NBOH 25B - NBOH 25C - NBOH 25CN - NBOH 25D - NBOH 25E - NBOH 25F - NBOH 25H - NBOH 25I - NBOH 25P - NBOH 25T2 - NBOH 25T7 - NBOH 25TFM - NBOH 25x - NBOMe 25B - NBOMe 25C - NBOMe 25CN - NBOMe 25D - NBOMe 25E - NBOMe 25F - NBOMe 25G - NBOMe 25H - NBOMe 25I - NBOMe 25iP - NBOMe 25N - NBOMe 25P - NBOMe 25T2 - NBOMe 25T4 - NBOMe 25T7 - NBOMe 25TFM - NBOMe Other 25I - NB34MD 3C - x 3C - AL 3C - BZ 3C - DFE 3C - E 3C - P 4C - x 4C - B 4C - D 4C - T - 2 DOx DOT DOB DOC DOEF DOET DOF DOI DOiPR DOM DON DOPR DOTFM MEM xFLY 2CBFly - NBOMe 2C - B - DragonFLY 2C - B - BUTTERFLY 2C - B - FLY Bromo - DragonFLY DOB - FLY TFMFly HOT - x HOT - 2 HOT - 7 HOT - 17 MDxx DMMDA DMMDA - 2 Lophophine MDA MMDA MMDA - 2 MMDA - 3a MMDMA Mescaline ( subst. ) 2 - Bromomescaline Allylescaline Asymbescaline Buscaline Cyclopropylmescaline Difluoromescaline Difluoroescaline Escaline Fluoroproscaline Isobuscaline Isoproscaline Mescaline Metaescaline Methallylescaline Proscaline Trifluoroescaline Trifluoromescaline TMAs TMA TMA - 2 TMA - 3 TMA - 4 TMA - 5 TMA - 6 Others βk - 2C - B βk - 2C - I 2CB - Ind 2CD - 5EtO 2CBCB - NBOMe 2 - TOM 3 - TE 3 - TM 4 - TE 4 - TM 5 - TOET 5 - TOM BOB BOD DESOXY DMBMPP DMCPA Fenfluramine Ganesha Jimscaline Macromerine MMA NBOMe - mescaline TCB - 2 Thioproscaline TOMSO Piperazines pFPP TMFPP Tryptamines Sub. Trypt. 4, 5 - DHP - α - MT 5 - MeO - α - ET 5 - MeO - α - MT α - ET α - MT x - DMT 4, 5 - DHP - DMT 2, N, N - TMT 4 - AcO - DMT 4 - HO - 5 - MeO - DMT 4, N, N - TMT 4 - Propionyloxy - DMT 5, 6 - diBr - DMT 5 - AcO - DMT 5 - Bromo - DMT 5 - MeO - 2, N, N - TMT 5 - MeO - 4, N, N - TMT 5 - MeO - α, N, N - TMT 5 - MeO - DMT 5 - N, N - TMT 7, N, N - TMT α, N, N - TMT ( Bufotenin ) 5 - HO - DMT DMT Norbaeocystin ( Psilocin ) 4 - HO - DMT ( Psilocybin ) 4 - PO - DMT x - DET ( Ethacetin ) 4 - AcO - DET ( Ethocin ) 4 - HO - DET 5 - MeO - DET ( T - 9 ) DET ( Ethocybin ) 4 - PO - DET x - DPT ( Depracetin ) 4 - AcO - DPT ( Deprocin ) 4 - HO - DPT 5 - MeO - DPT ( The Light ) DPT x - DiPT 1 - Me - 5 - MeO - DiPT ( Ipracetin ) 4 - AcO - DiPT ( Iprocin ) 4 - HO - DiPT ( Foxy Methoxy ) 5 - MeO - DiPT DiPT x - DALT ( Daltocin ) 4 - HO - DALT ( Daltacetin ) 4 - AcO - DALT 5 - MeO - DALT DALT x - MET ( Metocin ) 4 - HO - MET ( Metocetin ) 4 - AcO - MET 5 - MeO - MET MET x - MiPT ( Mipracetin ) 4 - AcO - MiPT ( Miprocin ) 4 - HO - MiPT 5 - Me - MiPT ( Moxy ) 5 - MeO - MiPT MiPT Ibogaine - related 18 - MAC 18 - MC Coronaridine Ibogaine Ibogamine ME - 18 - MC Noribogaine Tabernanthine Voacangine Others 4 - HO - DBT 4 - HO - EPT 4 - HO - McPT ( Lucigenol ) 4 - HO - MPMI ( Meprocin ) 4 - HO - MPT 5 - MeO - EiPT 5 - MeO - MALT 5 - MeO - MPMI Aeruginascin Baeocystin DBT DCPT EiPT EPT MPT PiPT Others 5 - MeO - DiBF AL - 38022A ALPHA Dimemebfe Efavirenz Lorcaserin M - ALPHA RH - 34 Also empathogens in general ( e.g. : 5 - APB, 5 - MAPB, 6 - APB and other substituted benzofurans, MDAI, MDMA ). Dissociatives ( NMDAR antagonists ) Arylcyclo ‐ hexylamines Ketamine - related 2 - Fluorodeschloroketamine Arketamine ( ( R ) - ketamine ) Deschloroketamine Ethketamine ( N - Ethylnorketamine ) Esketamine ( ( S ) - ketamine ) Ketamine Methoxetamine Methoxmetamine Methoxyketamine Norketamine Tiletamine PCP - related 3 ' - HO - PCP 3 ' - MeO - PCE 3 ' - MeO - PCMo 3 ' - MeO - PCP BDPC Dieticyclidine ( PCDE ) Eticyclidine ( PCE ) Methoxydine ( 4 ' - MeO - PCP ) PCPr Phencyclidine ( PCP ) Rolicyclidine ( PCPy ) Tenocyclidine ( TCP ) Others BTCP Gacyclidine PRE-084 Morphinans Dextrallorphan Dextromethorphan Dextrorphan Racemethorphan Racemorphan Diarylethylamines Diphenidine Ephenidine Fluorolintane Methoxphenidine Others 2 - MDP 8A - PDHQ Aptiganel Budipine Delucemine Dexoxadrol Dizocilpine Etoxadrol Ibogaine Midafotel NEFA Neramexane Nitrous oxide Noribogaine Perzinfotel Remacemide Selfotel Xenon Deliriants ( mAChR antagonists ) Atropine Benactyzine Benzatropine Benzydamine Biperiden BRN - 1484501 Brompheniramine BZ CAR - 226,086 CAR - 301,060 CAR - 302,196 CAR - 302,282 CAR - 302,368 CAR - 302,537 CAR - 302,668 Chloropyramine Chlorphenamine Clemastine CS - 27349 Cyclizine Cyproheptadine Dicycloverine Dimenhydrinate Diphenhydramine Ditran Doxylamine EA - 3167 EA - 3443 EA - 3580 EA - 3834 Elemicin Flavoxate Hyoscyamine JB - 318 JB - 336 Meclozine Mepyramine Myristicin Orphenadrine Oxybutynin Pheniramine Phenyltoloxamine Procyclidine Promethazine Scopolamine Tolterodine Trihexyphenidyl Tripelennamine Triprolidine WIN - 2299 Others Cannabinoids ( CB agonists ) Natural Cannabinol THC ( Dronabinol ) THCV Synthetic 5F - x 5F - AB - FUPPYCA 5F - AB - PINACA 5F - ADB 5F - ADB - PINACA 5F - ADBICA 5F - AMB 5F - APINACA 5F - CUMYL - PINACA 5F - NNE1 5F - PB - 22 5F - SDB - 006 AM - x AM - 630 AM - 679 AM - 694 AM - 1220 AM - 1221 AM - 1235 AM - 1241 AM - 1248 AM - 2201 AM - 2232 AM - 2233 JWH - x JWH - 007 JWH - 015 JWH - 018 JWH - 019 JWH - 030 JWH - 073 JWH - 081 JWH - 098 JWH - 116 JWH - 122 JWH - 149 JWH - 167 JWH - 182 JWH - 193 JWH - 198 JWH - 200 JWH - 203 JWH - 210 JWH - 250 JWH - 251 JWH - 398 JWH - 424 Other 4 - HTMPIPO A-796,260 A-836,339 AB - 001 AB - 005 AB - CHFUPYCA AB - CHMINACA AB - FUBINACA AB - PINACA ADAMANTYL - THPINACA ADB - CHMINACA ADB - FUBINACA ADB - PINACA ADBICA ADSB - FUB - 187 AMB - FUBINACA APICA APINACA APP - FUBINACA CB - 13 CP 47,497 CP 55,244 CP 55,940 CUMYL - PICA CUMYL - PINACA CUMYL - THPINACA DMHP EAM - 2201 FAB - 144 FDU - PB - 22 FUB - 144 FUB - APINACA FUB - JWH - 018 FUB - PB - 22 FUBIMINA HU - 210 HU - 308 JTE 7 - 31 JTE - 907 Levonantradol MDMB - CHMICA MDMB - CHMINACA MDMB - FUBINACA MEPIRAPIM MAM - 2201 MDA - 19 MN - 18 MN - 25 NESS - 0327 NESS - 040C5 Nabilone Nabitan NM - 2201 NNE1 Org 28611 Parahexyl PTI - 1 PTI - 2 PX - 1 PX - 2 PX - 3 QUCHIC QUPIC RCS - 4 RCS - 8 SDB - 005 SDB - 006 STS - 135 THC - O - acetate THC - O - phosphate THJ - 018 THJ - 2201 UR - 144 WIN 55,212 - 2 XLR - 11 D agonists Apomorphine Aporphine Bromocriptine Cabergoline Lisuride Memantine Nuciferine Pergolide Phenethylamine Piribedil Pramipexole Ropinirole Rotigotine Salvinorin A Also indirect D agonists, such as dopamine reuptake inhibitors ( cocaine, methylphenidate ), releasing agents ( amphetamine, methamphetamine ), and precursors ( levodopa ). GABA enhancers CI - 966 Eszopiclone Ibotenic acid Muscimol ( Amanita muscaria ) Zaleplon Zolpidem Zopiclone Inhalants ( Mixed MOA ) Aliphatic hydrocarbons Butane Gasoline Kerosene Propane Aromatic hydrocarbons Toluene Ethers Diethyl ether Enflurane Haloalkanes Chlorofluorocarbons Chloroform κOR agonists 2 - EMSB 2 - MMSB Alazocine Bremazocine Butorphan Butorphanol Cyclazocine Cyclorphan Cyprenorphine Diprenorphine Enadoline Herkinorin Heroin HZ - 2 Ibogaine Ketazocine Levallorphan Levomethorphan Levorphanol LPK - 26 Metazocine Morphine Nalbuphine Nalmefene Nalorphine Noribogaine Oxilorphan Pentazocine Phenazocine Proxorphan Racemethorphan Racemorphan Salvinorin A Spiradoline Tifluadom U-50488 U-69,593 Xorphanol Others Glaucine Isoaminile Noscapine Pukateine Ophthalmologicals : mydriasis and cycloplegia ( S01F ) Anticholinergics / antimuscarinics Atropine Scopolamine Methylscopolamine Cyclopentolate Homatropine Tropicamide Sympathomimetics Phenylephrine Ephedrine Ibopamine Drugs used for glaucoma preparations and miosis ( S01E ) Sympathomimetics Apraclonidine Brimonidine ( + timolol ) Clonidine Dipivefrine Epinephrine Parasympathomimetics muscarinic Aceclidine Pilocarpine muscarinic / nicotinic Acetylcholine Carbachol acetylcholinesterase inhibitors Demecarium Ecothiopate Stigmine ( Fluostigmine Neostigmine Physostigmine ) Paraoxon Carbonic anhydrase inhibitors / ( sulfonamides ) Acetazolamide Brinzolamide ( + timolol ) Diclofenamide Dorzolamide ( + timolol ) Methazolamide Beta blocking agents Befunolol Betaxolol Carteolol Levobunolol Metipranolol Timolol Mepindolol Prostaglandin analogues ( F ) Bimatoprost ( + timolol ) Latanoprost ( + timolol ) Tafluprost Travoprost ( + timolol ) Unoprostone Other agents Dapiprazole Guanethidine Ripasudil Muscarinic acetylcholine receptor modulators mAChRs Agonists 77 - LH - 28 - 1 AC - 42 AC - 260,584 Aceclidine Acetylcholine AF30 AF150 ( S ) AF267B Alvameline AQRA - 741 Arecoline Bethanechol Bevonium Butyrylcholine Carbachol CDD - 0034 CDD - 0078 CDD - 0097 CDD - 0098 CDD - 0102 Cevimeline Choline cis - Dioxolane Clozapine Desmethylclozapine ( norclozapine ) Ethoxysebacylcholine Itameline LY - 593,039 L - 689,660 LY - 2,033,298 McNA343 Methacholine Milameline Muscarine NGX - 267 Ocvimeline Oxotremorine PD - 151,832 Pilocarpine RS86 Sabcomeline SDZ 210 - 086 Sebacylcholine Suberyldicholine Talsaclidine Tazomeline Thiopilocarpine Vedaclidine VU - 0029767 VU - 0090157 VU - 0152099 VU - 0152100 VU - 0238429 WAY - 132,983 Xanomeline YM - 796 Antagonists 3 - Quinuclidinyl benzilate 4 - DAMP Aclidinium bromide ( + formoterol ) Abediterol AF - DX 250 AF - DX 384 Ambutonium bromide Anisodamine Anisodine Antihistamines ( first - generation ) ( e.g., brompheniramine, buclizine, captodiame, chlorphenamine ( chlorpheniramine ), cinnarizine, clemastine, cyproheptadine, dimenhydrinate, dimetindene, diphenhydramine, doxylamine, meclizine, mepyramine ( pyrilamine ), mequitazine, perlapine, phenindamine, pheniramine, phenyltoloxamine, promethazine, propiomazine, triprolidine ) AQ - RA 741 Atropine Atropine methonitrate Atypical antipsychotics ( e.g., clozapine, fluperlapine, olanzapine ( + fluoxetine ), rilapine, quetiapine, tenilapine, zotepine ) Benactyzine Benzatropine ( benztropine ) Benzilone Benzilylcholine mustard Benzydamine BIBN 99 Biperiden Bornaprine Camylofin CAR - 226,086 CAR - 301,060 CAR - 302,196 CAR - 302,282 CAR - 302,368 CAR - 302,537 CAR - 302,668 Caramiphen Cimetropium bromide Clidinium bromide Cloperastine CS - 27349 Cyclobenzaprine Cyclopentolate Darifenacin DAU - 5884 Desfesoterodine Dexetimide DIBD Dicycloverine ( dicyclomine ) Dihexyverine Difemerine Diphemanil metilsulfate Ditran EA - 3167 EA - 3443 EA - 3580 EA - 3834 Emepronium bromide Etanautine Etybenzatropine ( ethybenztropine ) Fenpiverinium Fentonium Fesoterodine Flavoxate Glycopyrronium bromide ( + beclometasone / formoterol, + indacaterol ) Hexahydrodifenidol Hexahydrosiladifenidol Hexbutinol Hexocyclium Himbacine HL - 031,120 Homatropine Imidafenacin Ipratropium bromide ( + salbutamol ) Isopropamide J - 104,129 Hyoscyamine Mamba toxin 3 Mamba toxin 7 Mazaticol Mebeverine Meladrazine Mepenzolate Methantheline Methoctramine Methylatropine Methylhomatropine Methylscopolamine Metixene Muscarinic toxin 7 N - Ethyl - 3 - piperidyl benzilate N - Methyl - 3 - piperidyl benzilate Nefopam Octatropine methylbromide ( anisotropine methylbromide ) Orphenadrine Otenzepad ( AF - DX 116 ) Otilonium bromide Oxapium iodide Oxitropium bromide Oxybutynin Oxyphencyclimine Oxyphenonium bromide PBID PD - 102,807 PD - 0298029 Penthienate Pethidine pFHHSiD Phenglutarimide Phenyltoloxamine Pipenzolate bromide Piperidolate Pirenzepine Piroheptine Pizotifen Poldine Pridinol Prifinium bromide Procyclidine Profenamine ( ethopropazine ) Propantheline bromide Propiverine Quinidine Revefenacin Rociverine RU - 47,213 SCH - 57,790 SCH - 72,788 SCH - 217,443 Scopolamine ( hyoscine ) Scopolamine butylbromide ( hyoscine butylbromide ) Silahexacyclium Sofpironium bromide Solifenacin SSRIs ( e.g., femoxetine, paroxetine ) Telenzepine Terodiline Tetracyclic antidepressants ( e.g., amoxapine, maprotiline, mianserin, mirtazapine ) Tiemonium iodide Timepidium bromide Tiotropium bromide Tiquizium bromide Tofenacin Tolterodine Tricyclic antidepressants ( e.g., amitriptyline ( + perphenazine ), amitriptylinoxide, butriptyline, cidoxepin, clomipramine, desipramine, desmethyldesipramine, dibenzepin, dosulepin ( dothiepin ), doxepin, imipramine, lofepramine, nitroxazepine, northiaden ( desmethyldosulepin ), nortriptyline, protriptyline, quinupramine, trimipramine ) Tridihexethyl Trihexyphenidyl Trimebutine Tripitamine ( tripitramine ) Tropacine Tropatepine Tropicamide Trospium chloride Typical antipsychotics ( e.g., chlorpromazine, chlorprothixene, cyamemazine ( cyamepromazine ), loxapine, mesoridazine, thioridazine ) Umeclidinium bromide ( + vilanterol ) WIN - 2299 Xanomeline Zamifenacin Precursors ( and prodrugs ) Acetyl - coA Adafenoxate Choline ( lecithin ) Citicoline Cyprodenate Dimethylethanolamine Glycerophosphocholine Meclofenoxate ( centrophenoxine ) Phosphatidylcholine Phosphatidylethanolamine Phosphorylcholine Pirisudanol See also : Receptor / signaling modulators Nicotinic acetylcholine receptor modulators Acetylcholine metabolism / transport modulators LCCN : sh85009366 GND : 4143355 - 5 Retrieved from `` https://en.wikipedia.org/w/index.php?title=Atropine&oldid=805867363 '' Categories : Antidotes Deliriants Entheogens Muscarinic antagonists Tropane alkaloids Tropane alkaloids found in Solanaceae World Health Organization essential medicines Propionates Primary alcohols Oneirogens Glycine receptor agonists Secondary metabolites Chemical substances for emergency medicine Hidden categories : Webarchive template wayback links Template : drugs.com link with non-standard subpage Articles with changed EBI identifier ECHA InfoCard ID from Wikidata Drugs with no legal status Drugboxes which contain changes to verified fields Drugboxes which contain changes to watched fields All articles with unsourced statements Articles with unsourced statements from December 2015 Articles with unsourced statements from November 2014 Wikipedia articles with LCCN identifiers Wikipedia articles with GND identifiers RTT Talk Contents About Wikipedia Беларуская Български Català Čeština Cymraeg Dansk Deutsch Ελληνικά Español Esperanto Euskara فارسی Français Gaeilge Galego 한국어 Հայերեն Hrvatski Ido Italiano עברית Кыргызча Latviešu Lietuvių Magyar മലയാളം मराठी Nederlands 日本 語 Norsk ଓଡ଼ିଆ Oʻzbekcha / ўзбекча پښتو Polski Português Română Русский Scots Shqip Simple English Slovenčina Slovenščina Српски / srpski Srpskohrvatski / српскохрватски Suomi Svenska ไทย Тоҷикӣ Türkçe Українська Walon 中文 Edit links This page was last edited on 18 October 2017, at 03 : 54. 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Question: where does atropine block the release of acetylcholine
Answer: muscarinic receptors