Usage
Atropine and Hydrocortisone are typically not administered as a fixed combination product but can be co-administered in certain clinical settings for specific medical conditions. Atropine is primarily an anticholinergic and muscarinic antagonist, while Hydrocortisone is a glucocorticoid (corticosteroid). The combined use often arises in emergency or critical care situations.
Atropine is used for:
- Bradycardia (slow heart rate), especially during intubation or after cardiac arrest
- Reducing secretions before anesthesia or during surgery
- Treating organophosphate poisoning
Hydrocortisone is used for:
- Adrenal insufficiency
- Allergic reactions (anaphylaxis)
- Inflammatory conditions
- Shock
Alternate Names
Atropine:
Hydrocortisone:
- Hydrocortisone Sodium Succinate (IV form)
- Hydrocortisone Sodium Phosphate (IV form)
- Cortisol
Brand names vary depending on the manufacturer and formulation.
How It Works
Atropine:
- Pharmacodynamics: Atropine competitively antagonizes acetylcholine at muscarinic receptors. This action inhibits the parasympathetic nervous system, leading to increased heart rate, reduced secretions (salivary, bronchial), and bronchodilation.
- Pharmacokinetics: Atropine is readily absorbed after intramuscular (IM), intravenous (IV), subcutaneous (SC) or oral administration. It is metabolized in the liver and excreted primarily in the urine. It has a half-life of approximately 2-3 hours in adults and older children, while it can be longer in infants less than 2 years old.
Hydrocortisone:
- Pharmacodynamics: Hydrocortisone exerts its effects by binding to glucocorticoid receptors in the cytoplasm, which then translocate to the nucleus and modulate gene expression. This results in diverse effects including anti-inflammatory, immunosuppressive, and metabolic actions.
- Pharmacokinetics: Hydrocortisone is administered intravenously (IV) or intramuscularly (IM). It is metabolized primarily in the liver and excreted in the urine with a half-life of approximately 1.5-3 hours.
Dosage
Dosages for Atropine and Hydrocortisone are independent of each other and should be determined based on the specific clinical indication.
Standard Dosage
Adults: Atropine
- Bradycardia: 0.5-1mg IV bolus, repeated every 3-5 minutes up to a total dose of 3 mg.
Adults: Hydrocortisone
- Adrenal crisis: 100 mg IV bolus followed by a continuous infusion of 100-200 mg over 24 hours.
Children: Atropine
- Bradycardia: 0.01-0.02 mg/kg IV bolus (minimum dose: 0.1 mg, maximum single dose: 0.5 mg; maximum total dose: 1 mg in child and 2 mg in adolescents ), may repeat every 3-5 minutes.
Children: Hydrocortisone
- Adrenal crisis: 2 mg/kg IV bolus followed by continuous infusion of 50 mg/m²/day
Special Cases
Dosing adjustments may be necessary for both Atropine and Hydrocortisone in elderly patients and those with renal or hepatic impairment.
Clinical Use Cases
Both drugs are frequently used together during intubation, particularly rapid sequence intubation (RSI), where atropine helps prevent bradycardia and hydrocortisone aids in managing hypotension. Surgical and ICU settings may also warrant co-administration, with dosing titrated based on the individual patient needs.
Side Effects
Atropine Common Side Effects
- Dry mouth
- Blurred vision
- Urinary retention
- Constipation
- Tachycardia
Atropine Rare but Serious Side Effects
- Delirium
- Hallucinations
- Hyperthermia
Hydrocortisone Common Side Effects
- Fluid retention
- Increased blood sugar
- Mood changes
- Insomnia
Hydrocortisone Rare but Serious Side Effects
- Immunosuppression
- Osteoporosis
- Gastric ulcers
Contraindications
Atropine:
- Angle-closure glaucoma
- Obstructive uropathy
- Tachyarrhythmias
Hydrocortisone:
- Systemic fungal infections
- Hypersensitivity to corticosteroids
Drug Interactions
Atropine: Other anticholinergic drugs, antihistamines, some antidepressants.
Hydrocortisone: NSAIDs, anticoagulants, antidiabetic drugs.
Pregnancy and Breastfeeding
Atropine: FDA Pregnancy Category C. Use only if the potential benefit outweighs the potential risk to the fetus. Small amounts are excreted in breast milk.
Hydrocortisone: Readily crosses the placenta. Use during pregnancy requires careful monitoring. May be excreted in breast milk.
Drug Profile Summary
(See individual drug profiles in earlier sections)
Popular Combinations
Atropine is often co-administered with other medications during RSI such as succinylcholine and midazolam. Hydrocortisone might be administered alongside other agents for treating specific conditions like anaphylaxis (adrenaline, antihistamines).
Precautions
(See individual drug profiles in earlier sections)
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Atropine during intubation?
A: Adults: 0.5 - 1 mg IV; Children: 0.01 – 0.02 mg/kg IV (minimum dose 0.1 mg)
Q2: What are the common side effects of Hydrocortisone?
A: Common side effects include fluid retention, elevated blood sugar, mood changes, insomnia.
Q3: Can Atropine be given IM?
A: Yes, atropine can be given IM, IV, or SC.
Q4: What is the role of Hydrocortisone in anaphylaxis?
A: Hydrocortisone helps to prevent a delayed or biphasic reaction after the initial anaphylactic symptoms are treated with epinephrine and antihistamines.
Q5: What is the mechanism of action of Atropine?
A: Atropine is a competitive antagonist of acetylcholine at muscarinic receptors, thereby inhibiting parasympathetic effects.
Q6: Are there any contraindications to using Atropine?
A: Contraindications include angle-closure glaucoma, urinary retention, and certain tachyarrhythmias.
Q7: How should Hydrocortisone be administered in adrenal crisis?
A: Hydrocortisone should be given IV bolus followed by continuous infusion.
Q8: What are the signs of atropine overdose?
A: Signs of atropine overdose include delirium, hallucinations, hyperthermia, and dilated pupils.
Q9: Can Atropine and Hydrocortisone be used during pregnancy?
A: Both drugs can be used during pregnancy if the benefits outweigh the risks, but they should be used with caution and under close monitoring by a healthcare professional.
Q10: How does hepatic impairment affect the dosage of these drugs?
A: Dosage adjustments might be necessary in patients with hepatic impairment, specifically for hydrocortisone. It is important to monitor liver function tests and adjust the dose as needed.
