Page 105 - ITPS-7-4

INNOSC Theranostics and
Pharmacological Sciences Atropine-induced psychosis in organophosphate poisoning

pantoprazole (40 mg IV BD), ondansetron (4 mg IV BD), a Clinical pharmacists closely monitored the patient for
multivitamin (1 amp IV Omni die), sucralfate (10 mL oral potential drug interactions and adverse reactions, paying
Ter in die), and haloperidol (5 mg IM) (Table 2). particular attention to the enhancement of atropine’s effects
by PAM and the additive anticholinergic effects when
Table 1. Case details combined with antipsychotics. Patient counseling focused

Category Details on medication adherence and lifestyle modifications,
Patient information 45-year-old male emphasizing stress management, fasting, physical activity,
social engagement, and meditation.
Presentation Ingestion of 250 – 500 mL phenthoate
insecticide Administering atropine before PAM was highlighted
Initial treatment (local) Atropinization and gastric lavage to mitigate muscarinic-mediated symptoms, and
Treatment on transfer Repeat gastric lavage, 1 g pralidoxime, benzodiazepines were recommended for seizure management.
atropine infusion (30 mL/h) Trauma protocols, particularly those emphasizing airway
Medications As per the treatment chart (Table 2) integrity, were followed, and anticholinergic selection
Clinical monitoring Drug interactions and adverse reactions was tailored based on receptor targeting. Management
monitored by clinical pharmacists of atropine-induced psychosis involved discontinuing
Key drug interactions • Pralidoxime enhancing atropine effects atropine and considering alternative muscarinic agents,
• Additive anticholinergic effects with such as physostigmine, glycopyrrolate, or scopolamine.
antipsychotics Antipsychotics, such as haloperidol and benzodiazepines
Patient counseling Focused on: were also recommended for symptom control.
• Medication adherence
• Lifestyle modifications (stress 3. Discussion
management, fasting, physical activity,
social engagement, meditation) Atropine-induced psychosis is a rare but clinically
Special considerations • Administer atropine before pralidoxime for significant adverse effect observed in the management of
muscarinic symptoms OP poisoning. While atropine is a cornerstone treatment for
• Use benzodiazepines for seizure
management OP toxicity due to its potent anticholinergic properties, its
Trauma protocols Airway management emphasized use, particularly at high doses, can lead to adverse reactions,
including psychosis. This discussion delves into recent case
Atropine-induced • Discontinue atropine studies, management strategies, and adverse drug reactions
psychosis management • Consider alternative muscarinic
agents (physostigmine, glycopyrrolate, associated with atropine-induced psychosis. Recent case
scopolamine) studies have highlighted the occurrence and management
• Use haloperidol and benzodiazepines for of atropine-induced psychosis. For instance, a study of
symptom control 292 cases of phenthoate (the World Health Organization
Anticholinergic selection Tailored based on receptor targeting Class II OP insecticide) self-poisoning reported less severe

Table 2. Treatment chart
Medication Dose Route Frequency Indication Special Notes
Atropine Infusion at IV Infusion Continuous Management of muscarinic symptoms Administered before pralidoxime to mitigate muscarinic
30 mL/h effects
Pralidoxime 1 g IV BD Antidote for organophosphate Enhances the effect of atropine; repeat dosing at BD
poisoning intervals
Ceftriaxone 1 g IV BD Prophylaxis for potential infections Broad-spectrum antibiotic
Thiamine 100 mg IV BD Nutritional support Prevents Wernicke’s encephalopathy
Pantoprazole 40 mg IV BD Gastric protection Proton pump inhibitor
Ondansetron 4 mg IV BD Nausea and vomiting control Antiemetic
Multivitamin 1 amp IV OD Nutritional support Single daily dose
Sucralfate 10 mL Oral TID Gastric mucosal protection Protects against gastric irritation from ingested substances
Haloperidol 5 mg IM As needed Management of atropine-induced Antipsychotic; used for symptom control
psychosis
Notes: amp: Ampoule; BD: Bis die (twice daily); OD: Omni die (once daily); IM: Intramuscular administration; IV: Intravenous administration;
TID: Ter in die (3 times a day).

Volume 7 Issue 4 (2024) 3 doi: 10.36922/itps.4607