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April 15, 2003


Atropine Can Be Available for Easier Treatment of Mass Casualties, Emory Study Finds

ATLANTA -- In the event of a large-scale exposure to a nerve agent or organophosphate insecticide that might result in poisonings of many victims within a short period of time, a powdered form of atropine can be mixed with existing stocks of dilute liquid to rapidly and effectively treat large numbers of people, according to a study published in the April 2003 issue of the Annals of Emergency Medicine.

The findings are based on a study by Robert J. Geller, MD, associate professor of pediatrics at the Emory University School of Medicine and medical director of the Georgia Poison Center, and five other authors. The study concluded that existing atropine stocks could be readily augmented by fortification with powdered atropine for properly-dosed, immediate and inexpensive use.

Atropine is the preferred antidote for immediate management of toxic poisoning associated with nerve agents. In the article, Dr. Geller and his colleagues from the Georgia Poison Center, Grady Memorial Hospital and the Mercer University Southern School of Pharmacy explain that although atropine is commercially available, it is only available in a solution that is relatively dilute.

If given intravenously to one of two persons at a time, the solution works fine, but becomes impractical if large numbers of victims need care at the same time. It is faster and easier to administer the medicine people through intramuscular injection, but this requires a more concentrated solution that is commonly available. This high concentration can be successfully achieved by fortifying existing injectable atropine with bulk pharmaceutical-grade atropine powder.

The authors used a concentration of 2 mg/mL, thereby increasing the amount available and facilitating its intramuscular administration. An independent analysis of the resulting formulation was then done to assess its potency, absence of pyrogens and stability. Atropine that is commercially available comes supplied at concentrations of either 0.4 mg/mL or 1 mg/mL. This formulation makes it necessary to administer the commonly recommended initial dose of 2 to 6 mg intravenously. The article is based on a chemical analysis of the result when powder was mixed with dilute atropine.

"By making the powder more concentrated, you reduce the number of injections you need to give someone for an effective dose," Dr. Geller said. "What we did was validated a simple method of mixing the powder back with a smaller amount of stuff to have lots of atropine available."

The product maintained its potency at refrigeration temperature for at least eight weeks after preparation and at room temperature for four weeks. Once all materials were available, the compounding of the preparation required about one hour to complete.

Dr. Geller said he was pleased with the results.

"This validates exactly what we expected," he said.

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