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
The findings are based on a study by Robert Geller, associate professor
of pediatrics at the 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
Atropine is the preferred antidote for immediate management of toxic
poisoning associated with nerve agents. In the article, Geller and
his colleagues from the Georgia Poison Center, Grady Hospital and
the Southern School of Pharmacy at Mercer University explain that,
although atropine is commercially available, it is only available
in a solution that is relatively dilute.
If given intravenously to one or two persons at a time, the solution
works fine, but this method becomes impractical if large numbers
of victims need care. It is faster and easier to administer the
medicine to people through intramuscular injection, but this requires
a more concentrated solution than 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.
The resulting formulation was independently analyzed to assess its
potency, absence of pyrogens and stability.
Commercially available atropine 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
“By making the powder more concentrated, you reduce the number
of injections you need to give someone for an effective dose,”
Geller said. “What we did was validate 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.
Geller said he was pleased with the results. “This is exactly
what we expected,” he said.