• GA
• GB
• VX

See pages on individual agents for details of atropine treatment.

Atropine should not be given to pregnant women or nursing mothers if at all possible. It can be secreted in the milk leading to a child taking in a toxic dose. There is a general lack of information on its effects on the fetus and the newborn.

Atropine counters the effects of G- and V- nerve agents by blocking a form of the receptor for the nerve impulse carried by acetylcholine (specifically the muscarinic cholinergic receptor). As the nerve agents cause overstimulation of the receptor, the effect is partially reversed.

Atropine is most effective against muscarinic acetylcholine receptors of the peripheral nervous system. It is less effective against muscarinic receptors of the central nervous sytem and is ineffective on nicotinic receptors.

Current US and NATO practice for treatment of nerve agent exposure uses a combination of relatively low doses of each of atropine, diazepam, and an oxime. The only army that has had to treat nerve agent exposure in battle, that of Iran, found effective ways of dealing with exposure without such complex treatments. Iran did not have significant supplies of oximes or diazepam and was largely dependent on atropine treatment at forward aid stations. Given the choice between trying and saving some people, and not trying and watching them die, they used extremely aggressive treatment with atropine. Doses several-fold higher than recommended in the West were used and doctors learned how to observe patients for signs of recovery. Small numbers of victims were also treated with oximes and diazepam, but high doses of atropine administered by experienced physicians succesfully controlled symptoms for which oximes and diazepam are thought necessary.

Japanese responses in the 1995 sarin attack on the Tokyo subway system followed standard procedures with patients given intravenous atropine and diazepam upon arrival at the emergency treatment center at St. Luke's Hospital. Pralidoxime (as the iodide) given when sarin was identified as the agent. It was found that intravenous atropine did not reverse the miosis (constriction of the pupils) caused by the agent. Washing the eyes with standard commercial ophthalmic solutions (0.5% tropicamide and 0.5% phenylephrine hydrochloride or 1% cyclopentolate hydrochloride) or atropine eye drops relieved this problem.