Sublingual atropine

[paramedicmike]

I encountered an hospice patient recently who was being given sublingual atropine to "suppress coughing" according to the hospice nurse. This was the first time I'd seen anything like this. The RN didn't have much more information other than to say that "that's what we do".

My own research on sublingual atropine is turning up mixed results. Some studies say it works (more with Parkinson's patients than with anything else. The patient in question was not suffering from Parkinson's.). Others say there's not much to it.

Anyone else ever come across anything like this? Can you shed some light on the practice? Is this common practice? (Like I said, I've never seen this before. But then again, I don't work in hospice.) I'm presuming the mechanism to suppress coughing is the anti-cholinergic effects in reducing oral secretions. But that's only a semi-educated guess.

Anybody have anything to contribute to the general knowledge base here?

Thanks.

-be safe

[Dustdevil]

I'm presuming the mechanism to suppress coughing is the anti-cholinergic effects in reducing oral secretions. But that's only a semi-educated guess.

That's why we give it pre-op, so that would be my guess too. I have not heard of this particular use though.

[AZCEP]

It can also reduce the bronchoconstriction in the larger airways. Combined with the reduction in bronchial secretions, I guess it makes sense. With the amount of PNS innervation in the upper airway, using it sublingual could make things a bit easier. First I've heard of it this way though.

[DartmouthDave]

Hello,

I have never seen or heard of Atropine SL before but I have seen it give IM before. Not so much for coughing but if the palliative patient has excessive oral secretion and wet lungs. In theory, the Anti-Ach effects should dry things out some and make it less unpleasant for the patient (if still aware) and equally as important, the family. Near the end MOS4 is added to surpress and smooth over unpleasant respiratory patterns for the family (if done right).

I have also seen Scopolamine used as a patch, IV and IM. For similar effects.....dry out secretions.

For excessive coughing the only thing I have seen used is Codeine Elixir or IM/PO.

Cheers

[Dustdevil]

Personally I use the Fentanyl patch when I have a particularly nasty cough.

Go big or go home.