Atropa Belladonna: William Curtis (1777)

Medical atropine is a long way from the herbal extracts used since the fourth century BCE for their anticholinergic effects. Synthetic atropine was first manufactured in 1901 by Professor Richard Willstätter after being used as a plant derivative for its effects of pupillary dilatation and in relation to anaesthesia (Nobel Media, 2019).

While no longer indicated during cardiac arrest for a patient in asystole or pulseless electrical activity (PEA), atropine is still included in the UK clinical practice guidelines for the treatment of symptomatic bradycardia, supraventicular dysrhythmias requiring suppression, and as part of the treatment for organophosphate exposure (Brown et al, 2016). Chemically, atropine is a racemic mixture of the L- and D-hyoscyamine, with the L-isomer causing most of its physiologic effects. Atropine is mostly excreted unchanged in the urine with a smaller proportion metabolised to some degree before urinary excretion.