Atropine alert

THE Therapeutic Goods Administration (TGA) has advised health professionals to exercise “extreme caution” if considering off-label prescribing of atropine eye drops to treat hypersalivation.

The issue is detailed in the latest edition of the TGA’s Medicines Safety Update, with the warning following the 2014 death of an adult patient which has been attributed to accidental oral ingestion of a toxic quantity of atropine eye drops which had been prescribed off-label for sublingual administration.

A coronial inquest heard evidence that the plastic dispenser bottle was very easy to empty, and that the deceased took at least 6-8ml of the solution leading to an overdose.

Other items addressed in the update include new warning statements which are being implemented for neuromuscular blocking agent containing medicines (NMBAs), which are used to cause paralysis during anaesthesia.

Administration errors involving these medicines can be caused by look-alike selection errors, with the Therapeutic Goods Order No 91 - Standards for prescription and related medicines updated to require the statement “WARNING: Paralysing agent” prominently on the outer carton and ampoule of the medications.

Affected medicines are currently specified as S3 and include suxamethonium, pancuronium, vecuronium, atracurium, rocuronium, mivacurium and cistacurium - details at tga.gov.au.