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Atropine overdosage with a suppository formulation containing atropine sulfate
1School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
International Journal of Pharmaceutical Compounding
|August 31, 2013
Summary
A patient experienced atropine poisoning due to a compounding error in migraine suppositories. Analysis revealed a 100-fold overdose of atropine sulfate, highlighting critical pharmacy vigilance.
Area of Science:
- Pharmaceutical Compounding
- Clinical Toxicology
- Analytical Chemistry
Background:
- Migraine treatment often involves ergotamine tartrate and caffeine (Cafergot).
- A patient presented with symptoms consistent with atropine poisoning after using reformulated Cafergot suppositories.
- The prescribed dose of atropine sulfate was 0.25 mg per suppository.
Purpose of the Study:
- To develop and validate a method for quantifying atropine sulfate in compounded suppositories.
- To investigate the cause of the patient's toxic effects.
- To ensure the accuracy and safety of compounded medications.
Main Methods:
- Development of a simple, sensitive, and accurate analytical method for atropine sulfate quantitation.
- Analysis of dispensed suppository samples.
- Comparison of found atropine sulfate levels with the prescribed dosage.
Main Results:
- The analytical method successfully quantified atropine sulfate in the suppositories.
- Dispensed suppositories were found to contain 25 mg of atropine sulfate each.
- This represents a 100-fold increase compared to the intended 0.25 mg dose.
Conclusions:
- A critical compounding error led to a significant atropine sulfate overdose.
- The incident underscores the importance of meticulous attention to detail in pharmaceutical compounding.
- Pharmacist vigilance is essential to prevent medication errors and ensure patient safety.
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