Atropine
| Evidence Level: L5 | Predicted Indications: 2 |
Table of Contents
Atropine: Non-selective muscarinic antagonist → migraine disorder
One-Sentence Summary
Atropine is an anticholinergic (muscarinic antagonist) medicine registered in Australia as an injection. The TxGNN model predicts it may be relevant to migraine disorder, but there are no registered clinical trials and the 11 publications compiled for this report are indirect or preclinical, so this remains a model prediction only.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | migraine disorder |
| TxGNN Prediction Score | 0.9956 |
| Evidence Level | L5 |
| Australia Market Status | Listed on the PBS Schedule (1 of 1 items) – TGA (ARTG) registration status is not included in this data |
| Number of PBS Items | 1 (valid: 1) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Atropine is generally known as a non-selective muscarinic antagonist, so its effects would be expected to come from blocking cholinergic signalling.
Several preclinical studies link cholinergic and parasympathetic signalling to migraine biology. These include meningeal mast cell cholinergic modulation in a rat migraine model (PMID 36485173), plasma protein extravasation in rat dura mater after parasympathetic ganglion stimulation (PMID 9344563), and central cholinergic involvement in antinociception in rodents (PMID 8930196). A muscarinic antagonist could plausibly modulate these pathways.
However, none of these studies shows that atropine itself treats or prevents migraine. The link is hypothetical and should be treated as a hypothesis for further research.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
None of the publications below tested atropine as a treatment for migraine in patients. The most relevant are preclinical mechanistic studies.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 36485173 | 2024 | Preclinical mechanistic study | Eur J Neurosci | Cholinergic modulation and mast cells in neurogenic inflammation in a rat migraine model |
| 9344563 | 1997 | Preclinical animal study | Exp Neurol | Parasympathetic ganglion stimulation induced plasma protein extravasation in rat dura mater |
| 8930196 | 1996 | Preclinical animal study | J Pharmacol Exp Ther | Central cholinergic system involved in sumatriptan-induced antinociception in rodents |
| 17186568 | 2007 | Review | J Appl Toxicol | Pharmacology of anisodamine, an atropine derivative and non-specific cholinergic antagonist |
| 2943405 | 1986 | Clinical physiology study | Cephalalgia | Systemic atropine reduced attack-related sweating, tearing and nasal secretion in chronic paroxysmal hemicrania (a different headache disorder) |
| 10193781 | 1999 | Preclinical ex vivo study | Br J Pharmacol | Effects of analgesic drugs on nicotine-evoked relaxation of guinea-pig basilar artery |
| 1786517 | 1991 | Preclinical pharmacology | Br J Pharmacol | Ergotamine and dihydroergotamine act as 5-HT1C agonists (indirect) |
Australia Market Information
| ARTG Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| ARTG 1089H | Atropine Injection (Bridgewest) | Injection containing atropine sulfate monohydrate 600 micrograms in 1 mL | Not recorded in the local data |
Safety Considerations
Key warnings and contraindications are not available in the data compiled for this report. Please refer to the TGA-approved Product Information (PI) for safety information.
Drug interactions: An interaction screen returned 100 interacting drugs. Most of those listed are Moderate in severity, including:
- Opioids: fentanyl, alfentanil, codeine, dihydrocodeine, tramadol
- Other anticholinergic or antimuscarinic agents: hyoscyamine, aclidinium, amitriptyline
- Antihistamines: chlorpheniramine, acrivastine, phenyltoloxamine
- Others: botulinum toxin type A, acebutolol, acetylcholine, galantamine, amantadine, loperamide, ethanol
Minor interactions include acetaminophen and hydrochlorothiazide.
Conclusion and Next Steps
Decision: Hold
Rationale: The TxGNN score is high (0.9956), but there are no clinical trials and no study directly examining atropine in migraine. Supporting literature is indirect and preclinical, so the evidence level is L5.
To proceed, the following is needed:
- Mechanism of action data and a clearer account of how muscarinic blockade would affect migraine pathways
- Direct preclinical or clinical studies of atropine (or a similar antimuscarinic) in migraine
- Warnings and contraindications from the TGA Product Information, followed by a formal safety review
- Assessment of whether the available injectable form and route suit a migraine use
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.