Atropine

T ade Na e
Atro-Pen
The Cla

antiarrhythmics
Pha Cla
anticholinergics

I dica i
IM Given preoperatively to decrease oral and respiratory secretions.
IV Treatment of sinus bradycardia and heart block.
IV Reversal of adverse muscarinic effects of anticholinesterase agents (neostigmine, physostigmine, or
pyridostigmine).
IM IV Treatment of anticholinesterase (organophosphate pesticide) poisoning.
I hal Treatment of exercise-induced bronchospasm.

Ac i
Inhibits the action of acetylcholine at postganglionic sites located in:
Smooth muscle,
Secretory glands,
CNS (antimuscarinic activity).
Low doses decrease:
Sweating,
Salivation,
Respiratory secretions.
Intermediate doses result in:
Mydriasis (pupillary dilation),
Cycloplegia (loss of visual accommodation),
Increased heart rate.
GI and GU tract motility are decreased at larger doses.

The a e ic Effec
Increased heart rate.
Decreased GI and respiratory secretions.
Reversal of muscarinic effects.
May have a spasmolytic action on the biliary and genitourinary tracts.
Pha ac ki e ic

Ab i Well absorbed following subcut or IM administration.

Di ib i Readily crosses the blood-brain barrier. Crosses the placenta and enters breast milk.

Me ab li a dE c e i Mostly metabolized by the liver; 30–50 excreted unchanged by the kidneys.

Half life Children 2 yr: 4–10 hr; Children 2 yr: 1.5–3.5 hr; Adults: 4–5 hr.

TIME ACTION PROFILE i hibi i f ali a i

ROUTE ONSET PEAK DURATION

IM, subcut rapid 15–50 min 4–6 hr

IV immediate 2–4 min 4–6 hr

C ai dica i P eca i

C ai dica ed i
Hypersensitivity;
Angle-closure glaucoma;
Acute hemorrhage;
Tachycardia secondary to cardiac insufficiency or thyrotoxicosis;
Obstructive disease of the GI tract.

U e Ca i l i
Intra-abdominal infections;
Prostatic hyperplasia;
Chronic renal, hepatic, pulmonary, or cardiac disease;
OB Lac a i Safety not established; IV administration may produce fetal tachycardia;
Pedi Infants with Down syndrome have increased sensitivity to cardiac effects and mydriasis. Children
may have increased susceptibility to adverse reactions. Exercise care when prescribing to children with
spastic paralysis or brain damage;
Ge i Increased susceptibility to adverse reactions.

Ad e e Reac i Side Effec

CNS drowsiness, confusion, hyperpyrexia

 , , yp py

EENT blurred vision, cycloplegia, photophobia, dry eyes, mydriasis

CV tachycardia, palpitations, arrhythmias

GI dry mouth, constipation, impaired GI motility

GU urinary hesitancy, retention, impotency

Re tachypnea, pulmonary edema

Mi c flushing, decreased sweating

I e ac i

D gD g
anticholinergic effects with other a ich li e gic , including a ihi a i e , ic clic
a ide e a , i idi e, and di a ide.
Anticholinergics may alter the absorption of other all ad i i e ed d g by slowing motility of the
GI tract.
A acid absorption of a ich li e gic .
May GI mucosal lesions in patients taking oral a i chl ide tablets.
May alter response to be a bl cke .

R e D age

P ea e he ia T Dec ea e Sali a i Sec e i

IM IV SC Ad l 0.4–0.6 mg 30–60 min pre-op.

IM IV SC Child e kg 0.01–0.02 mg/kg/dose 30–60 min preop to a maximum of 0.4 mg/dose; minimum:
0.1 mg/dose.

IM IV SC Child e kg 0.02 mg/kg/dose 30–60 min preop then every 4–6 hr as needed.

B ad ca dia

IV Ad l 0.5–1 mg; may repeat as needed every 5 min, not to exceed a total of 2 mg (every 3–5 min in
Advanced Cardiac Life Support guidelines) or 0.04 mg/kg (total vagolytic dose).
IV Child e 0.02 mg/kg (maximum single dose is 0.5 mg in children and 1 mg in adolescents); may repeat
every 5 min up to a total dose of 1 mg in children (2 mg in adolescents).

E d acheal Child e use the IV dose and dilute before administration.

Re e al f Ad e e M ca i ic Effec f A ich li e e a e

IV Ad l 0.6–12 mg for each 0.5–2.5 mg of neostigmine methylsulfate or 10–20 mg of pyridostigmine

bromide concurrently with anticholinesterase.

O ga h ha e P i i g

IM Ad l 2 mg initially, then 2 mg every 10 min as needed up to 3 times total.

IV Ad l 1–2 mg/dose every 10–20 min until atropinic effects observed then every 1–4 hr for 24 hr; up to 50
mg in first 24 hr and 2 g over several days may be given in severe intoxication.

IM Child e lb 2 mg.

IM Child e lb 1 mg.

IM Child e lb 0.5 mg.

IV Child e 0.02–0.05 mg/kg every 10–20 min until atropinic effects observed then every 1–4 hr for 24 hr.

B ch a

I hal Ad l 0.025–0.05 mg/kg/dose every 4–6 hr as needed; maximum 2.5 mg/dose.

I hal Child e 0.03–0.05 mg/kg/dose 3–4 times/day; maximum 2.5 mg/dose.

A e e
Assess vital signs and ECG tracings frequently during IV drug therapy. Report any significant changes in
heart rate or BP, or increased ventricular ectopy or angina to health care professional promptly.
Monitor intake and output ratios in elderly or surgical patients because atropine may cause urinary
retention.
Assess patients routinely for abdominal distention and auscultate for bowel sounds. If constipation
becomes a problem, increasing fluids and adding bulk to the diet may help alleviate constipation.

T ici O ed e
If overdose occurs, physostigmine is the antidote.

P e ial Diag e
Decreased cardiac output (Indications)
Impairedoral mucous membrane (Side Effects)
Constipation (Side Effects)

I le e a i
IM Intense flushing of the face and trunk may occur 15–20 min following IM administration. In children,
this response is called "atropine flush" and is not harmful.
Ra e Inject directly into the endotracheal tube followed by several positive pressure ventilations.
Dilute with 5–10 mL of 0.9 NaCl.
Ra e Inject directly into the endotracheal tube followed by several positive pressure ventilations.

Pa ie Fa il Teachi g
May cause drowsiness. Caution patients to avoid driving or other activities requiring alertness until response to
medication is known.
Instruct patient that oral rinses, sugarless gum or candy, and frequent oral hygiene may help relieve dry
mouth.
Caution patients that atropine impairs heat regulation. Strenuous activity in a hot environment may
cause heat stroke.
Pedi Instruct parents or caregivers that medication may cause fever and to notify health care
professional before administering to a febrile child.
Ge i Inform male patients with benign prostatic hyperplasia that atropine may cause urinary hesitancy
and retention. Changes in urinary stream should be reported to health care professional.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products
being taken and to consult with health care professional before taking other medications.
Pedi Instruct parents or caregivers that medication may cause fever and to notify health care
professional before administering to a febrile child.
Ge i Inform male patients with benign prostatic hyperplasia that atropine may cause urinary hesitancy
and retention. Changes in urinary stream should be reported to health care professional.

E al a i De i ed O c e
Increase in heart rate.
Dryness of mouth.
Reversal of muscarinic effects.