Atropine Sulphate

Indications

Atropine Sulphate is used for: Bradycardia, Organophosphorus poisoning, Anesthesia adjunct

Adult Dose

Anesthesia Premedication 0.4-0.6 mg IV/IM/SC 30-60 minutes before anesthesia; repeat q4-6hr PRN Sinus Bradycardia (ACLS) 0.5-1 mg or 0.04 mg/kg IV q5min, no more than 3 mg Organophosphorus poisoning Adult: 2 mg IV/IM, every 10-30 minutes until muscarinic effects disappear or atropine toxicity appears. In severe cases, dose can be given as often as every 5 minutes. In moderate to severe poisoning, a state of atropinisation is maintained for at least 2 days and continued for as long as symptoms are present. Bronchospasm 0.025 mg/kg in 2.5 mL NS q6-8hr via nebulizer; no more than 2.5 mg/dose Asystole/Pulseless Electrical Activity (ACLS) 1 mg IV q3-5min PRN if asystole persist up to 0.04 mg/kg

Child Dose

Anesthesia Premedication <5 kg: 0.02 mg/kg/dose 30-60 minutes preop; then q4-6hr PRN >5 kg: 0.01-0.02 mg/kg IV/IM/SC; no more than 0.4 mg Sinus Bradycardia 0.02 mg/kg IV/IO q5min for 2-3 doses PRN; single dose no less than: 0.1 no more than 0.5 mg (children), 1 mg (adolescents) Total: No more than: 1 mg (children) Bronchospasm 0.025-0.05 mg/kg in 2.5 mL NS q6-8hr via nebulizer; no more than 2.5 mg/dose Organophosphate or Carbamate Poisoning IV: 0.03-0.05 mg/kg IV/IM/IO/ET q10-20min PRN to effect; then q1-4hr for at least 24 hours

Renal Dose

Administration

Contra Indications

Glaucoma, chronic respiratory disease, sick sinus syndrome, thyrotoxicosis, cardiac failure, pyloric stenosis, prostatic hypertrophy.

Precautions

Reflux oesophagitis, elderly, infants and children. Pregnancy. Lactation: Trace amounts enter breast milk; use with caution (AAP Committee states "compatible with nursing")

Pregnancy-Lactation

Pregnancy Drug readily crosses the placental barrier and enters fetal circulation; there are no adequate data on developmental risk associated with use of atropine in pregnant women; adequate animal reproduction studies have not been conducted with atropine Lactation Drug reported to be excreted in human milk; there are no data on effects of atropine on breastfed infant or effects on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition

Interactions

Additive anticholinergic effects with quinidine, antidepressants and some antihistamines.

Adverse Effects

Side effects of Atropine Sulphate : Dry mouth, dysphagia, constipation, flushing and dryness of skin, tachycardia, palpitations, arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness, confusion, excitement, hallucinations, delirium and may progress to circulatory failure and resp depression. Inhalation: Dryness of mouth, throat. Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular ectopics.

Mechanism of Action

Atropine is an anticholinergic agent which competitively blocks the muscarinic receptors in peripheral tissues such as the heart, intestines, bronchial muscles, iris and secretory glands. Some central stimulation may occur. Atropine abolishes bradycardia and reduces heart block due to vagal activity. Smooth muscles in the bronchi and gut are relaxed while glandular secretions are reduced. It also has mydriatic and cycloplegic effect.