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Atropine

Anticholinergic

Antimuscarinic

ACP: Restoration of heart rate in bradydysrhythmias

ACP: Sinus bradycardia (rate < 50/minute) with hemodynamic compromise

ACP: Bradycardia secondary to atrioventricular nodal blocks

ACP: Treatment of organophosphate poisoning

ACP: Control of secretions in palliative care (requires additional endorsement)

  • Hypersensitive to atropine or other anticholinergics
  • Tachycardia
  • Narrow-angle glaucoma
  • Thyrotoxicosis
  • Prostatic hypertrophy
  • Myasthenia gravis

Atropine must be given in the correct dose and must be given quickly: underdosing, or slow administration, may cause paradoxical slowing of the heart rate

ACP: Bradycardia

  • 0.6 mg IV push to maximum dose of 0.04 mg/kg (~3 mg in most patients)

ACP: Organophosphate toxicity

ACP: Secretion control in palliative care

  • 0.6 mg IM

Atropine must be given in the correct dose and must be given quickly: underdosing, or slow administration, may cause paradoxical slowing of the heart rate

Follow weight-based dosing

ACP: Bradycardia

  • 0.02 mg/kg IV push; minimum dose 0.1 mg; maximum dose 0.04 mg/kg

ACP: Organophosphate toxicity

Ampoule: 0.6 mg/mL (1 mL ampoule)

Atropine competitively antagonizes acetylcholine at muscarinic receptors, producing parasympatholytic and vagolytic effects. 

  • Onset: < 2 minutes (IM/IV)
  • Peak: 3 minutes (IM); 2-4 minutes (IV)
  • Duration: 2-6 hours(IM/IV)

Common adverse effects include tachycardia, dry mouth, headaches, blurred vision, and dysphagia.

Signs and symptoms of overdose are similar to adverse effects.

Atropine produces pupillary dilation.  Assessment of pupils may be unreliable.

Some evidence exists that suggests atropine may be heat sensitive, losing some potency after 4+ weeks of storage at temperatures consistently above 40°C. Degraded medication is unlikely to be harmful to patients, but may not carry the same clinical effects, thus requiring higher doses. 

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