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Atropine

Classification

Anticholinergic

Antimuscarinic

Indications

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)

Contraindications

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

Adult dosages

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

CliniCall consultation required prior to administration to discuss treatment plan.
1-2 mg IM/IV; repeat every 5-60 minutes until symptoms resolve

ACP: Secretion control in palliative care

0.6 mg IM

Pediatric Considerations And Dosing

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

CliniCall consultation required prior to administration to discuss treatment plan.
0.02-0.05 mg/kg IV; repeat every 10-20 minutes until symptoms resolve

Mechanism Of Action

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

Pharmacokinetics

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

Adverse Effects

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

Overdose

Signs and symptoms of overdose are similar to adverse effects.

Warning And Precautions

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.